SINGAPORE - As clinical sexologists, we help people with concerns or problems with their sexuality.
Although sexual medicine is a broad field that addresses the impact of general health on the quality of relationships, gynaecological cancer poses a clinical challenge that is not often discussed.
The roller-coaster sequence of sexual problems starts from the time of initial symptoms and diagnosis and continues even after cancer treatment such as surgery, radiotherapy and chemotherapy.
Whether we like it or not, all these events take a toll on the physical intimacy and, eventually, the sexual and overall quality of daily life.
It takes a brave heart and coping strategies to deal with the emotional exhaustion during this period.
For most patients, sexual interest wanes completely.
In the words of Mrs J, 47: "My life turned upside down not only from the detection of cervical cancer but also from the emotional impact. Sex was nowhere in my thoughts at that time."
With the help of a caring partner, she started feeling more "normal" after three years and is now ready to return to her daily routine as much as possible.
She and her partner realised that no matter how much they tried to downplay the importance of sex and, instead, focus on other aspects of their relationship, they missed it as an integral part of a healthy married life.
However, the variety of effects related to cancer and its treatment (such as fatigue, swollen limbs and fear of pain) had made it more difficult to rekindle Mrs J's sexual interest. She was silently dreading discomfort, pain and bleeding.
The nagging thought of a possible relapse of her cancer was also equally traumatising.
She is not alone.
About 60 to 70 per cent of women with gynaecological cancer suffer from sexual and psychological problems while their partners experience indirect psychological and sexual concerns.
While most of our patients think that some pain during attempts at sexual intercourse is normal, others are too embarrassed to talk to their gynaecologists or may not know how to raise this topic to them.
"I was completely shut off physically for three years and I am still recovering from that," said Mrs J when I first spoke to her.
Indeed, she seemed unsure if she was ready for a normal life again.
It appeared that the condition affected her emotionally more than it did physically.
After an in-depth discussion, she came to understand that there was no quick-fix solution to the problem.
She realised that more time was needed to work on a comprehensive programme which includes behavioural and psychosexual therapy, along with counselling sessions.
It was even more difficult for Mrs S, a 62-year-old woman with endometrial cancer, which affects the lining of the uterus.
After surgery, chemotherapy and pelvic radiation, she had additional issues to handle such as bladder and bowel irregularities as well as vaginal narrowing (having a constricted vagina).
These resulted in a tendency to avoid not only physical intimacy but also anything remotely sexual.
A multi-pronged approach had to be taken. This comprised counselling for the couple and specialist help for the specific issues faced by her.
Along the way, she found that the counselling helped her and her partner to better understand the cancer and the effects related to its treatment. The move also fostered mutual support within the relationship and helped her to develop skills in coping as well as in problem-solving.
Sex therapy helped her to revive and recreate sensual pleasure.
Psychotherapy was particularly effective in addressing her concerns about body image and in helping her cope with anxiety, depressive thoughts, physical or emotional stress and fatigue.
Her symptoms of dryness and pain significantly improved with the proper use of a vaginal moisturiser and a water-based lubricant, which also aided in vaginal lubrication.
After a few setbacks, she is now convinced that her quality of life is improving.
With the current advancements in early detection and timely treatment of the disease, many patients with gynaecological cancer are returning to normal lives with an expectation of long-term survival.
Ensuring that their quality of life is restored is a major responsibility for health-care professionals like us.
Women may also need some help to rebuild the damage done to their confidence, self-esteem and psyche.
Sexual function is a complex phenomenon and much of it involves the influence of the mind over the body.
As clinical sexologists, we take into consideration how long the couple have avoided sexual contact before seeking help, their level of motivation in resuming normal sexual life, their desire for physical intimacy, the quality of their non-sexual relationship, among other factors.
Together, we aim to help the couple nurture a cordial ambience that will both physically and psychologically prepare them to be "normal" with each other once again.
Dr B Srilatha runs the female sexual dysfunction clinic at the National University Hospital Women's Centre and is a full-time researcher in sexual medicine at the department of obstetrics and gynaecology at the Yong Loo Lin School of Medicine at the National University of Singapore.
A free public forum on Cancer & Sexuality will be held this Saturday, 12.30pm to 4.30pm, at NUHS Tower Block, Level 1 Auditorium, 1E Kent Ridge Road.
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