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Women affected lose a lot of things to cancer. From the loss of energy and appetite to the loss of hair, we know that cancer treatments take a toll on the body. But one thing we don’t hear about as often is the loss of libido. The truth is that while cancer treatments can destroy the disease, they can also destroy your sex drive. Yet, according to a report published in Psycho-Oncology, communication with oncology providers about sexual issues is poor. Perhaps it’s because we still aren’t comfortable talking about sexual pleasure, or because, in the shitty scheme of things, sex is the furthest thing from a patient’s mind.
“Loss of libido is common, but unfortunately, many sexual issues in survivorship are not necessarily prioritized,” says Janna Andrews, MD, an oncologist and assistant clinical professor of radiation medicine at the Zucker School of Medicine at Hofstra/Northwell, where she specializes in breast and gynecological cancers. “To be fair, patients may not talk about it as much, as many women see their lack of interest in sex as natural or part of the process.”
Nevertheless, Dr. Andrews admits that many physicians may not be asking about things like pain, fatigue, or fertility. “If we are treating the whole patient and not just the cancer, we would want to know if the patient was experiencing issues in their sexual health,” she says. Sexual health has yet to be fully integrated into oncology care, and so it is important, as a patient, to be proactive in discussing it.
According to the National Cancer Institute, cancer treatments like chemotherapy, hormone therapy, and radiation therapy can lower estrogen levels in women, resulting in less interest in sex, decreased pleasure, vaginal dryness, and painful intercourse. For premenopausal women, chemotherapy can push women into early menopause, which can also affect a woman’s libido, Dr. Andrews explains. This has commonly been referred to as “chemopause.” Pain medicines and aromatase inhibitors (a class of drugs used to treat breast cancer) are also known to contribute to sexual dissatisfaction.
What’s more, the physical changes in the body—whether from the treatment or from a surgery such as a mastectomy or an ostomy—can lead to body distortion that causes women to shy away from intercourse. “Many women don’t necessarily feel attractive, so I imagine the symptoms are amplified or persist for longer periods of time," says Dr. Andrews. In fact, many women note that the loss of libido and body image issues last anywhere from months to years without intervention.
There is no need to suffer in silence, as there are many potential treatments for low libido. Some physicians will suggest starting with lubrication or establishing a successful pattern of foreplay with your partner. A low-dose estrogen cream may also have potential, says Dr. Andrews. According to breastcancer.org, researchers are also studying if Viagra may be of some benefit by sending blood to the clitoris, vulva, and vagina.
If your sex life is being affected as a result of cancer, Dr. Andrews encourages you to speak up: “Without either the patient or the physician discussing sexual issues as much as they probably should be discussed, many women will continue to live with the symptoms.”