Original Article

Impact of Sexual Dysfunction on Breast & Prostate Cancer Patients and their Spouses

Manoj Pandey¹, SreeRekha KR²

• ¹Department of Surgical Oncology, Institute of Medical Sciences,Banaras Hindu University, Varanasi, India
• ²Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, India.

• Submitted: January 11, 2012,
• Accepted February 1, 2012;
• Published: February 4, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effects of the cancer treatment last even after the completion of definitive treatment. These impairments are often visible in social, occupational, personal and sexual life. Over the last decade, clinicians have accepted that while survival and disease-free survival are critical factors for evaluation of treatment cancer patients, overall quality-of-life is fundamental [1]. Normal (or close to normal) sex life is vital since an absence may hinder or delay the emotional recovery of the patients. The conventional treatment methods however, lay lesser emphasis on the psychosexual recovery and rehabilitation when it comes to post treatment counseling of a cancer patient.

To a considerable extent, breast, cervix and prostate cancer patients are seen to report sexual dysfunctions at a much higher rate then other cancers. Expressed problems can arise on the part of the patient as well as the spouse. At times both the patient and spouse contribute equally. The problems are at times anatomical or physiological and on the other mostly psychological. Investigators at The University of Texas M. D. Anderson Cancer Center, working with researchers at the Cleveland Clinic, found that 85 percent of 1,236 prostate cancer patients surveyed reported having erectile dysfunction (ED) in the past six months [2]. This is one example of anatomical sexual dysfunction due to nerve damage.

Right from the point of discovery of the presence of cancer, the patients start facing major psychological problems. Their lives suddenly become focused on medical examinations, hospital visits and getting treatment for the cure of the illness. This results in life being focused on the disease. As a consequence sexual life is often put on the backburner.

Secondly, poorer marital quality may also contribute higher levels of patient distress from the spouse [3]. Here a diagnosis of cancer becomes an excuse or a precipitating factor for poor sexual relations and sex. One’s sexuality is such a small part of what one’s whole life is about, but even still, it is an important and integral part. One does not realizes what the absence of sex in life can do to their lives till it is done and often it remains unrecognized till the psychological evaluation of the patient. Cancer can cause a loss of confidence about sexual attractiveness, create appreciable changes in perceived body image, and apprehension about intimate relationships at times the fear of pain, or fear of doing harm may prevent the partner from having sex [4]. This is more often seen in the cases of cancer of the genitals even when the cancer is cured for good. Mastectomy on the other hand can be the cause of some of the most serious adjustment problems. These problems are seldom discussed and reported from Indian subcontinent due to delicate social fabric, where talking sex is considered as taboo. Sexual problems are often difficult for most women to discuss openly, however failure to discuss them with health professionals and spouses can cause greater problems and may take even longer to be resolved [5,6]. If left unattended the problems compounds with time and ultimately reach a point of no return. This is more applicable in Indian context where even the normal women do not discuss sex forget about the patients. The trend is slowly changing in Metros however only a handful of population resides there and this does not reflect the true Indian society.

It has to be kept in mind that virtually all forms of cancer treatments can reduce energy and vitality, besides causing listlessness for some period of time. Chemotherapy can cause nausea; vomiting and hair loss and can produce uncomfortable mouth and vaginal lesions, there by making it physically impossible for patient to have sex. Indelible markings on the breast for radiotherapy beside the loss of breast itself can be a constant reminder of the disease, and be a deterrent to sexual activity. Hormone therapy can cause a decrease in sexual desire. It is most important to realize that all these reactions and side effects are normal and are bound to be there; patients need be apprised of these and should be sexually rehabilitated the moment these effects are over. During the treatment, this lack of interest is accentuates as common healing methods (chemotherapy) result in physical disabilities sustained over a reasonable period of time [7]. Concerns about sexual attractiveness coupled with fears of sexual dysfunction create acute problems for the patient as well as spouse during this period.

Women who experience premature ovarian failure as a result of chemotherapy for breast cancer are at particular risk of sexual dysfunction, including a loss of desire and pain during intercourse [2,8]. It is also not unusual for the husband to find his partner unattractive following a mastectomy. These are only minor or perceived problems and can be overcome by good counseling at the beginning, during and at the end of treatment.

