Sexual Health and Family Building
“We know that many people are not getting the help they need related to their sexual health and family-building goals. These issues are vitally important to rebuilding life after cancer.” – Catherine Benedict, PhD
“Survivorship” after a cancer diagnosis can mean a lot of different things to different people. As a psychologist, I am interested in all of the ways cancer impacts the lives of my patients – the day to day challenges that occur between doctor visits, when real life is happening. It is important to understand the whole person, not just the part that is a “cancer patient.” What I have found in my work is that many of the effects of cancer and its treatment go unnoticed by oncologists and care teams, especially when we think about issues that last long past the end of treatment. There often isn’t enough time during doctor visits or sometimes patients – and doctors – feel uncomfortable or embarrassed talking about certain topics. This is often the case when cancer treatment leads to problems with sexual health or fertility.
More than 60% of people treated for cancer end up with long-term problems related to sexual functioning. Sexual health depends on physical, psychological, and social well-being, and cancer may impact each of these aspects of sexuality directly and indirectly. Cancer treatment may affect sexual functioning by interfering with a man’s ability to get and maintain an erection or cause a woman to experience pain during intercourse due to vaginal atrophy or side effects such as vaginal irritation or dryness. Other side effects such as fatigue or emotional changes can also impact sexuality by affecting how someone thinks and feels about their body, his/her comfort level in being intimate with a partner, and changes within couples’ relationships.
Likewise, for patients who have not completed family-building at the time of diagnosis, as many as 50% will experience problems with fertility. This is an important quality of life issue for many people and can be highly distressing to think about. Coping with uncertainty is a challenging task and many people would benefit from better counseling to address questions about their fertility and family-building options after cancer.
Several studies have shown that changes in sexuality and fertility rank in the top three most commonly reported concerns among cancer survivors. Despite this, only a small proportion of those who experience sexual or fertility problems see a health professional for treatment or counseling.
We know that experiencing problems in either one of these areas can be extremely difficult and lead to feelings of distress, anxiety, and uncertainty about how to handle the issue. We also know that many people are not getting the help they need related to their sexual health and family-building goals. These issues are vitally important to rebuilding life after cancer. We must start having conversations about the sexual changes and fertility problems that can occur in order to normalize the experience and connect people to resources and care that will help solve problems.
At Stanford, I’m working to build resources that address unmet needs around sexuality, intimacy, fertility, and family-building, and to support patients in taking “next steps” toward regaining their sense of self and the life they want. We are building a model of multidisciplinary care with a team of experts from across the Stanford health care system to establish cancer survivorship programs that meet the physical and emotional needs of our patients facing sexual health and fertility problems after cancer.