The Who’s Who of Sexual Health in Survivorship

by Marloe Esch RN, BSN, OCNSurvivorApril 22, 2022View more posts from Marloe Esch RN, BSN, OCN

The Who’s Who of Sexual Health in Survivorship: Building a Sexual Wellness Recovery Team

Disclaimer: This information is not a substitute for medical care. Always inform your healthcare team of any concerning symptoms you are experiencing, and consult with your provider before starting new treatments, therapies, or health routines.

Changes in sex, intimacy, and relationships are common after cancer.  But if you are experiencing an issue, it can feel pretty lonely, and you may not know who to ask for help. Your primary care or oncology care teams are always a good place to start. After all, sexuality is just another aspect of survivorship care (and health in general), and most clinicians are happy to have these conversations (although you might have to be the one to bring it up!).

Sometimes, though, problems are best addressed by a professional with sexual health-related expertise. If this is the case, your primary care or oncology care team may offer a referral to one or more appropriate specialists, depending on your specific concern. Let’s take a look at some of the different players that can contribute to your sexual wellness recovery team of experts.

Specialty Medical Care 

Doctors, advanced practice providers such as nurse practitioners (NPs) and physician assistants (PAs), and nurses can work in specialized areas of medicine that address different aspects of sexual health, including endocrinology, reproductive system specialties, and urology.

Endocrinology

Endocrinology is the branch of medicine that deals with diagnosing and treating endocrine system disorders. Glandular endocrine organs throughout our bodies secrete chemical messengers (hormones) that regulate a multitude of different body processes, including reproduction and sexual functioning. For example, parts of our brain (the hypothalamus and pituitary gland) make hormones that tell our ovaries or testes to produce estrogen and testosterone, which play a role in various aspects of sexuality. Cancer treatments can disrupt this process and alter levels of these sex hormones, which may affect sexual desire, physical arousal, and fertility.

Alterations in the function of other endocrine glands can also impact sexual functioning. For example, hypothyroidism and adrenal insufficiency in survivors can contribute to problems with sleep, fatigue, and lack of energy, which may indirectly affect sexual desire and function. Endocrinology specialists can assess for and help manage many of these issues.

Gynecology and Andrology

These are specialties that focus on diagnosing and treating problems of the reproductive system. Gynecologists are experts in medical care for people with female reproductive organs and physiology, and commonly care for women throughout their lifespan. The lesser-known specialty of andrology is concerned with medical care for people with male anatomy and physiology. Andrology is sometimes considered a specialty of urology (see below).

Soapbox alert: These sex-specific specialties raise an important debate about what being male or female actually means, which requires a bit of reflection. Adhering to the conventional idea of biological sex as a male/female binary can be problematic, because it’s actually not accurate. Check out the section titled “Sex is a Spectrum, Silly!” to learn why.

Urology

Providers who specialize in urology focus on the medical and surgical care for urinary system disease and dysfunction. Because of the anatomical proximity of the urinary tract to the reproductive organs and genitalia, symptoms or problems can be related. Urologists often deal with male sexual health concerns, and urogynecologists combine female reproductive and urinary tract care.

Pharmacists

With all of the medications that may have been part of your cancer treatment and symptom management plan, it’s possible that you already have a great relationship with your pharmacist! Pharmacists are experts in medication use, drug interactions, and side effects. Don’t be afraid to ask if a new medication could impact your sexual function or be responsible for symptoms you might have developed since starting it. Sexual side effects can occur with some medications, and your pharmacist is a good resource for determining if this is a possible cause for your concerns. They may also be able to help you talk with your provider about alternative options. You can also ask questions about over-the-counter (OTC) medications and supplements.

Pelvic Floor Physical Therapy

This specialty area of physical therapy focuses on the rehabilitation and health of your pelvic floor muscles, which are important for sexual function and response. Some of the challenges that a pelvic floor PT can work with you to address include sexual pain, orgasm or ejaculation issues, and problems with incontinence (loss of control of bowel or bladder function). These professionals are often a critical piece of the sexual wellness rehabilitation puzzle after cancer!

