The World Health Organization defines sexual health as, “…a state of physical, emotional, mental, and social wellbeing in relation to sexuality.”(1) The definition goes on to discuss the importance of consent, safety, and an opportunity for pleasure in examining sexual wellbeing.

Pebble Kranz, MD, FECSM, IF, MSCP, is a Sexual Medicine and Menopause Medicine Specialist and founder of the Rochester Center for Sexual Wellness. As a leading expert in our community, she focuses on prioritizing sexual wellbeing and addressing sexual health concerns for her patients. Dr. Kranz is a member of the Breast Cancer Coalition’s Advisory Council and is a strong advocate for the breast and gynecologic cancer survivor community.

When it comes to sexual health and wellbeing, Dr. Kranz explains that changes in sexual experiences throughout an individual’s life are expected. However, a diagnosis such as gynecologic cancer, and the subsequent treatment, have the potential to impact one’s sexual wellbeing at a much more sudden and destabilizing rate. “The sexual impact is largely in relationship to the treatments, not in relationship to the disease,” she elucidates.

With such concerns arising from gynecologic or breast cancer treatment (or treatment for other types of cancer), Dr. Kranz affirms that there are steps to take to address an individual’s needs: “Bottom line is, no matter where somebody is in their cancer experience, there is something to be done about improving their pleasure in their body.”

Sexual Concerns Following Cancer Treatment

According to Dr. Kranz, every type of cancer treatment has the potential to affect sexual function. Surgery can impact sexual function and sensation; for individuals who have a mastectomy, they may lose nipple sensation or sensation around the breasts. For those diagnosed with gynecologic cancer that requires surgery in the pelvis, Dr. Kranz explains that this can impact blood flow, nerve supply, and muscle function. Chemotherapy can impact sexual function, often through hormonal suppression. Radiation can cause contractures (tightening) of the skin, which includes the skin of the vaginal canal. Immunotherapies can also have impacts on the skin.

In addition to these direct effects from cancer treatments, an individual may be prescribed medications to address such effects that also cause sexual function concerns on a secondary level.

The top sexual concerns that patients report to Dr. Kranz during or after treatment for gynecologic and breast cancers are overall vulvar and vaginal dryness, decreased arousal, and sexual pain. Following these are concerns with desire, motivation, interest in or willingness and receptivity to sexual play, and changes in sensation and/or orgasm. Disruptions to the digestive system and urinary issues caused by treatment can also impact an individual’s desire for sex or intimacy.

Dr. Kranz emphasizes that a primary concern that needs to be addressed first – if present – is sexual pain, sharing, “If somebody is having pain with sexual play, we must deal with that. Pain is not expected in any aspect of our sexual play.”

There are a variety of ways to address pain and other concerns depending on one’s needs, including medical interventions, relational therapies, or individual sex therapy. No matter the sexual concern that someone is presenting with, Dr. Kranz advises self-advocacy.

“My recommendation is if somebody has a concern that is persistent, my advice is to continue to seek care until you get that concern addressed. It’s not a problem with you and your body; it’s a problem with the care that you’ve been able to access thus far.”

Focusing on Body Compassion and Healing

Treatment for gynecologic or breast cancer can result in both internal and external changes. With these two types of cancer in particular, some female-identifying patients may have struggles with connecting with their bodies, especially since these cancers affect organs that are often representative of their gender. The removal of a breast(s) or a hysterectomy, for example, can impact one’s sense of identity. This in turn may impact one’s sexual wellbeing.

“Our relationship with our sexuality starts with our relationship to our own bodies and how we feel in our bodies,” Dr. Kranz explains. After undergoing cancer treatment that can be incredibly invasive, it can be challenging to create a new compassionate relationship with one’s body. Dr. Kranz encourages a gentle exploration of what feels good in one’s body now, following treatment, realizing that it may look different than what felt good previously.

“Sexual flexibility, in this regard, is a key element of healing,” she notes. “Allowing time to mourn sexual changes and losses while also discovering new ways of experiencing pleasure is a process of continual exploration.”

Fortunately, Rochester and the surrounding region have incredible resources for anyone who is experiencing sexual concerns. The Rochester Center for Sexual Wellness (rochestercenterforsexualwellness.com), along with a strong community of certified sex therapists in the area, offer help and ways of finding connection once more to one’s body.

As a final note, for those who are in menopause (whether due to cancer treatment or the natural life cycle), Dr. Kranz will soon be offering a group featuring elements of Cognitive Behavioral Therapy (CBT), which is an evidence-backed non-hormonal alternative to addressing hot flashes.

Sexual wellbeing looks different for everyone, and it will likely be different for every individual following treatment for gynecologic, breast, or other types of cancer. The Breast Cancer Coalition remains dedicated to representing the whole person and their experiences from diagnosis through survivorship. With gratitude, we thank Dr. Kranz for supporting our survivor community and for advocating for healing, pleasure, enjoyment, and presence in our bodies.

1  https://www.who.int/health-topics/sexual-health