In 2020, it is estimated that more than 1.9 million women who recover from cancer or live with the disease for many years, which becomes “chronic” thanks to treatment, are more than 1.9 million (more than 6% of the Italian female population). These women very often, during and after treatment, live with disorders affecting the uro-genital system, which have a strong impact on their social and sexual life in particular. This is an important phenomenon that is rarely talked about in Italy because, on the one hand, the women themselves are most of the time silent, because they are ashamed and embarrassed, but also because they are convinced that nothing can be done clinically. sight (only 10% find the courage to talk about it), on the other hand there are doctors who do not encourage their patients to confide even on these more “intimate” aspects related to the disease. “Sexual dysfunction is an unfortunately common side effect of cancer treatment,” said a Today Teacher. Vitaliana De Sanctis, radiation oncologist at AOU Sant’Andrea in Rome, and board member of MothersMothers APS -, and there seems to be a big gender disparity in how doctors discuss sexual health with their patients. In a survey of nearly 400 cancer survivors, 87% said they had experienced sexual side effects, but most also said their oncologist had not formally asked about them, especially with female patients.
So doctors don’t talk and patients don’t ask. In order to break this taboo, it was born in 2020, from an idea of the Association for Social Promotion She loves me, she doesn’t love me« Sexandthecancer®“. The project aims to promote, on the one hand, a new awareness among women with oncological pathology of the right to well-being and to have a satisfying relational life; on the other hand, promote the training of doctors, psychologists and healthcare personnel concerned in order to understand the problem, know the possible remedies and overcome the embarrassment of talking about it with patients. And since breaking a taboo involves profound cultural, educational and social changes, Sexandthecancer® also decided to promote an exhibition entitled “Ballad sensual“, which will be held on May 27, 28, 29 at the Galleria La Nica in Rome, where artistic storytelling, through the support of Science, aims to help overcome the taboo of the “unsaid”. Sexandthecancer® they don’t stop there: at the end of May, an online listening and orientation desk is also planned for cancer patients to help them understand and manage uro-genital problems resulting from oncological therapies.
Teacher. De Sanctis, how does a woman’s sex life change after a cancer diagnosis?
“Sexuality is a very complex and varied dimension, to which both physical and psychological aspects contribute. Therefore, it is understandable that the occurrence of an oncological disease can negatively impact sexual activity by interfering at both levels. It all depends on the type of tumor and the location of the disease and therefore on the treatment(s) used, such as surgery, chemotherapy, hormone therapy and radiotherapy. In addition, it is also necessary to take into account the meaning that sexuality has played in the personal history of each patient and the phase of life in which she finds herself at the time of the diagnosis: if, for example, she is of childbearing age and therefore wish to have children or if you are already in menopause”.
What are the side effects of cancer therapies on sexuality?
“They range from hormonal imbalances induced by specific therapies, to fatigue caused by chemotherapy treatments, to vaginal dryness caused by both systemic (hormone therapy) and local (surgery, radiotherapy/interventional radiotherapy) treatments. Some of the most common complaints include irritation, itching, recurrent vaginal and urinary tract infections, urinary urgency, painful urination, poor lubrication, vaginitis, vaginal atrophy, vaginal stenosis, and painful penetration (dyspareunia ), low libido.
Can cancer treatments also cause infertility, premature menopause or other “irreversible” problems?
“Hormonal therapies for breast cancer induce a situation of iatrogenic menopause (consequence of a therapy), which is however reversible with the suspension of the latter, always taking into account the age of the patient. Certain treatments on the pelvis (pelvis), such as surgery and radiotherapy, can, on the other hand, induce an irreversible iatrogenic menopause”.
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What impact do these side effects have on the psychological sphere of the patient and on the couple relationship?
“The impact is often significant. In fact, alongside physical discomfort, as can be seen during hormone therapy, which can modify the sexual response by reducing libido and inducing vaginal dryness and, therefore, dyspareunia, it must be considered that in in other cases, psychological discomfort may also coexist, sometimes present as the only factor likely to have a negative impact on the patient’s quality of sexual life. Indeed, the simple perception of a body altered by therapies (surgery in particular, hair loss with chemotherapy) can lead the patient to a negative attitude towards her sexual sphere through embarrassment, shame and feeling of inadequacy. against his. .body image. In most cases, however, physical and psychological factors tend to co-exist and interact with each other, shaping very complex scenarios in which patients and their partners experience sexual activity as a real problem” .
How can women who experience these disorders manage and resolve them?
“The impact on the quality of sexual life is an issue that is not often talked about, so it is difficult to have incidence / prevalence figures in Italy. This is precisely why the project was born Sexandthecancer®, because we talk about it, to contribute to breaking the taboo of the “unsaid”. It is a multifactorial symptomatology, therefore a multidisciplinary approach by different specialists is essential, including for example the gynecologist, the psycho-oncologist, the physiatrist. For some patients, potential limitations in sexual activity may not be an issue, while for others the impact may be significant and compromise the person’s quality of life. In this case, the first step is to talk to your doctor, ask him for information and instructions on how to manage the side effects of therapies to have a satisfying sex life.
What role does the psycho-oncologist play?
“As mentioned before, the psycho-oncologist is particularly important, because it is sometimes difficult for the patient to bring out and manage this type of discomfort. A course with a “dedicated” psychologist can help not only the woman, but also the partner. Indeed, helping to maintain or resume communication within the couple is essential. Sometimes the couple tends to avoid talking about a loss of sexual understanding, out of discomfort or so as not to hurt the sick partner, thus triggering a vicious circle which risks creating a fracture”.
How important is doctor-patient communication in improving sexual health after cancer?
“I would say fundamental. First of all, it is important that the attending physician is present at the beginning of the therapies but also afterwards, to provide the patient with information relating to the side effects of the oncological treatments which can have a negative impact on the quality of the sexual life. . But it is also important that the patient brings out this problem during doctor-patient interviews”.
So, is adequate training of doctors and health personnel also becoming necessary?
” Absolutely yes. Among the objectives of Sexandthecancer® there is also that of sensitizing the institutions so that the training of doctors and health personnel is included in the university training courses, also in the light of the gender medicine law, and that the available therapies are included in the Essential Levels of Assistance (LEA) to women with oncological pathology. This is another sore point, indeed currently available therapies such as vaginal laser, local therapies with lubricants and hyaluronic acid, pelvic floor rehabilitation, psychological support, are often available almost always only in private and only in certain cases provided by the Health Service. National, thus increasing the “financial toxicity” of oncological pathologies”.