UBC Reports | Vol. 50 | No. 11 | Dec. 2, 2004

Cancer and Sex: The Unspoken Harm

By Hilary Thomson

When Linda Mercer underwent a radical hysterectomy to treat her cancer, she found herself and her husband struggling to regain a satisfying sex life.

It’s not often discussed, but it’s a fact: surgery that can save a cancer patient’s life often robs her of sexual arousal and satisfaction.

Cervical cancer is the third most common cancer among women aged 20-49 years. In Canada, about 1,450 women are diagnosed and 420 die of cervical cancer each year.

At least 40 per cent of women who have had a radical hysterectomy to treat cervical cancer or endometrial cancer, like Mercer had, develop significant cancer-induced dysfunction related to genital arousal, says psychologist Lori Brotto, an assistant professor in UBC’s department of obstetrics and gynecology.

In January 2005, Brotto will launch North America’s first study to explore a psychoeducational treatment aimed at helping cancer survivors treated with radical hysterectomy regain their sexual health. The treatment integrates psychological counseling with exercises and information to help patients gain insights about feelings, thoughts and behaviour.

“This is an area that is virtually unstudied,” says the 29-year-old Brotto. “Women’s sexuality research in general is about 20 years behind similar investigations of men’s sexuality because of taboos and an assumption that male and female responses are the same.”

When Mercer was asked to participate in a pilot of the study, she jumped at the chance.

“The program offered me hope and being with a group of other women with cancer made me feel that I wasn’t alone,” says the 55-year old. “I got help in understanding both the positive and negative patterns of thoughts and ideas that affected my feelings -- it was very concrete advice. Cancer is such a dark time, but you can enjoy having sex after cancer, there are treatments available -- there’s a light out there, and it’s getting brighter.”

Working with colleagues at BC Cancer Agency (BCCA), Brotto will recruit 66 women, aged 19-50 years old, with a history of cervical cancer treated by radical hysterectomy within the last five years. The research team, located at Vancouver Coastal Health Research Institute (VCHRI) will work with survivors to offer counseling and record feedback about sexual function. These psychoeducational aspects of the program will be supplemented with treatment with sildenafil citrate, known commercially as Viagra ®.

Participants’ progress will be followed for six months after their final session.

Cervical cancer affects the cervix or lower part of the uterus leading into the vagina. Early stage cervical cancer and endometrial (uterus lining) cancer is commonly treated by radical hysterectomy -- removal of the entire uterus, adjacent lymph nodes as well as the upper one-third of the vagina.

Many women also have both ovaries and fallopian tubes removed, and some receive radiation / chemotherapy which may further impair sexual function. Estrogen production stops with removal of the ovaries, resulting in reduced elasticity of the vaginal wall, making intercourse painful.

In addition, surgery often damages the autonomic nerves that supply sensation to the genital area.

The psychological effects of hysterectomy can be numerous and complex and depression is common, says Brotto. Many survivors no longer feel like women because their genitalia have been altered. There is often the emotional loss of being unable to bear children. Survivors may have a different body image, seeing themselves as dehumanized and just a medical object. Many avoid looking in the mirror because their own body now repels them.

In addition to anxiety over their own and partners’ response or lack of it, women are also fearful about a recurrence of cancer. Many women believe that intercourse can cause cancer to recur or that they can pass cancerous cells to their partner, says Brotto.

Her new study will expand on the pilot which tested the effectiveness of a treatment manual that contains information and exercises to help restore healthy sexual functioning. Brotto hopes to develop the manual so it can be used by both women and health-care providers.

“The link between sexual health and quality of life is well established,” says Brotto, a Michael Smith Foundation for Health Research Scholar. “I hope this treatment can improve women’s sexual well-being which in turn can lead to a better quality of life for cancer survivors.”

The project has been funded by the Canadian Institutes of Health Research, the Government of Canada’s agency for health research. CIHR provides leadership and support to more than 8,000 researchers and research teams in every province in Canada.

BCCA, an agency of the Provincial Health Services Authority, provides cancer care across the province.

VCHRI is a joint venture between UBC and Vancouver Coastal Health that promotes development of new researchers and research activity.