Enhancing Sexual Health for Cancer Survivors

Changes to sexual function after cancer treatment are extremely prevalent, affecting up to 90% of female patients with cancer and 40%-85% of male patients with cancer. Sexual health concerns include low libido, genitourinary syndrome of menopause, dyspareunia, erectile dysfunction (ED), hypogonadism, body image concerns, and impacts on intimate relationships. Given the significant impact of sexual dysfunction on quality of life, oncology professionals should integrate sexual health discussions into routine patient care, regardless of the patient's age, sex, or cancer type. Sexuality is best understood in a biopsychosocial framework and cancer treatments including chemotherapy, surgery, radiation, and endocrine therapy can affect all of these domains. Management of genitourinary syndrome of menopause includes nonhormonal and low-dose local hormonal options. Pelvic floor dysfunction and vaginal stenosis can be treated with pelvic floor physical therapy and use of vaginal dilator therapy. ED can be treated with phosphodiesterase type 5 inhibitors and if needed, interventions such as intracavernosal injection of vasoactive agents, urethral suppositories, vacuum erection devices, and surgical implants are available. Cancer treatments such as chemotherapy, radiation, and androgen-deprivation therapy can lead to hypogonadism in men, which can be treated with testosterone therapy, unless contraindicated. Psychosocial counseling, sex therapy, and couples counseling are options for impact to sexual response, body image, and relationship concerns. A comprehensive, patient-centered approach to sexual health can help improve outcomes and overall well-being for cancer survivors.