The impacts of acute and late radiotherapy toxicities on women’s sexual health are frequently neglected during cancer treatment. But women should be cautioned about sexual dysfunctions and told about post-treatment sexual rehabilitation options early in their treatment, not just in survivorship, experts tell Oncology Nurse Advisor.

Radiotherapy and other cancer treatments can profoundly change a woman’s sexual anatomy, function, and overall sexual health.1-3 Women undergoing radiotherapy for gynecologic or rectal cancers—particularly those receiving pelvic brachytherapy or external-beam radiation fields that include the sexual organs—are at particular risk for sexual dysfunction.4 Radiotherapy is frequently an adjuvant to surgical interventions that destroy or modify sexual organs.4 Radiotherapy and other treatments for breast or brain cancer can also affect a woman’s sexuality by contributing to chronic fatigue, lack of physical strength, diarrhea, or depression.5 (See Table 1.)

Table 1. Radiotherapy-related female sexual issues

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Depression or anxiety
Sleep disruption
Cognitive changes
Self-image problems
Libido changes
Skin changes
Loss of normal skin sensation
Loss or impairment of ability to orgasm
Vaginal dryness
Vaginal pain or discomfort
Vaginal atrophy (shortening, stenosis)
Vaginal fibrosis
Changed body odors
Loss of normal bowel or bladder function or control
Sources: Mirabeau-Beale KL, Viswanathan AN. Quality of life (QOL) in women treated for gynecologic malignancies with radiation therapy: A literature review of patient-reported outcomes. Gynecol Oncol. 2014;134:403-409. DOI:10.1016/j.ygyno.2014.05.008; Sanchez Varela V, Zhou ES, Bober SL. Management of sexual problems in cancer patients and survivors. Curr Probl Cancer. 2013;37:319-352. DOI:10.1016/j.currproblcancer.2013.10.009.

Pelvic radiotherapy’s acute and late toxicities can be specific to sexual anatomy and function, such as vulvar atrophy and vaginal fibrosis, stenosis, shortening, or discharge. 1-3 Changes in vaginal anatomy and function make dyspareunia—pain during sexual intercourse—the most common sexual problem reported by cancer survivors.