Matthew Miller, MD
What is it?
Being diagnosed with and treated for a cancer of the head and neck may result in difficulty being physically and/or emotionally intimate. These issues may be compounded by the fact that, given their sensitive nature, they are not often discussed during visits with the head and neck cancer care team.
How common is it among head and neck cancer patients?
As many as half of all patients treated for head and neck cancer will experience some form of sexual dysfunction after treatment. Of these, the vast majority report that they have a decreased interest in sex and decreased sexual enjoyment. Dry mouth can have a substantial effect upon physical intimacy. Over 65% of long-term survivors will experience moderate to severe dry mouth symptoms after head and neck radiation. In addition, up to 20% of patients treated with radiation to the skull will also have reduced pituitary gland function – which can also lead to physical problems with sexual performance.
What are the signs/symptoms?
The most common issue is decreased interest in sex. Depression, fatigue, poor self-image, and anxiety are often present and may contribute. In addition, many patients with Human Papillomavirus (HPV)-related tumors are fearful of transmitting the virus to their partners. As a result, most patients will experience a reduction in the frequency of sexual activity after treatment. Physically, dry mouth can make kissing and oral sexual behaviors more difficult and less pleasurable. Issues such as reduced libido, changes in menstrual cycles, hot flashes, vaginal dryness, and erectile dysfunction may be present in the context of pituitary gland dysfunction.
How is it diagnosed?
The key to identifying these issues is to tell your doctors when they occur. Over 2/3 of patients with these issues do not ever discuss them with their head and neck cancer doctors. Your doctor may use questionnaires to identify which physical and psychological factors may be contributing to the issues that you are experiencing and to what extent they are playing a role. If there are signs of pituitary dysfunction, you may undergo blood testing as well.
How is it treated?
Psychological and emotional concerns related to sexuality can be treated using a number of different counseling and sex therapy techniques. Your doctor may refer you to a specialist for this. Medications can be used to improve dry mouth symptoms. If you have a pituitary gland disorder, hormone therapy is often used and is typically under the direction of an endocrinologist (hormone specialist)
When should I call my doctor?
If you are experiencing any significant personal or relationship distress as a result of sex/intimacy issues it is critical that you contact your doctor. At the same time, it may be just as important to let your doctor know about minor issues, questions, or concerns in this area for reassurance of what can typically be expected after treatment. Pain during sexual activity, problems with genital function, or abrupt changes in menstrual cycles may indicate a hormone disorder and should be reported to your doctor.