Nathalie McKenzie was 30 years old and a newlywed when she was
diagnosed with breast cancer and had a double mastectomy.
of a sudden I didnít have breasts anymore," said
McKenzie, a gynecologic-oncology surgeon at University of
Florida Health Cancer Center at Orlando Health.
I am, physically, obviously disfigured. I donít feel like
putting on a sexy nightgown even as a newlywed and prancing
around my new husband."
didnít bring up her concerns with her oncologist. She felt
timid and thought of him as a father figure. And when she
talked about it with a gynecologist friend, the friend
expressed surprise that McKenzie was even thinking about sex
while going through cancer treatment.
cancer therapies have improved dramatically in the past few
decades, gaps remain in addressing long-term medical and
psychological effects of cancer and its treatments among
survivors. Intimacy and sexual function are one of the least
discussed issues in cancer care, experts say, and it could
have a significant impact on the survivorsí quality of life
think that itís a big issue for both men and women,"
said Jan Perun, a nurse practitioner who helps oversee the
Breast Cancer Survivorship Clinic at UF Health Cancer Center.
difficult to point a finger at any particular part of the
patient-provider equation for this shortfall. While
oncologists and primary care providers are busy with the
medical side of cancer, patients are many times hesitant to
bring up the issue ó as McKenzie was ó because theyíre
either shy or think that the topic pales in comparison to
is a big part of life, and if itís not, itís not, but most
of us agree that itís a big part of life, and therefore we
should talk about it," said McKenzie, who is now 41 and
has two children. "And if we donít feel comfortable
talking about it, thatís OK, but we should have handy
resources to provide to our patients to talk about it."
the National Cancer Institute and the American Cancer Society,
two of the leading cancer organizations in the country, asked
more than 2,000 primary-care doctors and medical oncologists
about how they saw their roles in providing follow-up care for
when it came to sex, both oncologists and primary-care
providers said, ĎThatís not me. Thatís not my role.í
So that right there tells you, we have a problem," said
Catherine Alfano, vice president of survivorship at American
one of the issues thatís not addressed during or after
cancer, neither by providers, nor by patients.
than 14 million cancer survivors were alive in 2014, 1.2
million of them in Florida, which ranks second in the nation
in the number of cancer survivors after California, according
to the American Cancer Society.
cancer and prostate cancer are the most common types of
cancers among women and men, respectively, followed by colon
and rectal cancer in men and uterine cancer in women.
cancers are closely tied to sexual function and body image,
but itís not clear how often the topic comes up during or
after treatment, or how many patients donít seek help.
Montanez was a 29-year-old married woman living in Puerto Rico
when she was diagnosed with cervical and uterine cancer 11
a complete hysterectomy and rounds of radiation. It was a
stressful time, and her marriage dissolved. A few years later,
she began noticing physical changes that she wasnít
expecting: Her vagina began to close off little by little,
partly because of a late side effect of radiation.
(the doctors) told me was that radiation could give me
colitis, but they said nothing about the vagina. They just
told me that I could have intercourse," said Montanez,
who now lives in Orlando.
time she ended up in Dr. Christopher Walkerís office at
UroGyn Specialists of Florida two years ago, she had to have
from surgery, there are also less invasive treatments
available ó from drugs to creams, dilators and sensors used
in pelvic-floor therapy ó that can help address many sexual
side effects that could result from cancer surgery and
radiation. But questions about sex post-cancer often go
actually have women in this office that have cried ó it is
so common ó because they cannot meet the needs of their
significant others, and theyíve tried, quote,
everything," said Perun. "There are some things over
the counter that you can use, but a lot of these side effects
are pretty overwhelming, and they require medical support and
Jamin Brahmbhatt, a urologist at Personalized Urology &
Robotics at South Lake Hospital, said men tend to be more
forthcoming about their concerns, but even if theyíre not,
"if they have a biopsy, before results come back, we
start having the conversation about treatment options. Ö The
biggest issue is when patients donít know what is going to
Michael Rothenberg, a clinical sexologist in Winter Park,
regularly counsels couples who seek help because of intimacy
issues related to cancer.
I tell people is that sex is a form of communication. And what
I do in the office is help people develop a dialogue," he
said. "Itís helping them to understand that what once
worked for them and the things they did before may not work
now. Itís about changing your mind-set. Ö You can add
things to the plate," said Rothenberg, whose national and
international lectures on sex after cancer are usually packed.
who didnít want to be identified to protect her partnerís
identity, said her fiancť waited for her for more than a year
to be sexually intimate again.
cancer diagnosis, she had a hysterectomy followed by
hesitant even after she was given a green light to have sex.
"Iím not the same person that he met a few years ago. Iíve
gained weight. I feel like Iíve aged. Iíve lost my muscle
tone. Itís taken a toll on me. But he called me beautiful
all the time."
gynecologic oncologist discussed intimacy issues with her
during treatment. "She said, ĎYou are going to be fine.í
She said, ĎGo out, have sex, enjoy life.í And she was