Survivorship and quality-of-life programs to help patients regain physical, emotional and spiritual health are an important part of cancer care. One area that experts say deserves greater attention — restoring sexual health — is the focus of a new clinic specifically for women at Roswell Park.
Cancer and cancer treatment affect patients’ ability to interact intimately in a number of ways, including lack of interest, issues with body image and pain, explains gynecologic oncologist Melissa Moffitt, MD, Assistant Professor of Oncology at Roswell Park, who heads the clinic. “This program addresses the treatment and management of any issues that impede a return to sexual health and enjoyment.”
“The whole reason you go through cancer treatment is to live life,” says Dr. Moffitt. “Being sexual is a part of life and worthy of whatever priority it needs to get it back.”
Women are particularly at risk for sexual side effects. “The treatments for three of the top four women’s cancers in the US include pelvic or breast surgery, pelvic or breast radiation, chemotherapy and anti-estrogen therapy, which directly impacts sexual function for many women.”
Conditions we can help
Among the most common issues that women face are:
- Pain with intercourse
- Lack of interest or low libido
- Vulvar and vaginal dryness
- Physical changes or scarring from mastectomy or other surgery
- Changes in body image
- Changes in anatomy or function of genitals or skin
- Coping with an ostomy (colostomy, urostomy or nephrostomy)
- Anxiety, depression and fear related to intimacy
These can be sensitive and uncomfortable topics for patients and practitioners to bring up. “This is why a clinic like this is so important,” says Dr. Moffitt. “As a gynecologic oncologist, I’m uniquely experienced and trained to discuss and treat these issues. Some problems are a surprisingly easy fix.”
For example, radiation to the pelvis or surgery can result in scarring or changes to the vagina, vulva and perineum that make sex painful or even impossible, as in cases where the vagina may “heal” closed. “Sometimes vaginal dilators are the best option, and other cases are quickly fixed with minor surgery,” says Dr. Moffitt.
Other problems arise from treatment- or surgery-induced menopause, and hormonal or anti-estrogen therapy. Some women at very high risk for breast or ovarian cancers, due to BRCA or other genetic mutations choose to undergo cancer-preventive surgery to remove the breasts or ovaries, which affects their sexual lives.
What to expect during an appointment
A visit to the clinic involves a physical exam and a woman-to-woman discussion to identify problems and develop a treatment plan. Dr. Moffitt takes a broad, multidisciplinary approach that may include options such as reconstructive or corrective surgery to repair structures or minimize scarring; counseling; mindfulness; acupuncture; pelvic physical therapy; a change in medications, and use of lubricants, creams, vaginal dilators or other devices.
“As oncologists, we’ve become better at addressing treatment side effects like peripheral neuropathy, fatigue and chemo brain,” says Dr. Moffitt. “When cancer treatment leads to sexual dysfunction, we need to be just as diligent about addressing it. Improved sexual function improves quality of life.”
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