Sexuality-MW: The Body2
The Medicine Wheel: Effect of Cancer Treatment
on Sexuality

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    How can cancer surgery affect my sexuality?
    • Whether the changes in your sexuality are short term (temporary) or permanent (long term) will depend on the type of surgery you have.
    • Surgery that removes the womb and ovaries will make you unable to have children (sterile/infertile) and may change how you function sexually.
    • Surgery to the bladder or colon/rectum can damage nerves that affect how you respond to sexual activities and may decrease arousal
    • Surgery to other areas of your body should not affect fertility, but may change sexual function because of changes in your body image or emotional concerns.
    • Surgery to lymph nodes (see lymphedema branch) may cause swelling, pain and discomfort that affects sexual functioning

    CeCe Whitewolf
    Confederated Tribes of Umatilla
    Dx 1998 Breast Cancer

    "But what's happened and again no one tells me this and I and I try to ask the doctor to about this and he was old man and oh he must have been about 65 or 70. And I said because no one has explained to me about my insides and what it's like ya know what's in there? And I said well what have you done to me now, can I still have sexual intercourse? And what's going to happen? And he told me he said well I made you a cul-de-sac. I said, a cul-de-sac, what do you mean a culture sack? So he said he described it kind like he's made a little end, a circle end and that I'm cut off at the end like a culture sack and I said oh okay. Something's wrong though, the culture sack must not be, is not very long or something happened to the culture sack because what happens now is whenever Ron and I have sexual intercourse. I bleed every time, I ... It's like I have a menstrual cycle after we have our sexual intercourse. So something's wrong, and so I've got to go into the doctor and now I think I have to tell him that my culture sack is too short."
    to play Video Vignette - click audio only

    What kinds of surgeries can affect my sexuality?

    • Hysterectomy [hiss-ter-ek-toe-me]
      • Removal of the uterus (womb) and cervix .
      • The upper end of the vagina is sewn shut after the womb and cervix are taken out.
      • The vagina will be a little bit shorter (most women do not notice).
      • While you are healing from surgery, your partner needs to be gentle.
      • The normal time to wait to start having sex again is about 6 weeks after surgery (ask your provider for a definite length of time).
      • Orgasm may feel a bit different since the nerves that make the clitoris respond to touch may be changed by your surgery.

    • Oophorectomy [oo-four-ek-toe-me]
      • Removal of the ovaries.
      • Will cause menopausal (change of life) symptoms (hot flashes, mood swings) if both ovaries are removed.
      • These symptoms start very soon after your surgery rather than happening slowly as happens with the normal change of life.
      • See the section on menopause for more information about these symptoms.    menopause link

    • Mastectomy or lumpectomy
      • Removal of all or part of the breast
      • Mastectomy [mast-ek-toe-me] removes all of the breast tissue
      • Lumpectomy [lump-ek-toe-me] removes part of the breast (the lump or area of the cancer and some surrounding tissue)
      • Surgery to the breast can affect your sexuality if touching your breasts was part of your sexual arousal.
      • Removing all or part of your breast can affect your body image. This may make you feel less womanly or attractive
      • Making a new breast shape (breast reconstruction) at the time of mastectomy or even months later may decrease some of the sexual side effects of mastectomy (see the CancerBACKUP website under resources for more information)

    • Abdomino-perineal resection [ab-dom-in-oh pear-ih-knee-al ree-sec-shun]
      • For cancers of the colon or rectum
      • Nerves to the womb, cervix and clitoris may be changed by your surgery
      • Sensations during sex and orgasm may not be the same as before your surgery.

    • Vulvectomy [vuk-vek-toe-me]
      • Simple vulvectomy removes the labia majora, labia minora and clitoris
      • Radical vulvectomy removes all the above tissues, plus local skin and lymph nodes in your pelvis
      • Sensations during sex will be changed
      • Body image changes often affect your sexuality

    • Creation of a Stoma [stow-mah]
      • A stoma (opening) may be made if you have surgery to your bladder, kidneys, colon or rectum. A stoma also may be made if you are treated for advanced cervical or ovarian cancer
      • When making a stoma, an opening is made in the skin of the abdominal wall to bring urine or stool out of the body (some may have an opening for stool and an opening for urine)
      • The stoma is usually covered with a pouch to collect the stool or urine
      • A stoma can make some lovemaking positions uncomfortable.
      • Worry about the pouch leaking during lovemaking is common; emptying the pouch just before lovemaking will make this less likely

    • Removal of lymph nodes (see lymphedema branch)

    Can radiation therapy affect my sexuality?

    • Changes in sexuality and your ability to have children may be short term, last a long time but get better or may be permanent.
    • Long term effects are most commonly due to:
      • The total dose of radiation you get
      • What part of the body is treated
      • How long the treatment lasts (number of weeks)
      • How old you are when you begin your radiation treatments
        • Women closer to normal change of life will have fewer problems with menopause symptoms than those who are younger
        • if you were able to have children before your radiation treatments

    What kinds of changes in my sexuality can I expect?

