How can I bring up the topic of sexual health with my oncologist?

Mary K. Hughes, a psychiatric clinical nurse specialist at the University of Texas MD Anderson Cancer Center in Houston

People with all types of cancer may experience cancer- and treatment-related sexual changes. For women, surgery can cause physical changes, while cancer and its treatment can disturb hormone levels and lead to vaginal dryness and low libido. For men, surgery and radiation can damage nerves or blood vessels and cause erectile dysfunction, while chemotherapy, targeted therapy and immunotherapy may lower testosterone levels. Common side effects of treatment, including fatigue, nausea, bowel or bladder problems, skin issues, and pain, can affect your comfort with and desire for sex. Cancer takes an emotional toll, which can impact how you feel about sex. Cancer-related clinical depression also can lead to low libido in both men and women.

In our society, we like to joke and tease about sex, but we don’t often talk about it honestly. You may feel embarrassed to bring up sexual health and worry about what your care team will think of you. You might think, “How dare I think about sex when I’m fighting for my life!” Also, the time you have with your oncologist is limited, so you may think concerns about sex don’t merit discussion. However, it’s important to recognize that your sexual health is a quality-of-life issue. If it’s important to you, then it’s worth having a conversation about.

To broach the topic, think about whom on your care team you feel most comfortable talking with. For example, many people find it easier to mention sexual health to a nurse than to their oncologist. Consider saying, “Remember when you talked about sexual changes with treatment? What did you mean by that?” To help get the conversation started, ask about support for any side effects, such as erectile dysfunction, vaginal dryness or changes you’ve noticed in your interest in or feelings about sex.

Depending on your concerns, your health care provider may refer you to a psychologist, a clinical social worker, a counselor, a gynecologist, a urologist or an endocrinologist. Some cancer centers have dedicated sexual health programs. A sexual health counselor can offer strategies you may find helpful, such as using lubricants or planning with your partner when to have sex.

It may feel difficult to talk about sexual health concerns, but most people are relieved once they do. Finding the courage to speak up is the first step to getting help with this aspect of life, which can improve your quality of life, sense of well-being and relationships.

SEXUAL HEALTH // The Centers for Disease Control and Prevention provides an overview of the health professionals who can help survivors address sexual health concerns. // MD Anderson Cancer Center offers a guide on sexuality and cancer for patients and their partners.

The expert’s response was edited for clarity and based on an interview with Kendall K. Morgan.