The wives of prostate cancer patients quite accurately appraise how satisfied their husbands were with the sexual support they were providing and how well the patients felt that their partner understood their experience. A number of patients report decrease in desire, penile stiffness and reduced frequency of intercourse and orgasm after treatment of prostate cancer [9]. In a cross-sectional study on 116 prostate cancer patients and their partners, Badr and Carmack Taylor showed a very high rate of sexual dysfunction. The patients’ and their partners’ sexual functions were well correlated. They observed that the partners of patients with poor erectile function were more likely to report that the couple avoided open spousal discussions [10]. Greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels of mutual constructive communication. They also showed that poor erectile dysfunction lead to mutual avoidance and poor communication, while a mutual constructive communication between patients and partners results in marital adjustment [10]. Partners of the breast patients are not quite as accurate in their estimations, underestimating the amount of support they provided and the degree of understanding they had about their wives, illness. In addition, wives of prostate cancer patients accurately appraised how important their husbands thought about various kinds of support were for them to provide. This perhaps reflects the effect of gender on sexual quality of life, where if the spouse is a woman, she understands, and if the spouse is male, he does not or does not want to understand. The husband may also release sexual energy elsewhere, even if this means visiting prostitutes, where the wives perhaps cannot depending upon the social pressure and fabric. Even after patients recover, they may be worried that having sex will cause the illness to break out again. Part of the issue borders on lack of awareness, as people may also have fears that the illness may be contagious or sexually transmitted. Issues such as these can be addressed with comparatively less effort. Good communication between partners and with medical professionals can help minimize the difficulties in resolving sexual concerns. It is essential for partners to communicate in order to find new ways to express their sexuality [11,12].

It is extremely important that patients are kept well informed about their illness and its immediate consequences in the short term and in the long term. They will want to know what impact it will have on every aspect of their life - including their sexual life. For instance, people need to know whether the treatment will have any effect on their sexual function or fertility. Since most men and women with cancer are over fifty years of age, it becomes important to put their sexual responses in perspective (vis-à-vis aging and menopause). Most patients however choose to be silent about their sexual problems. In the current era of widespread screening for prostate cancer, many patients are diagnosed with early-stage tumors that are managed aggressively and presumed curable. This approach may come with a great human cost in terms of sexual function. With patients diagnosed at ever younger ages, the quality –of-life impairments in term of sexual dysfunction are often associated with treatment and may have a long-lasting impact [13].

Conclusions

The need for assessment of psycho-sexual dysfunction can not be underestimated, in most societies it is still considered a taboo and patients and their spouses are not willing to talk about their sexual life. There is urgent need to increase the awareness and address the problems as and when they are found. Patients should be encouraged as the early intervention can probably prevent a patient from becoming psycho-social cripple.

Author’s contribution

MP Conceived and designed the study, edited the final version of the manuscript.
KS did the literature search and prepared the manuscript

Competing interests

The authors declare that there are no financial or other conflict of interests.

Funding Support

Nil

References

[1]. Bottomley A. The Cancer Patient and Quality of Life. The Oncologist 2002;7:120-125

[2]. Ganz PA, Rowland JH, Desmond K, et al. Life after breast cancer: Understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 1998; 16: 501-504.

[3]. Hack T, Cohen LJ, Robson LS, Goss P. Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 1999; 17: 143-149.

[4]. Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to breast cancer. Semin Oncol. 1996;23(1 Suppl 2):89-97

[5]. Boehmer U, Case P. Physicians don't ask, sometimes patients tell: disclosure of sexual orientation among women with breast carcinoma. Cancer 2004;101:1882-1889.

[6]. Huber C, Ramnarace T, McCaffrey R. Sexuality and intimacy issues facing women with breast cancer. Oncol Nurs Forum 2006; 33 :1163-7.

[7]. Broeckel JA, Thors CL, Jacobsen PB, et al.: Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy. Breast Cancer Res Treat 2002; 75: 241-8,

[8]. Schover LR, Yetman RJ, Tuason LJ, et al. Comparison of partial mastectomy with breast reconstruction on psychosocial adjustment, body image, and sexuality. Cancer 1995; 75: 54-64.

[9]. Steineck G, Helgesen F, Adolfsson J, et al.: Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 2002; 347: 790-6

[10]. Badr H, Carmack Taylor CL. Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psycho Oncology 2008. Epub ahead of print.

[11]. Carlson LE, Ottenbreit N, St. Pierre M, Bultz BD. Partner understanding of the breast and prostate cancer experience. Can Nurs 2001; 24: 231-239.

[12]. Henson HK. Breast Cancer and Sexuality. Sexuality and Disability 2002; 20: 261-275.

[13]. Schover LR. Counseling cancer patients about changes in sexual function. Oncology 1999; 13: 1585-1591.