Over 60% of the 15.5 million cancer survivors in the US end up with severe sexual problems that do not go away by themselves, yet fewer than 20% ever get help from a health professional. In surveys, oncologists, nurses, psychologists, and other professionals agree that sex is an important issue to discuss—yet each group also asserts that talking about sex is “not my job!” Doctors think nurses should do it&mdash;nurses think doctors should do it&mdash;and psychologists just think some other professional should do it!

Infertility affects fewer cancer survivors, but each year in the US, another 170,000 people under age 45 are diagnosed with cancer and half will face damaged fertility. With men and women starting families at later ages, more young adults are facing cancer-related infertility. We can freeze sperm or eggs for the future, but only about 25% of men and 5% of women take advantage of these technologies.

Even in top cancer centers, with excellent care and easy availability of sex therapists, gynecologists, urologists, sperm banks, and fertility preservation programs, sex and fertility often falls off the radar in discussions with patients. Only 15% of cancer patients in the US are treated at major cancer centers that would be most likely to provide reproductive health care, and only 6 centers (to my knowledge) have specialized clinics to help with sexual problems.

As a psychologist myself, I have always been an advocate for empowering patients to make the best health decisions.

What if you are a 52-year-old man diagnosed with prostate cancer and have the surgeon telling you that nerve-sparing prostatectomy is your best shot at a long life while the radiation oncologist says you can avoid erection problems and urinary problems if you have proton beam therapy?

What if you are a 34-year-old woman, 4 months pregnant with your first and very wanted child, when you find out you have breast cancer? Your local doctor tells you to terminate your pregnancy if you want to live, but you find articles on the internet that say you may be able to have good cancer treatment and save your baby?

What if you are a happily-married 68-year-old woman on hormone therapy for breast cancer that shrinks your vagina and makes sex so painful that you just give it up?

I founded Will2Love as an online place where people can find the answers to their questions 24/7, in the privacy of home, without depending on their oncology team to take enough time to truly educate them.

And on Tuesday, February 21, I’ll be co-moderating the #CureConnect tweetchat at 9 PM EST, to discuss cancer-related sexuality and fertility issues. Please join me for an opportunity to ask any questions you might have, share advice and tips and dispel some myths.

Articles

Leslie R. Schover, founder of the Will2Love online resources, discusses the sexual health and fertility issues that can come as a result of cancer treatment, and how these issues can be managed. Join us for our #CureConnect tweetchat, Tuesday 2/21, on this topic.

Nowhere to Turn: Cancer-Related Problems with Sexual Health or Fertility

Leslie R. Schover, PhD, Professor, Department of Behavioral Science, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, explains how nurses can become more comfortable discussing sexual health with cancer patients.  Sexual health side effects are common amongst cancer patients and survivors, but they are often not discussed, said Schover.

Dr. Schover on How to Talk About Sexual Side Effects With Patients 

Leslie R. Schover, PhD, clinical psychiatrist, professor, behavioral science, The University of Texas MD Anderson Cancer Center, discusses vaginal dryness and pain in patients with breast cancer treated with aromatase inhibitors.

It is known that women often experience vaginal dryness and pain after starting aromatase inhibitors. In a survey of women who are sexually active in their first two years of treatment with aromatase inhibitors, nearly 80% reported that they experienced new sexual problems and 25% of women stopped having sex.

Schover says that oncologists have been slow to recognize the destructive nature of aromatase inhibitors. Patients should be encouraged to stay sexually active and consider the use of an over-the-counter vaginal moisturizer, lubricant, and dilator. Schover says her initial impressions are that women are not experiencing as much pain with intercourse compared with those who had no preventive treatment.

Leslie R. Schover on Vaginal Dryness and Pain in Breast Cancer Patients Treated With AIs

Leslie R. Schover, PhD, clinical psychiatrist, professor, behavioral science, The University of Texas MD Anderson Cancer Center, discusses the web-based intervention 

Tendrils: Sexual Renewal and Motherhood after Cancer

Schover says the website, which is still in beta testing, was supported by a small business grant from the National Cancer Institute. An efficacy trial of the website was conducted and a trial examining the website’s ability to prevent sexual problems in women starting aromatase inhibitors is ongoing.

Schover says she decided to choose an Internet intervention to “jump over the heads” of the oncology physicians and go straight to the patients. This way, patients are given the information they need, when they need it. In addition to the educational aspect, Schover says, the website offers cognitive behavior therapy techniques that can be done on a self-help basis.

Leslie R. Schover, PhD, clinical psychiatrist, professor, behavioral science, The University of Texas MD Anderson Cancer Center, discusses the web-based intervention Tendrils: Sexual Renewal and Motherhood after Cancer.

Dr. Schover on the Web-Based Intervention "Tendrils" for Breast Cancer Survivors

Leslie R. Schover, PhD, clinical psychiatrist, professor, behavioral science, The University of Texas MD Anderson Cancer Center, discusses low sexual desire in breast cancer survivors.

Schover says low sexual desire is one of the top two sexual problems in breast cancer survivors as well as all women treated for cancer. Pain and vaginal dryness, the second most common sexual problem, often cause a low sexual desire. However, there are other factors besides pain and vaginal dryness that causes breast cancer survivors to lose interest in sex, Schover says.

Schover believes that this topic is not discussed as much as it should be in clinical settings.

Leslie R. Schover, PhD

Articles

Nowhere to Turn: Cancer-Related Problems with Sexual Health or Fertility

Dr. Schover on How to Talk About Sexual Side Effects With Patients

Leslie R. Schover on Vaginal Dryness and Pain in Breast Cancer Patients Treated With AIs

Dr. Schover on the Web-Based Intervention "Tendrils" for Breast Cancer Survivors

Dr. Schover on Low Sexual Desire in Breast Cancer Survivors