Breast cancer and sexuality, three messages for doctors and patients
After cancer, more than one in two women (57%) experience pain during sexual intercourse, and a quarter report a decrease in desire. Problems associated with genitourinary syndrome (the so-called vaginal dryness caused by therapy-induced premature menopause), recurrent cystitis, insomnia, tiredness and even psychological stress that leads to a sense of apparently unmotivated sadness.
The data are those collected by the “Sex and The Cancer” listening desk, a psychological and medical orientation project dedicated precisely to sexuality after cancer, created by a former cancer patient, Amalia Vetromile, now president of the Mamanonmama association.
The survey, presented at the end of October at a conference in Rome entitled “What women don’t say”, involved around 1,400 women between the ages of 45 and 55 from every part of Italy.
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The integrated sexology model
If there is a positive fact, however, it is that both the awareness of women and the sensitivity of doctors and other professionals who deal with the well-being and rehabilitation of patients are increasing. There is still a long way to go, it’s true, but sexuality after cancer is being talked about more and more. So much so that at the last International Congress of Psycho-Oncology, promoted by the University of Milan, an entire session was dedicated to integrated sexuality in oncology.
What is it about? “Integrated sexology is an approach which, as the word suggests, brings together the skills of several specialists, in particular gynecologists and psychotherapists, with ad hoc training, to offer patients the possibility of returning to a normal emotional life – he answers Viviana Galimberti, director of the Senology Division and of the Women Cancer Center of the European Institute of Oncology (IEO) in Milan, a true “women’s house” which includes various clinics, including that of Integrated Sexology – Cancers of the breast and gynecological ones have many aspects in common, especially regarding the perception of femininity and sexuality. It should also be remembered that approximately 15% of breast cancers currently affect women under 40, who must therefore face early menopause. This clinic and this approach are a consequence of the progress made in recent years, which allow us not only to increase survival, but to take charge of life after cancer as a whole.”
Who is the sexologist?
In this vision, in which body and mind cannot be separated, who is the sexologist? And what does he do, exactly? “There are two distinct figures: the sexologist consultant and the sexologist therapist, as if they were two levels – he replies Eleonora Preti, gynecologist at the Women Cancer Center specializing in pathologies of the lower genital tract – the first is the counselor, who can be a doctor, a psychologist, a nurse, a midwife, a physiotherapist and so on – trained to provide information and educate patients – and this alone solves most of the problems. The second does actual therapies, and can be a doctor or a psychologist.”
A taboo for many doctors
Unfortunately, however, patients often do not know who to turn to and are not even prepared for the effects of anti-cancer treatments on sexuality. According to literature data, in fact, just 15% of oncologists ask specific questions to their patients.
How to overcome the impasse? “An oncologist may not know how to treat sexological symptoms, because it is not his expertise, but he can certainly provide information on the side effects of the treatments he prescribes-comments Ludovica Scotto, psychologist, psychotherapist and sexologist at the Women Cancer Center – After starting treatment, you can also ask very simple questions to check for symptoms or discomfort in the sexual sphere. Already in itself, this openness to communication legitimizes the woman to talk about it, and relieves her from the sense of guilt that she almost always takes on for bringing a further problem into the couple – or into her own life if she is single”.
The questions to ask yourself
Asking questions about sexuality, however, may not be as simple as you think, he reflects Florence Didierpsycho-oncologist at the IEO: “It is also normal for doctors or psychologists to feel embarrassed and uneasy when dealing with this topic. First of all, therefore, one should be trained to deal with the topic of sexuality in a natural way with patients. I am It is precisely the information, and specific training, that help to overcome embarrassment. There are also models for communication that facilitate dialogue. Why we, the doctors, should always be the ones to take the first step, to give patients ‘permission’ to talk about it , because we are the experts.”
Three messages to keep in mind
At the basis of everything there are three important messages to get across: that sexual problems linked to cancer, surgery and drugs are very frequent; which today can be addressed with an integrated approach that combines different therapies – physical, pharmacological or psychological, which can also be for couples; and that the sooner you can talk about it, the sooner you can intervene, the sooner (and better) you can recover sexual well-being.
