Seminars Article
Barriers to sexual recovery in women with urologic cancers

https://doi.org/10.1016/j.urolonc.2020.11.011Get rights and content

Abstract

Sexual health concerns are prevalent and distressing in oncology patients and survivors. While urologic cancers are more prevalent in men, women often have more advanced disease at initial diagnosis, require more advanced surgical resection, and experience higher postoperative complication rates, as well as morbidity and mortality. Women with urologic cancers undergo treatment that is highly likely to impact their sexual function and well-being, however, attention to sexual recovery in this patient population has been limited. Barriers to sexual recovery in women with urologic cancers are biopsychosocial in nature and include complications related to treatment procedures, cancer-related distress, sexual anxiety and avoidance, partner and relational dynamics, and sexual communication skills. Healthcare providers do not adequately address sexual difficulties for these patients and their partners. Sexual minority women and transgender patients with urologic cancer have unique psychosocial and sexual health needs though, due to a lack of research, these remain poorly understood. More research is needed to pinpoint the sexual health needs of this specific oncology population and to explore how various treatment options, such as pelvic organ-sparing cystectomy, can impact sexual health outcomes. Evidence-based and multidisciplinary oncologic and survivorship care, which includes licensed mental health providers, certified sex therapists, and other sexual health experts, is essential for assisting women in their sexual recovery following urologic cancer.

Section snippets

Impact of treatment on sexual function

Treatment for urologic cancers may directly result in a number of challenging sexual side effects for cisgender women [12,20]. Surgical procedures and other treatments that affect the pelvis can cause pelvic floor tension myalgia and dyspareunia [21]. In the case of radical cystectomy, removal of a portion of the vaginal wall can create a shortened vaginal vault and the potential for fistulas and pelvic organ prolapse [12]. As a result, patients are at increased risk of pain during penetrative

Psychosocial considerations

Psychosocial stress is a barrier to sexual health [30,31] and is common, if not predictable, in the face of a major life stressor like cancer. Cancer-related distress encompasses psychological, social, spiritual, and physical concerns that impact a person's ability to cope with their disease and the consequences of treatment [32]. Individuals with urologic cancers demonstrate notable anxiety, depression, and post-traumatic stress [33], [34], [35], which can persist well after treatment [36].

Lesbian, gay, bisexual, queer, and transgender patients

Health disparities have been increasingly documented between heterosexual and SGM populations. This includes increased cancer risk for SGM individuals who, compared to the heterosexual population, are more likely to have elevated rates of tobacco and alcohol use. SGM individuals have reduced rates of healthcare coverage, and are also less likely than their heterosexual and cisgender peers to seek preventive and routine healthcare due to harassment and discrimination from healthcare systems and

Barriers in healthcare

For many women, emergent sexual concerns during cancer treatment tend to persist, and even worsen, in survivorship. Embarrassment and shame often lead to patient reluctance to disclose sexual health concerns and, though patients express a preference for their healthcare providers to initiate sexual health conversations, few oncologists routinely do so [67], [68], [69], [70], [71]. Regarding urologic cancers, Gupta et al. [72] found that urologists performing radical cystectomy did not routinely

Clinical implications

Difficulties with sexual recovery after urologic cancer are likely to be present across biopsychosocial domains, including physiologic and anatomical changes in functioning, psychological adjustment, and relational challenges (see Table 1). In order to appropriately and effectively address these myriad domains, it follows that multiple aspects of sexual health must be routinely assessed and sexual rehabilitation must be multidisciplinary [69,78,79]. From a medical and physical standpoint,

Conclusion

Sexual health concerns are highly prevalent and distressing for oncology patients and survivors. Cisgender women with urologic cancers may be at especially high risk, given that treatment options are likely to directly and indirectly disrupt sexual functioning. More research is needed to pinpoint the sexual health needs of this specific oncology population, including SGM patients, and to explore how various treatment options, such as pelvic organ-sparing cystectomy, can impact sexual health

Conflicts of interest

None.

Acknowledgments

No other persons have made substantial contributions to this manuscript.

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