Chemotherapy, radiation, endocrine therapy for certain types of breast cancer can wreak havoc on the systems that underlie pleasurable sex, and sometimes leave women infertile. Vaginal dryness and tightness, resulting in pain during sex, loss of libido and a decreased ability to reach orgasm are the most common sexual symptoms. Decreased estrogen production in the ovaries, or their surgical removal, can push women into abrupt menopause, or exacerbate menopausal symptoms. Pelvic radiation therapy can narrow and shorten the vagina, decrease its elasticity and disrupt blood flow, all of which can impede sexual response and derail one's sexual self-image.
Even though Howard's new husband told her "1,000 times a day how much he likes bald women," she said, "the dryness was a major issue" for her.
"Throw in the nausea, fatigue, constipation, hot flashes, weight, gain, especially around the face and neck, and some extremely dark undereye circles, and I'd say I was feeling pretty unsexy.
"I was a newlywed, and to feel like my body was letting me down and failing me at the moment when I needed it to do something was really frustrating."
Dr. Shari Goldfarb, a medical oncologist at Memorial Sloan-Kettering Cancer Center in New York who treats breast cancer patients, developed an interest in these treatment-induced sexual side effects about six years ago while still a fellow at the center.
"I started talking to patients who were saying, 'Oh, I'm so glad you're asking about this. This is such an issue. What can we do about it?' I realized there was much interest in this area from patients, but that clinicians didn't necessarily address it or talk about it, because people didn't know what to do."
Goldfarb and her colleagues undertook two surveys, one of breast cancer patients and one of lymphoma patients, and found that more than three-quarters of the women reported sexual dysfunction.
"They felt their sexual dysfunction was from the anxiety of being diagnosed, or from a change in their relationship with their partner, but surgery, chemo, endocrine therapy also played a role, and were sort of the biggest culprits," she said.
With funding from the Susan G. Komen and Gabrielle's Angel Foundation, which also funded the initial surveys, she's now following 300 breast cancer and lymphoma patients between the ages of 18 and 50 for five years to gauge the impact of chemotherapy and other cancer treatments on sexual functioning and fertility.
"We'll determine baseline sexual function before any treatment, and then the predictors of sexual dysfunction, the best time to intervene and what the best interventions are," said Goldfarb. "We also want to learn more about who is able to have children after their treatment."
Bringing up sex and cancer together, though, can be sticky, especially for women. "For men, it's always how is this going to affect my sexual function. These have been taboo subjects for women, and they don't bring it up as much," said Goldfarb. "But most patients will say, 'I want to discuss it, but I feel awkward discussing it.'"
Surveys published in the British Journal Cancer and the Journal of Psychosocial Oncology found that less one-third of women brought up sexual problems stemming from their cancer treatment with their doctors.