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Sex and the Female Cancer Patient

Network - Spring 2011


By Mary Brolley

Cynthia Cargill is OK with “the new normal.” As long as it includes sex.

“I’ve been through a lot, and I’m happy to be alive,” Cargill says, then pauses.

“But my husband and I are too young to give up sex.” 

Cargill, 35, was treated for a recurrence of acute myelogenous leukemia (AML) with a cord blood transplant in 2008. 

She received heavy doses of chemotherapy that have wreaked havoc on her sex drive and ability to enjoy sex.

Not surprisingly, this has caused problems in her marriage of 12 years.

Cargill is not taking this lightly. “Fix me,” she jokes about her plea to her medical team.

The alkylating agent used in her transplant protocol attacked rapidly growing cells, exactly what was needed to kill leukemia cells. Unfortunately, it was also toxic to her ovaries, causing premature menopause.

The effects of this early menopause made intercourse extremely painful, Cargill says, and not surprisingly, her sex drive plummeted.

Gynecological researcher, therapist offers help

Though her cancer treatment is complete, this loss of intimacy and sexual health has hampered Cargill's full recovery.

Andrea Bradford, Ph.D., psychologist and instructor in the Department of Gynecologic Oncology at MD Anderson, counsels cancer patients having sexual difficulties.

For pain during intercourse, Bradford suggests patients use a combination of techniques: for a start, women can use a vaginal moisturizer several times a week and a lubricant for sex.  If pain persists, low-dose vaginal estrogen can often help. She also recommends the use of relaxation techniques to reduce tension and ease into sex.

Patients should also give themselves time to reestablish intimacy and sexual activity, she says.

“Cancer puts stress on even the strongest relationships. Shifting to the roles of caregiver and patient adds to the strain.”

She advises women suffering sexual side effects to rethink old habits and expectations, perhaps even “taking intercourse off the table” while the couple rekindles their romantic relationship.

‘We have a much closer bond’

Cargill knows there’s a strong psychological and emotional component to this situation.

She consulted Phyddy Tacchi, an advanced practice nurse in the Department of Psychiatry, during and after her treatment. Tacchi saw Cargill alone and with her husband Reagan.

“In our joint sessions, Phyddy helped me see that Reagan had some resentment of how much he’d had to take on. He’d had no time to himself.

“And I’d felt like, ‘Hey, I got cancer, and my treatment caused these problems,’” Cargill says. “‘It’s not like I got leukemia to spite you!’

Two years later, the couple is much more patient and open with each other, she says.

“We say, let’s work around it. We actually have a much closer bond after the cancer and treatment.”

As a result of the heavy doses of chemotherapy, Cargill entered menopause in her 30s. But since the Cargills already had two young children when she was diagnosed, she wasn’t too concerned about the treatment effects on her fertility.

Address fertility concerns with your medical team

For many other women patients, though, treatment effects on their ability to have children are of great concern. 

Experts like Bradford advise them to be as proactive and honest as possible when talking to their physicians before treatment begins.

The physician and medical team can explain which treatment effects are short-term and which are permanent. It may be possible to tailor treatment to be less harmful to the reproductive system.

If not, at least patients will know exactly what to expect and how to maximize their chances of maintaining fertility.

Whether or not a woman can get pregnant after cancer treatment depends on a number of factors, including: 

  • her age at the time of treatment, 
  • the type(s) of treatment, 
  • the kind and dose(s) of chemotherapy, if applicable, and 
  • the amount and target area of radiation, if applicable.

Bradford says female cancer survivors suffering from sexual difficulties should consider seeking expert help from:  

  • a gynecologist, who can rule out any other reason for pain during sex, 
  • in certain cases, a physical therapist who specializes in treating pelvic floor conditions, and/or 
  • a counselor or therapist who can help resolve negative thoughts or recurring worries, and, if indicated, use sex therapy to help resolve sexual problems.
            

In the summer issue of Network, we’ll explore the effects of cancer and treatment on male sexuality and fertility.

Resources

Are you a female cancer survivor dealing with sexual problems? 

Do you live near MD Anderson's main campus in Houston? 

A National Cancer Institute-funded program at MD Anderson is recruiting women who've been treated for cancer and want to:

  • recover sexual function and satisfaction, and, if relevant,
  • find answers to concerns about fertility and pregnancy after cancer treatment.

Tendrils is a free 12-week research program that involves using a website providing sexual education and counseling, as well as filling out online questionnaires concerning emotional adjustment, sexual function and quality of life. 

Half the participants will also come to 
MD Anderson for three 60-minute counseling sessions during the 12 weeks. For more information, call Pamela Lewis at 713-745-5535 or e-mail her at plewis@mdanderson.org.


© 2014 The University of Texas MD Anderson Cancer Center