Psychosocial Care

Sexuality Counseling

Sexuality counseling is a problem-specific, solution-focused approach to addressing sexual challenges that may arise as a result of changes in health, illness, aging, or other life circumstances. Counseling aims to improve sexual wellness and function through assessment, education, strategic goal-setting, and incorporating specific suggestions into your plan of care. Professionals providing counseling will work with you to identify your needs and priorities, and to implement practical strategies to achieve desired outcomes.

Any of the professionals listed above may provide sexuality counseling as part of their care, within their scope of practice and role responsibilities. Clinicians often integrate different sexuality counseling techniques into health visits like pelvic floor PT consultations, nursing education sessions, treatment follow-up appointments, or survivorship clinic encounters. They may also offer one-on-one counseling sessions that focus on addressing a specific sexual issue. Examples of topics that sexual counseling can address include contraception and safer sex practices, partner communication, intimacy, sexual pleasure, practical guidance for adapting to physical changes, and more.

Sex Therapy

Sometimes sexual challenges can be pretty complex. They may coincide with struggles such as anxiety or depression, substance abuse, significant conflict in your relationships, or sexual trauma and violence. Sometimes, treatments for cancer can trigger post-traumatic stress symptoms, significant grief over cancer-related losses, or negative changes in body image or self-concept. If these experiences resonate with you, or if you have tried sexuality counseling but have not seen an improvement, you may be best served by working with a licensed mental health professional. Sex therapists are licensed therapists with specialized training in treating sexual issues and all of the complicated components that can contribute to them.

Clinicians may choose to become certified in sexuality education, counseling, or therapy through a professional organization (such as AASECT). Certification requires additional training in sexual health competencies and skills beyond what is needed for their professional role.

Your Partner, and You!

Partners can also be a valuable part of your sexual wellness recovery team. If you are currently partnered, enlist their help and support! Because of their unique perspective, partners make great advocates and allies when discussing sexual concerns with professionals, and can be actively involved in problem-solving and implementing any plans of action to help you get your sex life back on track.

And last but not least, you! As the expert of your own body, your health care team counts on you to share with them what your experiences, concerns, and priorities are, and what you most need from them to achieve a state of health and well-being.

For tips and tricks on communicating about sex (with both partners and providers), check out a past article from Elephants and Tea titled Speaking of Sex: Be H.E.A.R.D.!”

Bottom Line

There are lots of people available to help answer questions and provide guidance regarding sexual concerns. A team approach is helpful, since different professionals will bring unique skills and expertise to the table. Some cancer centers offer multidisciplinary sexual health services as a part of their survivorship or quality-of-life clinics. If that’s not the case where you get your care, ask your provider to help you build your own!

Sex is a Spectrum, Silly!

Contrary to popular belief, determining a person’s sex is not as easy as checking “male” or “female” on a form. Biological sex is actually a complex interplay between several factors, including an individual’s chromosomes, hormonal makeup, internal reproductive organs and external genitalia, and other secondary sexual characteristics (like breast development or body hair patterns, for example). All of these components exist on a continuum and, taken together, determine where on the spectrum of biological sex a person lands.

Ignoring the natural diversity and variation of biological sex (and gender) can alienate individuals whose bodies and identities do not fit into these inadequate either/or categories (whether they identify as intersex, transgender, agender, genderfluid, nonbinary, or others). Finding a provider knowledgeable about and welcoming of diverse bodies and identities can be a difficult and frustrating experience. For help locating a provider, visit these following resources:

Curious to learn more? Check out Amanda Montañez’s visual representation of the sex spectrum in her article for Scientific American. Also, for some artsy exploration on the subject, check out Heather Edwards, a pelvic floor PT and AASECT certified sexuality counselor who creatively celebrates and elevates the beautiful diversity of human bodies as the author/illustrator of several volumes of Coloring Books for the Crotch Enthusiast. Box of crayons encouraged!

Bibliography/Resources:

This article was featured in the 2021 December Grief issue of Elephants and Tea Magazine! Click here to read our magazine issues.

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