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Fertility and Sexuality

Women that are premenopausal and are diagnosed with breast cancer may be concerned about their future fertility. Having an open and honest conversation with your medical treatment team about your desires for childbearing is absolutely essential prior to beginning therapy.

When partners of cancer patients were polled, it was determined that complete cessation or a marked reduction in frequency of sexual activity occurred in 59% of couples. Only 19% reported that the frequency of their sexual activity returned to pre-cancer frequency. Patients often reported feeling tired and partners reported difficulty seeing the cancer patient as a partner, not a patient.1

Sexual Side Effects of Cancer Treatment

Chemotherapy can cause musculoskeletal pain, weight gain or weight loss, nausea and pain during sexual intercourse which may affect sexual desire. These conditions typically improve within one year after chemotherapy has ended.Chronic pain definitely decreases sexual desire and may be managed by a variety of medications or alternative therapy options. Some medications, particularly those with sedative properties, may further decrease sexual desire in women, especially if they are taken in the evening.

Women’s body image and lack of self-esteem can contribute to significant barriers when it comes to sexual interaction with their partners and spouses. It is important for women to feel desired after treatment to help to alleviate these concerns. Discussions with your partner, participating in couple’s counseling and group meetings can help with this very personal issue. Communication between partners or spouses is critical to addressing intimacy issues, allowing couples to reconnect sexually after treatment.

Fertility and Breast Cancer Treatment

Breast cancer treatment, including chemotherapy, radiation and hormone therapy may have an impact on a woman’s ability to conceive after therapy. Aggressive chemotherapy is linked to infertility and premature ovarian failure as a result of ovarian tissue being destroyed.

Amenorrhea, or loss menstrual cycles, is also associated with aggressive chemotherapy in younger women, which is a key factor in decreased fertility. Research indicates that preservation of fertility is dosage-dependent with chemotherapy, meaning lower doses are more likely to preserve fertility and higher doses are not.3

However, just because a woman does not ovulate, does not mean that her eggs are not viable. The most commonly used option to preserve fertility in women undergoing breast cancer is to have their eggs harvested, fertilized and stored as embryos prior to the chemotherapy. The embryos can then be implanted when therapy is complete and the woman is ready to have children. Women undergoing this procedure may require ovarian stimulation in order to harvest enough eggs. The most commonly used drugs for ovarian stimulation include follicle stimulating hormone, clomiphene and letrozole.4

Pregnancy must also be carefully planned after treatment is complete. Women need to be physically and emotionally prepared for pregnancy, especially after treatment for breast cancer. Women that are planning to have children in the future need to inform their doctor or cancer treatment team as early as possible.5

References

1 Hawkins, Y., Ussher, J., Gilbert, E., et al. (2009). Changes in Sexuality and Intimacy After the Diagnosis and Treatment of Cancer: The Experience of Partners in a Sexual Relationship With a Person With Cancer. Cancer Nursing , 271-280.

2 Ganz, P. A., Kwan, L., Stanton, A. L, et al. (2011). Physical and Psychosocial Recovery in the Year After Primary Treatment of Breast Cancer. Journal of Clinical Oncology , 1101-1109.

3 Maltaris, T., Weigel, M., Mueller, A., et al. (2008). Cancer and fertility preservation: Fertility preservation in breast cancer patients. Breast Cancer Research .

4 Sonmerzer, M., & Oktay, K. (2006). Fertility Preservation in Young Women Undergoing Breast Cancer Therapy. The Oncologist , 422-434.

5 Gerber, B., Dieterich, M., Muller, H., et al. (2008). Controversies in preservation of ovary function and fertility in patients with breast cancer. Breast Cancer Reserach and Treatment , 1-7.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.