I Asked About Low Libido During Breast-Cancer Treatment
Women with cancer are not doomed to endure sexual dysfunction
This article originally appeared in Womens E-news on January 5, 2016.
By Kelly Michelson
I will never forget my doctor's response when I asked her about experiencing low libido during treatment for cancer. "Libido is complicated," she said.
It was just over two years ago that I was diagnosed with breast cancer. I had gotten married fewer than two months prior. As the mother of two children under 6 years old and the sole "bread winner" in my family, I had a lot going on. Libido wasn't the only thing complicated in my life.
Cancer complicated my life in many ways. Some things were obvious to everyone around me. I had multiple surgeries, walked around with an assortment of new hats covering my bald head and was often noticeably weary.
But the impact of breast cancer also hides behind closed doors. I was 45 years old and thrown prematurely into menopause, or as my fellow breast cancer survivors might say, "chemopause." With that came hot flashes and vaginal dryness. My mastectomy left me without sensation on half my chest and with daily pain.
In many ways, asking my doctor about sexual dysfunction made me unique. While in one study, 7 percent of women surviving with cancer had sought medical help for sexual issues, about 42 percent actually wanted help.
It's understandable why many women with cancer don't ask their doctors for help with sexual problems. When I was diagnosed, I thought I was going to die. I was focused on making choices about surgery, chemotherapy and radiation therapy while trying to keep my family intact. In that context, sex falls way down on the priority list.But it turns out that there are important reasons to prioritize sex. As Dr. Stacy Tessler Lindau describes in her recently published "manifesto," sexual dysfunction can cause relationship strain, which can impact socioeconomic and psychosocial well-being. It can cause a woman to suffer physically and psychologically, leading to poor quality of life and health.
The reality is that somewhere between 50 percent and 75 percent of women with breast cancer report persistent problems with sexual functioning. Too many women suffer needlessly.
Fortunately, there is a lot of online support for women with cancer. The American Cancer Society website has a section called, "Keeping your sex life going despite cancer treatment." The Susan B. Komen website has information and links to additional resources like the American Association of Sexuality Educators, Counselors and Therapists and the International Society for the Study of Women's Sexual Health. Another good source is the section on Sex and Intimacy at Breastcancer.org.
Despite these great options and advice from my doctors about lubricants, I continued having problems.
I worried that this was just one more thing I would have to live with. After all, it is hard to know what comes from having cancer and what comes from life in general. Some might say that my going through menopause was inevitable. Others might feel that I should just be grateful to be alive. True and TRUE! Still it was depressing for me to think that I wasn't getting everything that I could from life.
Then a fellow breast cancer survivor told me about a clinic called the Program in Integrative Sexual Medicine (PRISM). PRISM is one of growing number of programs across the country dedicated to treating sexual dysfunction in women with cancer. Here is where I finally developed a clear plan for getting better.
It turns out there is no magic bullet for treating sexual dysfunction. Even the recently approved "female Viagra" is being questioned by experts. But there are things that any woman, not just a woman with cancer, can do to treat sexual dysfunction. Pelvic physical therapy can help with weakness, tightness, or spasms of the vagina. Psychotherapy is useful. For some women, lubricants, medications or even surgical procedures are parts of a comprehensive treatment plan.
I was lucky to find a clinic dedicated to treating sexual dysfunction for women with cancer, but women shouldn't have to rely on luck.
First, doctors should warn women that they may experience sexual dysfunction before, during or after cancer treatment. They can encourage women to ask about treatment options or use screening questions to identify women at risk. Doctors should have basic training about treatment strategies and refer women to a dedicated clinic if needed. The Scientific Network on Female Sexual Health and Cancer provides resources online for professionals.
Second, we need more clinics dedicated to treating sexual dysfunction in women with cancer and assurances that insurance companies will pay for the treatments prescribed. My hour-long appointments were covered by insurance. But having such lengthy visits may not be sustainable in today's health care environment. Without insurance coverage, some women may not be able to access these resources. Such clinics should be available for men as well.
Third, there is still much to learn about sexual dysfunction. As Dr. Lindau describes in a medical journal, we need more research about how many women are affected, what causes sexual dysfunction and how problems evolve over time. We need to know more about the effectiveness of currently available treatments. Researchers and physicians need to develop new treatment strategies, including new drug therapies.
Yes, libido is complicated, but sexual dysfunction is a part of a woman's constitution. By using a holistic approach, we can help women with cancer live the fullest life possible.
- Kelly Michelson is associate professor of pediatrics at Northwestern and an attending physician in the pediatric intensive care unit at Ann and Robert H. Lurie Children's Hospital of Chicago. She is a member of the OpEd Project Public Voices Fellowship and a breast cancer survivor.