Women with anal cancer: What to know about sexual health
Around 5,000 people in the United States are diagnosed with anal cancer each year, which is often treated using radiation therapy.
Although radiation therapy can be effective in treating the cancer, it often causes side effects, including changes to patients’ sexual health. This is especially true for women. But many anal cancer patients are unaware that radiation therapy may be the reason for these changes, or they’re too embarrassed to talk with their doctors about this.
We talked with Cullen Taniguchi, M.D., Ph.D., to learn more about radiation therapy’s sexual side effects and how we’re helping patients cope. Here’s what he shared.
How can radiation therapy change skin?
Radiation can cause tenderness, redness, sores and scarring at the site of treatment. So when a tumor is located near the genitalia, patients may experience irritation that makes sexual activity uncomfortable or even painful. We often ask patients refrain from sexual activity until the skin starts feeling closer to normal, which is typically within 2 to 3 weeks after treatment.
What challenges does scarring present?
For women who receive radiation therapy as part of their anal cancer treatment, scarring at the end of the vagina is possible. This can block the cervix, making it difficult to conduct a Pap test. Also, scarring in the vagina can make penetration painful.
How can sexual side effects be managed?
To reduce the likelihood of external irritation at the genitalia, we can use intensity-modulated radiation therapy (IMRT). IMRT uses advanced computer software to direct multiple radiation beams of different intensities at the tumor, which allows us to treat the tumor with the highest possible dose while limiting exposure to the surrounding normal tissue. We make sure to specifically avoid the genitalia whenever possible – an option we don’t often have with other radiation techniques.
Patients can use over-the-counter skin ointments like Aquaphor to provide relief to the irritated skin and help with healing. If the irritation progresses, we can try thicker ointments like lanolin or medicated treatments like Silvadene.
In regards to scarring, MD Anderson offers women with anal cancer something unique. We use a vaginal dilator during and after radiation therapy to limit scarring. It’s a rubber cylinder that’s inserted to expand the end of the vagina. It pushes a large portion of the delicate tissues away from the treatment site to limit exposure and prevent scarring. Many of our patients report that with the consistent use of the vaginal dilator for about 10 minutes a day, they get back to normal a lot more quickly.
What other steps can patients take to lessen these side effects?
Once the treatment is over and the patient feels comfortable, sexual intercourse can also help reduce scarring. And we encourage patients to practice vaginal Kegel exercises, which is the tightening and release of muscles in the vaginal area, as well as anal Kegels to strengthen the sphincter. In addition to changes to their sexual health, patients who receive radiation to the pelvic area may also experience issues controlling urination and their bowels so Kegels help improve their control.
Are the side effects permanent?
Radiation therapy-related discomfort goes away over time, but we understand that it’s much slower than anyone wants. Studies on sexual health in patients who received radiation have found that patients don’t entirely lose sensation, so you can have pleasurable intercourse after you complete your therapy.
But the best approach is to talk to your care team about side effects prevention before starting radiation therapy. That way, you’ll know what side effects to watch for, and we can quickly address any concerns that arise during treatment.
What’s your advice for a woman recently diagnosed with anal cancer?
Anal cancer a rare disease, so the best way to increase your chances of successful treatment and quality of life is to seek care from someone with extensive experience treating this disease. Some doctors see one case of anal cancer a year, but we see several new patients a week. Our whole team of anal cancer experts knows how to treat this cancer while reducing the likelihood of sexual discomfort.
Sometimes our patients are surprised at the level of detail at which we’ll talk about this, but that’s what we’re here for. We want to restore you as close as we can to the person you were before your diagnosis.