Rethink Real Talk Recap: Sex, Cancer and Intimacy

We Need to Acknowledge Sexual Health is an Issue for Patients

Younger women are particularly vulnerable when it comes to sex issues related to having breast cancer. According to Dr. Elin Raymond, a Toronto-based Gynecologist and panelist, many of the sexual health effects related to treatment can be chronic and progressive.

Issues like changes in sexual function, activity, relationship quality, desire and arousal related to surgery, anti-estrogen therapy, chemotherapy, and psychological distress are just some of the examples she’s referring to. “Even after other areas of physical and emotional functioning return to normal, sexual functioning and satisfaction can continue to be difficult years after treatment,” she says.

In order for sexual health to not get overshadowed by other aspects of clinical care, we need more focus on maximizing treatment benefit without compromising important quality of life elements like sexual health and intimacy. “I think the failure of care providers to address sexual health in patients from the very beginning of their care pathway is a major barrier to providing help in this area for all patients.

We Need to Talk about it–and early!

In a society that is more sexually charged than ever, we are still having difficulties talking about sex. Yes, the topic can feel even more taboo when coupled with cancer, but the reality is talking equals healing through the de-stigmatization of illness. Cancer affects people’s libidos, the ability to be intimate with partners, sense of self-worth and self-esteem, relationships and the joy that sex can bring. Our panelists shared how isolated and alone they felt because no one was talking about these issues.

Several women on our panel said their nurses or doctors didn’t flag the potential physical and emotional sexual health issues early on. Instead, the focus was on immediate side-effects like hair loss or menopausal symptoms. They also shared that knowing about these issues sooner would have helped them to face them early.

Samantha Scime, the oncology nurse on the panel, says that in most cancer care settings, sexual health challenges get overlooked and if people aren’t being educated on the topic or asked if they’re experiencing these issues, providers can’t help. This can occur for a number of reasons–a perceived lack of time, lack of space in healthcare institutions to have sensitive conversations, limited provider knowledge or feeling like sexual health is not a priority when going through treatment.

As an oncology nurse, she feels the responsibility in on her to dismantle the perceived “taboo” around sexual health in the cancer care settings. “It needs to be normalized and a priority as soon as treatment starts and it’s the provider’s responsibility to make time for these conversations and to check in regularly,” she says.

 

We Need To Reframe the Conversation Around Sex

Let’s face it, sex can be awkward to talk about especially when you’re experiencing difficulties. According to Kim Cullen, a Psychologist in supervised practice, one helpful way to reframe things, and to create space for comfortable and even fun conversations, is to change our narrative from what’s wrong with our sex life to how can we make our sex life even better. “Communication really is like a bridge to a satisfying sex life, we need to build and cross that bridge as our way back to each other,” she says.

This means reinventing what sex means for you. Remember­—different doesn’t mean worse. In fact, reinventing what sex means can make it even better. Cullen poses questions like, “What are the fantasies you haven’t explored? Is there something you’ve wanted to try but have been too shy to ask for? Allow yourself to be curious, get creative, and have fun.”

She also recommends making time for your relationship. That means date nights, sex, and everything in between. It’s important to invest in and nurture our relationships! We often think that sex should always be spontaneous, and that scheduling sex is anything but sexy. Time spent catching up with a friend isn’t any less special because you’ve planned the get-together. Sex is no different, and the anticipation of it can make it even better.

We Need the Right Expertise and Tools

According to Dr. Raymond, if you are going through breast cancer treatment you need to be able to access support, education, treatment and timely referral for vaginal/sexual health concerns. Medical clinicians involved in all aspects of care need to ensure they are themselves educated and accessible for addressing this important aspect of living as a survivor. As a gynecologist who works with breast cancer survivors, she thinks it is vitally important to involve a multi-disciplinary team of professionals skilled in this area of physical and emotional care. She often refers patients to pelvic-floor physiotherapy and sexual therapists in addition to the individual’s oncologist or medical team.

There are many options for treatment that can improve an individual’s quality of life and vaginal and sexual health, such as medical, hormonal and laser treatments and physical therapies. As always, treatment paths will vary based on the individual and by case. Nevertheless, the full breadth of these options must be available from professionals skilled in the clinical context of breast cancer as well as management of menopausal or sexual health concerns. Caregivers should have the tools and knowledge to offer the most up to date, evidence-based options and therapies.  When these conditions are met, individual patients will feel their concerns are truly heard.

Dr. Raymond believes patient outcomes will improve when healthcare professionals allow them to identify this long-term quality of life issue from the beginning of their treatment. This early investment will allow for shared decision making and allow their care teams to address their symptoms and find the most appropriate course of action toward improving their health and welfare.

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This article was reposted from Rethink. See the full video of the talk here.

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