An Exploration of the Sexual Side Effects of OB-GYN Cancer Treatment

OB-GYN cancer treatment can lead to long-lasting side effects that can impact patients’ sexual health, but learning more about strategies to manage these side effects can help patients improve their sexual function. And that’s exactly what the “Managing the Sexual Side Effects of Cancer Treatment: Help Your Patients Get Their (Sex) Life Back” session explored at the 2021 ACOG Annual Clinical and Scientific Meeting.

Presented by Dr. Kristin E. Rojas, Assistant Professor Surgery at the Dewitt Daughtry Department of Surgery at the University of Miami Miller School of Medicine, this session explored the quality-of-life consequences with improved female OB-GYN cancer outcomes, with a focus on sexual health issues; screening and treating sexual health and other survivorship issues that arise during and after treatment; and best practices for managing common sexual side effects in the context of preventing cancer recurrence for further morbidity.

In this session, Dr. Rojas focused on a few crucial components to managing the sexual health of patients who have or had OB-GYN cancer, including recommended moisturizers and lubricants, what to do when sex is painful, and hormonal treatment options.

She broke down her recommendations into a few simple steps:

Step 1: Eliminate Irritants

While companies try to convince women that they need feminine hygiene products to deal with the natural smells and discharges of their vagina, Dr. Rojas argues that that’s not the case, especially for cancer patients. She recommends the following:

• Avoid any products with fragrances, dyes, parabens, and long-name chemicals
• Avoid any of “trendy” treatments, such as vaginal steaming, a vaginal “detox,” vaginal garlic, tea tree oil, yogurt, feminine washes, and especially jade eggs, as they can worsen pelvic floor muscle dysfunction
• Avoid using any type of soap on the vagina
• Limit the amount of interaction with detergent, bubble baths, toilet paper, panty liners, and tampons
• Encourage patients to spend time without underwear to help prevent infection

Step 2: Moisturization for Maintenance

Moisturization and lubrication are not the same thing. In order to help improve sexual health, Dr. Rojas recommends incorporating a daily moisturization routine. Here are a few of her suggestions:

• Moisturize every night after showering
• Start with a single-ingredient coconut oil before trying a vitamin E suppository, hyaluronic acid, or lactic acid
• Avoid any petroleum-based products, as they can degrade the latex in condoms
• To avoid post-coital urinary tract infections, she recommends taking a single-use nitrofurantoin, an antibiotic to treat bacterial infections

Step 3: Lubrication of Sexual Activity

Vaginal dryness and thinning of the vaginal walls are both common side effects that come from chemotherapy and radiation. Dr. Rojas highly recommends lubrication to avoid pain and discomfort during sexual activity. But she encourages patients to keep a few key considerations in mind when choosing a lubricant:

• Avoid any lubricant that is flavored, is warming, etc.
• She recommends a water-based lubricant because it doesn’t stain sheets, is good for silicone toys, and is safe to use with condoms
• A silicone-based lubricant has benefits, as well; it’s safe for condoms and doesn’t need to be reapplied as often as a water-based lubricant
• An oil-based lubricant, such as vitamin E oil, olive oil, or coconut oil, while effective, can be messier than traditional lubricants, and as mentioned previously, can degrade the latex in condoms

Step 4: Other Recommendations

Outside of the areas previously mentioned, there are a few pieces of information Dr. Rojas recommends sharing with your patients to help improve their sexual health, including:

• Referrals: Depending on the specific issue the patient is having, referring them to a urogynecologist for prolapse or incontinence or physical therapist for pelvic floor therapy can help your patients take big steps towards improving their sexual health

• Moisturize early: Early moisturizing can help prevent issues such as dryness from escalating into more permanent problems
• Screen for STDs: An underlying sexually transmitted disease may be the source of your patients’ sexual health concerns, so early screening is highly recommended

Vaginal hormones may play a role in managing these symptoms. The vagina can shorten and narrow with cancer treatments such as chemotherapy, immunotherapy, or radiation, and vaginal hormones and dilators can help make sex possible for patients. Some recommended treatments include vaginal estrogen, vaginal androgen, intravaginal dehydroepiandrosterone, or vaginal testosterone.

The recommendations to help treat dryness and alleviate painful sex are not just for breast and gynecological cancer patients.

• In lung cancer patients: focusing on vulvovaginal health, intimacy, and positioning can help minimize dyspnea
• In colorectal cancer patients: hormone replacement therapy can be beneficial in young survivors, as well as dilators and pelvic floor therapy after radiotherapy, or XRT
• In adolescent and young adult (AYA) cancer patients: Education early on about lubricants and safe sex practices can help prevent side effects such as these
• In sarcoma patients: Managing patients’ surgical mobility can help make sex functional and improve intimacy without penetration

But most importantly, Dr. Rojas encourages oncologists to start the conversation with their patients as soon as possible to clarify misconceptions, validate concerns, and share management strategies to help patients improve their sexual health.