Treatment of sexual problems subsequent to cancer: the integration of medical and psychological approaches

Gynaecological, digestive and urogenital cancers and their invasive treatment often cause sexual dysfunction and significant psychosocial distress and quality-of-life impairment. Paradoxically, patients seldom report their sexual difficulties in routine oncological consultations. Yet communicating sexual concern remains important to patients, in general, and is still an uncomfortable topic for practitioners. Sexual disorders can express themselves through the loss of physical well-being, negative body image, impotence, vaginal dryness, dyspareunia, loss of sexual desire or arousal, and, finally, reduced sexual satisfaction. In addition, residual pain, fatigue, infertility, narcissistic injury, anxiety, and depressive disorders are symptoms that can cause the interruption of sexual activity and impair the ability to cope with the impact of cancer treatment on sexual function. An early treatment programme, involving sexual rehabilitation, must be developed as soon as possible during the first year after cancer treatment to reduce sexual difficulties. Medical and psychological support can be provided to traumatized women. Assessment of cancer-related sexual problems (specific interviews), appropriate information, physical symptom management, psychological support and follow-up, sexual counselling, brief psychosexual interventions, group therapy, structured sensate focus exercises, and vaginal dilators using water-based lubricants are some of the techniques available to alleviate the damage caused by sexual disorders. The sexual aftermath of systemic cancer treatment in women remains an important challenge for medical teams. Therefore, its treatment should be an integral part of holistic and planned care and become routine in cancer care.