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	Sexuality - Cancer Survivors and Older Adults Ernest H. Rosenbaum, MD

Sexuality can be expressed in many ways--in how we dress and how we move and speak, as well as by kissing, touching, masturbation and intercourse. Changes in body image, tolerance for activity and anxieties about survival, family or finances can strain the expression of sexuality and can create concerns about sexual desirability. But if you were comfortable with and enjoyed your sexuality before your illness, the chances are excellent that you will be able to keep or regain a good sexual self-image despite any changes brought about by cancer. Cancer affects all aspects of your life. So it's not surprising that it can affect your sexual feelings and the ways you express those feelings. You and your spouse or partner remain sexual beings and may have much the same needs and desires as you had before the illness struck. Cancer treatment often affects hormone production and balance. Loss of menstrual periods (early menopause) may occur suddenly, as well as hot flashes, vaginal dryness, pain with sexual intercourse, fatigue, depression, and sleeping problems.1 A decrease of testosterone in men is associated with mild depression and often a loss of interest in sex and erectile problems.2 A discussion with your doctor is merited, as often these problems can be ameliorated with treatment. An endocrine consultation can be helpful. Dysfunction Sexual dysfunction is common, often due to fatigue, psychological despair and distress in patients receiving cancer therapy and needs assessment. Often, a discussion with patient and partner can be helpful in addressing sexual dysfunction problems. Changes, both emotional and physical, such as altered body image (mastectomy), gynecologic surgery and radiation (pelvic/vaginal)3,4 which can alter one's sexual feelings and function, merit review and consultation. Sex and the Elderly The sex life of elderly adults is another facet of their lives that is vulnerable to neglect. There is emerging evidence that older adults continue to have sex despite an age-related increase in the sexual dysfunction of both genders.5 It is important to note that the elderly are still at risk for contracting sexually transmitted infections. There are also specific legal statutes addressing the sex lives of the elderly in care homes that must be studied. Despite this risk, many physicians omit discussions with seniors about their sex life and many family members shy away from what can be an uncomfortable topic. 6,7 Conclusion Many people dealing with an illness, find that being sexually active is not important to them to maintain a loving, intimate relationship. This can be a healthy, normal choice for any individual or couple. However, the loss of interest may be transient for others, and they may be quite distressed either by their loss of libido (sexual interest) or by their inability to respond or perform sexually as they had in the past. If sexual intimacy has been a joy and comfort to you, you may want to resume or continue being sexually active even after your cancer has been diagnosed and has been treated or is being treated. This may require some adaptation of your normal sexual patterns, and it might be a challenge to change them. Make a point of sharing your concerns with your partner: he or she wants and needs to help sort out the problems. You may also need specific information and guidance from your doctor or a sex therapist. Don't be shy: take the initiative and ask your doctor any questions you have about your sexuality. Seek referral to a sexual counselor if needed. You can overcome many problems, reduce tensions and get much more sexual satisfaction. Intimacy does not require sexual intercourse but can be the closeness the survivor feels with someone he/she loves and cares about. It is a balance of personal feelings and hopes, and provides ways for closeness and love. References 1 Schultz PN, Klein MJ, Beck ML, Stava C, Sellin RV., Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors. J Clin Nurs. 2005 Feb;14(2):204-11. 2 Karakiewicz PI, Bhojani N, Neugut A, Shariat SF, Jeldres C, Graefen M, Perrotte P, Peloquin F, Kattan MW., The effect of comorbidity and socioeconomic status on sexual and urinary function and on general health-related quality of life in men treated with radical prostatectomy for localized prostate cancer. J Sex Med. 2008 Apr;5(4):919-27. 3 Montazeri A., Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. J Exp Clin Cancer Res. 2008 Aug 29;27:32. 4 Katz A., Interventions for sexuality after pelvic radiation therapy and gynecological cancer. Cancer J. 2009 Jan-Feb;15(1):45-7 5 DeLamater J, Hyde JS, Fong MC., Sexual satisfaction in the seventh decade of life. J Sex Marital Ther. 2008;34(5):439-54. 6 Zagaria,MAE., Sexual Activity and STDs Among Seniors, US Pharm. 2008;33(8):28-30 7 Kuehn BM., Time for "the talk"--again: seniors need information on sexual health. JAMA. 2008 Sep 17;300(11):1285-7.

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