I recently did an episode (number 240) on my “You Are Not Broken” podcast with Dr. Laila Agrawal, a medical oncologist who specializes in sexual dysfunction after cancer, a critical but highly overlooked topic.
In the episode, Dr. Agrawal discusses how she first became interested in this field – a patient’s distress over the loss of libido after cancer treatment inspired her to learn more, as medicine rarely prioritizes female sexual pleasure.
Here are the highlights of our conversation:
- Breast cancer treatment can profoundly impact sexuality in biological, psychological, and social ways. Understanding each facet is essential. Surgery, radiation, chemo, and hormone therapy all have sexual side effects. Body image issues and relationship challenges often emerge, too.
- Despite fear and urgency around diagnosis, there IS time to thoughtfully consider surgical options like mastectomy vs lumpectomy and weigh impacts on sensation and body image. Removing unaffected breast tissue does NOT improve cancer survival rates or reduce recurrence risk.
- Vaginal estrogen is considered safe for most breast cancer survivors and can effectively treat genitourinary issues like dryness, pain, and libido. Those on aromatase inhibitors require nuanced risk/benefit conversations first. Vaginal DHEA can be an alternative. The American Congress of Obstetricians and Gynecologists has a position statement on the use of vaginal estrogen after treatment for breast cancer.
- For low desire, non-hormonal medications like flibanserin and bremelanotide can help in some cases, but sex therapy and addressing lifestyle factors should come first. Pelvic floor physical therapy is also hugely beneficial for many.
Maintaining sexual health should be a standard part of cancer care.
Patients have a right to ask questions and get help. As Dr. Agrawal said, every cancer center could someday have sexual health resources built right in. Her dream (which I now share) is that, eventually, every person with cancer will have access to this support. With experts like her paving the way, I hope we continue moving closer to making that a reality.
