Adult women who survived cancer as a child report having less sex, less interest, less desire and less satisfaction than their sisters who never had cancer, according to a new study.
"These women are functioning really well, by and large, but there's this sliver of an issue that needs to be looked at more closely," said lead author Jennifer S. Ford.
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Women who had been diagnosed as teens, been treated with radiation of the brain or who ceased menstruating at a younger age (or never began) were at the biggest risk for sexual dysfunction.
"One of the most surprising things was to find this impairment many, many years after treatment," Ford told Reuters Health by phone. "You might expect things would go back to normal, but they did not."
Ford, of the psychiatry and behavioural sciences department at Memorial Sloan-Kettering Cancer Centre in New York, and her team compared survey responses from 2,178 young women who had been diagnosed with cancer before age 21 to answers by 408 of their sisters who had not had cancer.
Lower sexual activity
The average age of the cancer survivors at the time of the survey was 29 and all had survived at least five years. Leukaemia and Hodgkin lymphoma were the most common cancers the women had suffered as children.
After taking age, education level, marital status, income, ethnicity and race into account, the researchers found that almost 30 percent of cancer survivors reported not being sexually active in the past month, compared to 17 percent of their siblings.
Among the women who were not sexually active, survivors were twice as likely to say they had a lack of interest in sex, were too tired or had a physical problem with sex, according to the results in the Journal of Clinical Oncology.
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Overall, survivors were less likely to be married or to have a current sexual partner.
About 10 percent of cancer survivors had ovarian failure, or the lack of menstruation, and these women were more likely to report vaginal dryness, tightness, painful sexual intercourse or vaginal bleeding.
Of these women, who had essentially entered menopause too early, Ford explained, less than half were taking oral contraceptive pills or hormone replacement therapy to treat the problem, and those who were undergoing treatment didn't seem to be doing any better than those who were not.
Although ovarian failure was not linked to depression or anxiety, many sexual problems like lack of interest may stem from emotional consequences of growing up in cancer treatment, Ford said. The cancer itself, or the treatment, may lead to physical changes in the body, and social and emotional consequences may lead to delay in hitting some developmental milestones like becoming sexually active.
"It doesn't mean they don't hit those milestones, but they may reach them later on," Ford said.
Older cancer survivors also tend to experience psychosexual problems, but are often over age 60 and therefore mature physically and emotionally in terms of sex, said Bradley J. Zebrack of the University of Michigan School of Social Work in Ann Arbor.
He studies the effects of cancer on the psychosocial growth and development of adolescents and young adults.
Negative effect on development
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"Young people are less experienced, and at a stage in life when they are entering into intimate and sexual relationships for the first time," Zebrack told Reuters Health by email. "For young women, the physical and emotionally-debilitating side effects of cancer and its treatment appear to have a negative effect on their development in terms of sex and sexuality."
Some sexual effects may be related to treatment and may dissipate with time, he said. Early menopausal symptoms can be treated with medications or physical therapy.
Patients should know that cancer may affect their sexual interest, performance, and feelings about sex and their bodies, Zebrack said.
"In essence, let them know that treatment can affect sex, and that talking about this with friends, other young people who've had cancer, or a mental health provider such as a social worker, can be beneficial," he said. Sex therapists can be great resources as well, he said.
It's not yet clear whether childhood cancer and adult sexual life are related in the same way for men, Ford said, but the outcome may be similar.
"My guess is that we're underestimating the rate of sexual problems for cancer survivors," she said. "As clinicians we have a responsibility to be comfortable talking about this with our patients."
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SOURCE: Journal of Clinical Oncology