Let’s Talk About Sex…and Cancer: Q+A with Dr. Christine Chin

With major advancements in cancer therapies, the rate of patients surviving cancer and living longer after their diagnosis is increasing. This is fueling a growing need to address long-term health and well-being of patients once they’ve completed treatment, and one of the less talked about concerns cancer survivors face are the lasting sexual side effects from cancer treatment. 

Sexual dysfunction, which can include anything from negative body image issues and intimacy problems to experiencing painful sex or a low sex drive, affects anywhere from  40% to 100% of cancer patients, depending on specific diagnosis and treatment methods. While common side effects to cancer treatment such as fatigue, hair loss and nausea are more widely known, sexual side effects of therapy are not, especially among women.

“While the majority of male cancer patients are routinely asked about their sexual health, only a quarter of female cancer patients report being asked about their sexual health at any time during their cancer care,” says Christine Chin, MD, assistant professor of radiation oncology at Columbia University's Vagelos College of Physicians and Surgeons who specializes in gynecologic cancers. 

With 8.7 million female cancer survivors in the United States, according to American Cancer Society data, the need to address sexual dysfunction among women and provide appropriate education and services is enormous.

“We’re finding that in general, female cancer patients are hesitant to bring up conversation surrounding their sexual health during appointments,” says Dr. Chin. “It is a difficult topic to discuss but it is ultimately the responsibility of the provider, and we all need to be better about incorporating it into routine cancer care.”

Passionate about making a difference in women’s lives, Dr. Chin and her collaborators at NewYork-Presbyterian Hudson Valley Hospital and Lawrence Hospital, Drs. Julie Choi and Leah Katz, have launched a five-year study to investigate the impact routine sexual health screening may have on female cancer patients who have received pelvic radiation therapy. They hope that this quality of life pilot will help identify barriers to addressing pelvic health concerns in women, specifically among the diverse minority patient population that is cared for at Columbia.

Dr. Chin, who is a member of the Herbert Irving Comprehensive Cancer Center (HICCC), shares insight on the importance of women’s sexual health and cancer, a relatively uncharted area of research or discussion.

How does cancer treatment affect a women’s sexual health?

Surgery, such as hysterectomy, and chemotherapy often have an impact on sexual health due to a lowering of estrogen levels. This can affect a patient’s mood and energy, but patients may also experience a heightening of many menopausal symptoms such as hot flashes and vaginal dryness. Radiation can have an impact on sexual health as well because radiation treatments have a direct effect on the quality of vulvar and vaginal tissues being irradiated. For my gynecologic patients, for instance, radiating the pelvic area, or pelvis, has an effect on vaginal tissue quality which can cause scarring, dryness and atrophy of the vulvovaginal tissues which can lead to itching, discomfort, sensitivity and sometimes, infection. 

Are physicians starting to address some of these concerns now?

Slowly, but it’s not yet standard or consistent. Many clinicians lack the time and comfort to adequately assess and address sexual health issues with patients. It may be over looked if a patient is not proactive in bringing up their concerns during their appointment.  

Why isn’t sexual health a point of discussion for cancer patients and their doctors?

Studies have shown that many oncology providers feel uncertain or uncomfortable discussing sexual health with patients due to either a lack of training about sexual health, limited time or having concerns about making patients feel uncomfortable or offended. This stems from the fact that sexual health—how to assess, ask about and manage sexual health issues—is often overseen in the medical training curriculum, during both medical school and clinical residency.  

But oncology providers often serve as the frontline in addressing these issues. Many patients are not going to have access to something like a sexual health clinic because there aren’t many. And, in fact, most patients likely won’t pursue going to a sexual health clinic, so we really need to be proactive about helping them. I think this will improve as we become more aware of the multifactorial effects treatment can have on patients, and we need to be more attune to identifying how we can address their concerns. 

How do you help patients today?

One of the main things I discuss with all of my patients following pelvic radiation treatments is their pelvic health and how taking the time to perform some self care will help improve the quality of their pelvic (vulvovaginal) tissues following treatment. We discuss with patients the use of vulvovaginal moisturizers because many post-menopausal women will develop symptoms of vulvovaginal atrophy and dryness that may often be more pronounced following treatment. We also introduce patients to vaginal dilation practices and teach patients how to exercise the vaginal tissues. The importance of this is that when you stretch the tissue, you directly break down the scar tissue that often will form following surgery and radiation treatments. This can help prevent pain with any future sexual activity but also pelvic exams that may need to be performed for surveillance.

I enjoy taking the time to educate my patients on the rationale of these interventions, and it helps them put them into practice when they understand the importance.  

What message do you have for patients dealing with this now?

I would encourage patients to bring up any concerns with their doctor and ask about the potential side effects that can come from treatment. Sexual dysfunction caused by chemotherapy or radiation isn’t just about being sexually active, it’s about your health overall and quality of life. Again, I do think the onus is on us to start the conversation but the patient’s insight and feedback is invaluable. I think more of us are starting to do this and taking steps to raise awareness. We’re making progress but more work is needed.