In yesterday’s post, we talked about cancer survivorship side effects. Why this topic? Gynecologic cancer survivors have different side effects, and therefore, there is a need for a personalized approach to symptom management. Women with ovarian cancer most commonly report cognitive changes, gastrointestinal disruption, and neuropathy (numbness, most commonly in the fingers and toes). Among women with cervical cancer, the most common reported side effect is pelvic pain. Lastly, with uterine cancer survivors, increased body weight is a challenge. What all three of these cancer survivor groups have in common is the side effect of periodic sexual dysfunction.
Causes of sexual dysfunction in gynecologic cancer survivors can be due to effects of surgery, chemotherapy or radiation. Surgery and radiation therapy can cause thinning or swelling of the tissue and narrowing of the vagina. Chemotherapy can cause menopause with loss of estrogen causing thinning, decreased lubrication and painful intercourse.
Therapy for sexual dysfunction due to thinning includes the use of vulvar and vaginal moisturizers, which are non-hormonal products and are available over the counter. These same products can also be used prior to intercourse to help prevent vulvar tears and to potentially minimize pain during intercourse. Sometimes, topical or intravaginal hormones may be prescribed. Vaginal narrowing associated with surgery or radiotherapy can be treated with vaginal dilators several times a week. Lower extremity lymphedema (or swelling) is an unusual side effect of pelvic surgery and radiation, and it can cause sexual dysfunction. Treatment of lower extremity lymphedema involves early recognition and referral to a specialist for early intervention.
In addition to the physical effects of cancer therapy, many gynecologic cancer survivors report sexual dysfunction due to lack of sexual desire and/or arousal. This is another treatable problem that the specialists at Summa Health System can address. Sometimes hormonal therapy such as estrogens, progesterone and testosterone can help. Other options include mindfulness-based cognitive behavioral therapy.
More research is needed to further define, prevent and manage these long-term side effects. Technologic research in surgery, chemotherapy and radiation has the potential to aid in the prevention of side effects. So why do women undergo cancer therapy with potential side effects? Because they want to get back to a healthy life.
Stephen Andrews, M.D.
Chief, Gynecologic Oncology
Summa Akron City Hospital
Summa Health System