In the headlines today are multiple articles featuring a new study in JAMA Oncology with findings that suggest that we may be over-treating early stage breast cancers called DCIS. Immediately before reading this study, I happened upon an inspirational article in this month's Grey Journal (AJOG), "A Manifesto on the preservation of sexual function in women and girls with cancer" by Dr. Lindau et al of the University of Chicago. Before I went to medical school I worked in breast cancer research and focused on survivors of breast cancer. These two articles certainly hit a note with me- how many women had I met who had received a breast cancer diagnosis, undergone aggressive treatment, and survived, but were then left to pick up the pieces after this life-altering experience?
Here are some of the highlights of this Manifesto. First, women's cancers disproportionately affect sexual organs like the breast, cervix, uterus, ovaries. The cancer itself and subsequently the treatments can affect these organs and impair female sexuality. For example, some treatments cause physical alterations, loss of normal sensations and pain with contact, and even put women into pre-mature menopause. Imagine if a simple hug caused intense pain after a mastectomy, how this would change your approach to intimacy, both sexual and platonic.
Most importantly, this article draws attention to that fact that sexual health is important to cancer patients and providers are not routinely addressing this concern. Multiple barriers blockade the conversation. As a physician, it's easy for me to think of plenty: I don't want to make my patient uncomfortable, to sound insensitive to the gravity of the diagnosis, or to make assumptions about her values/preferences/desires. Perhaps the biggest fear of all, what if she tells me about symptoms that I don't know how to fix or that medicine cannot fix?
I have also been fortunate to work with some of the world's experts in cancer survivorship and seen how they carve out time during a packed appointment to address sexual health and quality of life. The most important first step for clinicians is to be aware of the problem. Then, we need to arm ourselves with knowledge about some of the most common concerns: vaginal dryness, incontinence, pain, loss of desire, .... The solutions may cause us to step outside our comfort zone and delve into alternatives from complementary medicine or physical therapy. Finally, we must take the plunge and start asking our patients about their sexual health. Just opening the door to discussion or setting aside a specific time or appointment to address these important issues will allow our patients to open up to us about their concerns. Although we may feel uncomfortable at first, the more we open that door, the more natural it will feel. I know that these steps will bring us closer to providing holistic, patient-centered care for women with cancer.