UBC Reports | Vol.
50 | No. 11 |
Dec. 2, 2004
Cancer and Sex: The Unspoken Harm
By Hilary Thomson
When Linda Mercer underwent a radical hysterectomy to treat
her cancer, she found herself and her husband struggling to
regain a satisfying sex life.
It’s not often discussed, but it’s a fact: surgery
that can save a cancer patient’s life often robs her
of sexual arousal and satisfaction.
Cervical cancer is the third most common cancer among women
aged 20-49 years. In Canada, about 1,450 women are diagnosed
and 420 die of cervical cancer each year.
At least 40 per cent of women who have had a radical hysterectomy
to treat cervical cancer or endometrial cancer, like Mercer
had, develop significant cancer-induced dysfunction related
to genital arousal, says psychologist Lori Brotto, an assistant
professor in UBC’s department of obstetrics and gynecology.
In January 2005, Brotto will launch North America’s
first study to explore a psychoeducational treatment aimed
at helping cancer survivors treated with radical hysterectomy
regain their sexual health. The treatment integrates psychological
counseling with exercises and information to help patients
gain insights about feelings, thoughts and behaviour.
“This is an area that is virtually unstudied,”
says the 29-year-old Brotto. “Women’s sexuality
research in general is about 20 years behind similar investigations
of men’s sexuality because of taboos and an assumption
that male and female responses are the same.”
When Mercer was asked to participate in a pilot of the study,
she jumped at the chance.
“The program offered me hope and being with a group
of other women with cancer made me feel that I wasn’t
alone,” says the 55-year old. “I got help in understanding
both the positive and negative patterns of thoughts and ideas
that affected my feelings -- it was very concrete advice.
Cancer is such a dark time, but you can enjoy having sex after
cancer, there are treatments available -- there’s a
light out there, and it’s getting brighter.”
Working with colleagues at BC Cancer Agency (BCCA), Brotto
will recruit 66 women, aged 19-50 years old, with a history
of cervical cancer treated by radical hysterectomy within
the last five years. The research team, located at Vancouver
Coastal Health Research Institute (VCHRI) will work with survivors
to offer counseling and record feedback about sexual function.
These psychoeducational aspects of the program will be supplemented
with treatment with sildenafil citrate, known commercially
as Viagra ®.
Participants’ progress will be followed for six months
after their final session.
Cervical cancer affects the cervix or lower part of the
uterus leading into the vagina. Early stage cervical cancer
and endometrial (uterus lining) cancer is commonly treated
by radical hysterectomy -- removal of the entire uterus, adjacent
lymph nodes as well as the upper one-third of the vagina.
Many women also have both ovaries and fallopian tubes removed,
and some receive radiation / chemotherapy which may further
impair sexual function. Estrogen production stops with removal
of the ovaries, resulting in reduced elasticity of the vaginal
wall, making intercourse painful.
In addition, surgery often damages the autonomic nerves
that supply sensation to the genital area.
The psychological effects of hysterectomy can be numerous
and complex and depression is common, says Brotto. Many survivors
no longer feel like women because their genitalia have been
altered. There is often the emotional loss of being unable
to bear children. Survivors may have a different body image,
seeing themselves as dehumanized and just a medical object.
Many avoid looking in the mirror because their own body now
In addition to anxiety over their own and partners’
response or lack of it, women are also fearful about a recurrence
of cancer. Many women believe that intercourse can cause cancer
to recur or that they can pass cancerous cells to their partner,
Her new study will expand on the pilot which tested the
effectiveness of a treatment manual that contains information
and exercises to help restore healthy sexual functioning.
Brotto hopes to develop the manual so it can be used by both
women and health-care providers.
“The link between sexual health and quality of life
is well established,” says Brotto, a Michael Smith Foundation
for Health Research Scholar. “I hope this treatment
can improve women’s sexual well-being which in turn
can lead to a better quality of life for cancer survivors.”
The project has been funded by the Canadian Institutes of
Health Research, the Government of Canada’s agency for
health research. CIHR provides leadership and support to more
than 8,000 researchers and research teams in every province
BCCA, an agency of the Provincial Health Services Authority,
provides cancer care across the province.
VCHRI is a joint venture between UBC and Vancouver Coastal
Health that promotes development of new researchers and research