Painful sex in women after cancer needs to be addressed, UC Davis researcher suggests

Painful sex in women after cancer treatment is relatively common, often treatable and needs to be addressed by medical providers, a UC Davis oncologist and researcher suggests.

Vanessa Kennedy, a gynecologic oncologist at UC Davis Health System, says that with improved diagnosis and treatment and higher rates of survival after cancer, more and more women are living with the long-term effects of treatment, including those that affect their sex lives. Despite the frequency of these problems, even gynecologists find it difficult to discuss the topic with their patients, both because of the discomfort of broaching the subject and because they often feel ill-equipped to assess the problem and offer solutions.

To fill this gap, Kennedy and co-author Deborah Coady of New York University Langone Medical Center in New York have written an extensive review article, titled "Sexual health in women affected by cancer: Focus on sexual pain." The paper, published recently in Obstetrics & Gynecology, highlights various causes of painful sex in women after cancer, including those related to surgery, chemotherapy, radiation and hormonal therapy, and provides guidance on medical evaluation, physical exams and treatment options.

"Sexual pain is often written off as 'in people's heads,' but it is more often a result of physical issues that can be helped," said Kennedy, assistant professor of gynecology and oncology. "It is important to be able to have the conversation comfortably and to know how to address the common issues that are often predictable, depending on a patient's treatment course."

Guidelines from leading cancer organizations recommend that medical providers routinely address sexual health during and after cancer treatment, but this remains an area of wellbeing too often overlooked, said Kennedy. She suggested that it may be due, in part, to the inclusion of sexual pain in the American Psychiatric Association's manual as a type of female sexual dysfunction and therefore a mental disorder. Although the association recently revised the language to exclude women with sexual pain related to "another medical condition," she said this historical perspective has led health care providers to consider it as something without physical cause and without treatment options.

Kennedy said the most common cause of sexual pain in women with cancer is low estrogen levels, which, in fact, has a physical basis and typically results from hormonal therapy, ovary removal or radiation to the pelvic region.

"Diagnosing a purely psychological basis for sexual pain is only appropriate after biologic causes have been completely evaluated and ruled out," said Kennedy, who recommends that gynecologists collaborate with cancer specialists to learn more about the possible effects of a patient's cancer therapy.

Kennedy said that women find it hard to bring up difficulties in their sexual life and would prefer that their doctors ask about it. The article addresses ways for doctors to open and continue a discussion, and provides a sexual-symptom checklist to help assess problems.

In response to the need for better care for the sexual health for women with cancer or who have had cancer, Kennedy has established a clinic at the UC Davis Comprehensive Cancer Center devoted to the issue.

"Time and time again, I see women who have had negative impacts for years following cancer therapy," she said. "It's an incredible relief for them to be able to just sit down and have the conversation."