Sexual Health During Breast Cancer: ‘Just Being Heard Is Important’

Sexual health is an important, though underdiscussed, issue for women undergoing breast cancer treatment.

Up to 75% of women being treated for breast cancer report that they have experienced sexual dysfunction; however, there is a lack of patient-provider communication about these issues.¹

In a recent interview with Oncology Nursing News, Michelle Taylor, ANP, discusses the importance of having these discussions about sexual health, and remedies that oncology nurses and advanced practice providers can recommend for patients experiencing these effects.

“The shift comes when you just try [to have these discussions]. Then next time you have the conversation, it’s a little easier,” Taylor, a nurse practitioner for adult patients at Dignity Health Cancer Institute at St. Joseph’s in Phoenix, AZ, said. “Sometimes even if you don’t know what advice to give to that woman, just being heard is something that is often very important.”

Oncology Nursing News: Why is sexual health important in women with breast cancer?

Taylor: When you're a breast oncology-specific [health care provider], you have a large population, typically, of women, between the age of 40 and 60, and they're working, they're in relationships. It's just not something that's talked about enough.

I think vaginal health specifically should be talked about more, because whether someone is engaging in intercourse or not, we know that vaginal dryness can be tied to things like more frequent [urinary tract infections], more frequency of urination, and incontinence. These can be pretty debilitating side effects. No, it's not a grade 3 diarrhea that's requiring emergent intervention, but it is a major quality-of-life issue.

Is there a specific type of cancer treatment that affects vaginal and sexual health?

The truth of the matter is, depending on which literature you're looking at, nearly 85% of men and women can experience sexual side effects from any modality of treatment for cancer therapy, including traditional IV chemotherapy, certainly these oral medications and even things like radiation and surgical intervention.

Sexual dysfunction occurs mainly in the breast cancer setting, as we are lowering estrogen levels, even when it's not a direct medication that does this, such as [goserelin acetate [Zoladex]) injections or an aromatase inhibitor. There is ovarian suppression that comes from chemotherapy, for example.

What are common sexual adverse effects from breast cancer treatment, and are there ways to treat them?

So, the first mechanism is typically vaginal dryness, and that can be layering on top of an already existing vaginal dryness. And then [there are] physical effects of stenosis of the vaginal canal, making intercourse uncomfortable, and also just simply the reduction in libido. There’s body dysmorphia that can happen to a woman who has gone through breast surgery, radiation, chemotherapy, so the physical changes that can happen as well.

So there's many layers to sexual health in this setting. And I think that there are ways to help curb some of this. A lot of the women are coming in with those existing symptoms already, and then we're exacerbating them.

Teaching a woman up front, being comfortable yourself, having those uncomfortable conversations once you let a woman know that you're here and willing to talk about really anything that they're experiencing [is important], I think they become more comfortable sharing those things. We tend to recommend proactive moisturization with things as simple as coconut oil, which is very safe for external moisturization, as well as lubrication for intercourse, but there are also products that contain hyaluronic acid that are vaginal moisturization products that are very easy to use overnight.

I can go on and on about this. It's a personal passion of mine, based on what we see our women experience here, but it is something that all oncology nurses should be aware of, no matter what setting they're working in.

Reference

Hernández-Blanquisett A, Quintero-Carreño V, Álvarez-Londoño A, et al. Sexual dysfunction as a challenge in treated breast cancer: in-depth analysis and risk assessment to improve individual outcomes. Front Oncol. 2022;12:955057. doi:10.3389/fonc.2022.955057.