Sexual Health

Enhancing Sexual Health for Cancer Survivors.

TL;DR

Changes to sexual function after cancer treatment are extremely prevalent and oncology professionals should integrate sexual health discussions into routine patient care using a comprehensive, patient-centered approach to improve outcomes and overall well-being for cancer survivors.

Key Findings

Sexual dysfunction after cancer treatment is extremely prevalent, affecting the large majority of both female and male cancer patients.

  • Up to 90% of female patients with cancer experience changes to sexual function after cancer treatment.
  • 40%-85% of male patients with cancer experience changes to sexual function after cancer treatment.
  • Sexual health concerns include low libido, genitourinary syndrome of menopause, dyspareunia, erectile dysfunction (ED), hypogonadism, body image concerns, and impacts on intimate relationships.

Cancer treatments across multiple modalities affect sexual health through biopsychosocial mechanisms.

  • Treatments including chemotherapy, surgery, radiation, and endocrine therapy can affect sexual health.
  • Sexuality is best understood in a biopsychosocial framework, meaning biological, psychological, and social domains are all affected.
  • Cancer treatments such as chemotherapy, radiation, and androgen-deprivation therapy can lead to hypogonadism in men.

Multiple nonhormonal and hormonal management options exist for genitourinary syndrome of menopause in female cancer survivors.

  • Management of genitourinary syndrome of menopause includes nonhormonal options.
  • Low-dose local hormonal options are also available for managing genitourinary syndrome of menopause.
  • Pelvic floor dysfunction and vaginal stenosis can be treated with pelvic floor physical therapy and use of vaginal dilator therapy.

Erectile dysfunction in male cancer survivors can be managed through a stepwise range of interventions.

  • ED can be treated with phosphodiesterase type 5 inhibitors as a first-line option.
  • Additional interventions include intracavernosal injection of vasoactive agents, urethral suppositories, vacuum erection devices, and surgical implants.
  • These options are available when initial pharmacological treatment is insufficient.

Hypogonadism resulting from cancer treatment in men can be treated with testosterone therapy when not contraindicated.

  • Chemotherapy, radiation, and androgen-deprivation therapy can all lead to hypogonadism in men.
  • Testosterone therapy is an available treatment for cancer treatment-induced hypogonadism.
  • Testosterone therapy is indicated unless contraindicated, suggesting clinical judgment is required regarding appropriateness.

Psychosocial interventions are recommended components of sexual health care for cancer survivors experiencing psychological and relational impacts.

  • Psychosocial counseling, sex therapy, and couples counseling are options for addressing sexual response, body image, and relationship concerns.
  • Sexual dysfunction has a significant impact on quality of life, underscoring the need for these interventions.
  • Oncology professionals should integrate sexual health discussions into routine patient care regardless of the patient's age, sex, or cancer type.

What This Means

This research summarizes what is known about sexual health problems in cancer survivors and how they can be addressed. The authors found that sexual difficulties after cancer treatment are extremely common — affecting up to 90% of women and up to 85% of men who have had cancer. These problems range from low sex drive and pain during sex to erectile dysfunction, hormonal changes, and concerns about body image and intimate relationships. The causes are tied to the physical effects of cancer treatments like chemotherapy, surgery, radiation, and hormone therapies, as well as psychological and social factors. The paper outlines a range of treatment options available to help cancer survivors with these issues. For women, options include non-hormonal therapies and low-dose local hormonal treatments for vaginal dryness and discomfort, as well as physical therapy and dilator therapy for pelvic floor problems. For men, erectile dysfunction can be treated with medications, injections, devices, or surgery, and testosterone therapy may be an option for hormone deficiency caused by treatment. Both men and women can benefit from counseling, sex therapy, and couples therapy to address the emotional and relational dimensions of sexual health. This research suggests that oncology care teams should make sexual health a routine part of cancer survivorship care for all patients, regardless of age, gender, or cancer type. A thorough, patient-centered approach that considers the physical, emotional, and social aspects of sexual wellbeing has the potential to meaningfully improve quality of life for the millions of people living after a cancer diagnosis.

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Citation

Agrawal L, O'Riordan L, Natale C, Jenkins L. (2025). Enhancing Sexual Health for Cancer Survivors.. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting. https://doi.org/10.1200/EDBK-25-472856