    • Radiation therapy to the pelvis can cause ovaries not to function as they should
      • Your monthly cycle may stop
      • You may have hot flashes and mood changes (see menopausal symptoms) Rick, please add link here
      • You may not feel aroused or have normal lubrication in your vagina
      • You may have diarrhea, sores in your vagina or be very fatigued (see fatigue branch)
      • The vagina may become narrower and less flexible after radiation therapy (see below for management)
    • Radiation therapy to the breasts:
      • May change how your breasts respond to touch or what clothing feels like on your skim
      • May change the color and flexibility of the skin
      • May affect sexuality through changes to body image
      • Arousal may be affected if touching the breasts was a usual part of your sexual activities

    Can I have sexual relations during radiation treatments?

    • Unless you have bleeding or pain, you can usually have intercourse during your radiation treatments.
    • Radiated skin may be very sensitive to touch
    • Unless intercourse or touching is painful, you should still be able to reach orgasm if you could before your treatments.
    • Ask your provider before using any lotions or creams on your irradiated skin

    Can radiation therapy affect a pregnancy?

    • Radiation treatments can damage an unborn baby
    • You should be sure you are not pregnant before starting your treatments
    • You need to use methods to prevent pregnancy during your treatment (condoms, birth control pills, etc.)
    • If you are pregnant when you are diagnosed with cancer, sometimes the radiation treatments can be delayed until after the baby is born. Be sure to talk with your healthcare provider about this.
    • You should not breast feed a baby from the breast that has been radiated. The possibility of breast infection is high. You can breast feed on the side that did not get radiation.

    Can chemotherapy affect my sexuality?

    • Depending on what type of chemotherapy you get, changes in sexuality may be short term, long term but eventually get better, or permanent.
    • In general, sexual side effects are related to:
      • type of chemotherapy drug you get (some are more likely to cause sexual problems than others)
      • dose of each drug that you are given
      • the total amount of time (in weeks or months) that you are treated with chemotherapy
      • how old you are (the closer you are to normal change of life, the less likely you are to have problems with menopausal side effects)
      • how long ago you finished chemotherapy (a longer time may be enough for your monthly cycles to start again).
      • If your chemotherapy includes more than one drug (two drugs will usually cause more problems than just one drug)
      • the medications used to treat you for nausea, pain or other treatment side effects
    • The most common side effects that may affect sexuality are:
      • Loss of your monthly cycle
      • Starting the change of life earlier than usual
      • Less interest in sex
      • Decreased or difficulty becoming aroused

    Can hormonal therapy affect my sexuality?

    • Hormonal therapies such as Tamoxifen, Zoladex, and other anti-estrogens are often used to treat cancer
    • These drugs may affect your sexuality because they can cause:
      • vaginal soreness, dryness or discharge
      • changes in your interest in sex (may be less or more than is common for you)
      • irregular monthly cycles
      • hot flashes and other menopausal symptoms
      • acne on your face, neck, back or arms
      • For men taking female hormones, breast may get larger

    Can biologic therapy affect my sexuality?

    • Many of the new cancer treatments include drugs that affect different body systems or pathways that allow normal (and cancerous) cells to grow and function. These drugs may or may not affect sexuality (not a lot is known about this yet).
    • The most common side effects of these drugs that may affect sexuality are:
      • flu like symptoms (aches, muscle soreness, fever)
      • fatigue,
      • less vaginal lubrication
      • skin rash
      • decreased sexual desire
      • irregular or no monthly cycle
      • pelvic pain
      • body image changes

    Can having a bone marrow or stem cell transplant affect sexuality?

    • Bone marrow or stem cell transplants are done to treat some types of cancer such as leukemia or multiple myeloma
    • These treatments are very intense and have many side effects,
    • Common side effects that may affect sexuality include:
      • Less interest in sex
      • narrowing of the vagina
      • less vaginal lubrication
      • pain during intercourse
      • body image changes
      • chronic fatigue
      • chronic diarrhea

    Are there any other treatments that may affect my sexuality?

    • Drugs used to manage cancer treatment side effects (pain or nausea) can affect sexual function such as:
      • Less interest in sex
      • Lowered ability to have an orgasm
    • Drugs likely to affect sexuality include:
      • Antidepressants (treat depressions)
      • Anti-nausea drugs (prevent nausea and vomiting)
      • Sedatives (help you to sleep)
      • Tranquilizers (make you less anxious)
      • Antihistamines (used to treat symptoms of allergies)
      • Steroids (used to prevent nausea and treat some forms of cancer)
      • Narcotics (used to treat pain)

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