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    Sexual Counseling

    At least a third of survivors of childhood cancer have difficulty with their sex lives.  Common problems include concern about body image or revealing a history of cancer to potential dating partners, difficulty with vaginal dryness or pain with sexual activity, and worries about whether their sexual response is “normal.”  Young women who have had surgery or radiation to the pelvic area are at risk for pain during sexual activity because of scar tissue around or in the vagina.  Some women who have had a high dose of radiation therapy to the ovaries, intensive chemotherapy, or women who had surgery removing both ovaries have premature ovarian failure.  They no longer have menstrual cycles and are likely to have severe vaginal dryness.  Unless a young woman is at risk for a cancer that is sensitive to estrogen, the most effective way to help with this problem is to give estrogen replacement.  If pills or patches do not resolve the problem, vaginal estrogen creams, rings, or suppositories may be helpful since they directly treat the genital area.  If there is concern about taking estrogen, nonhormonal vaginal moisturizers can be used 2 to 3 times a week, including Hyalo-GYN TM, LuvenaTM, or ReplensTM.  During sexual activity, a water-based or silicone-based vaginal lubricant may still be needed for comfort.  When girls have treatments destructive to the ovaries before puberty, they may also need hormone replacement in order to develop breasts, body hair, etc.  Some young women may also have reconstructed vaginas, and need to understand how to have the best sexual function, depending on the type of reconstruction.  It is difficult enough for many parents to talk openly about sex to daughters, and the complicated physical changes from gynecologic cancer make their task much more difficult.  It is a good idea for a young woman going through teen years or starting her sex life after gynecologic cancer to have a few sessions of counseling with an expert in sexual issues related to cancer.  This gives an opportunity to understand her body, ask questions, and get support and reassurance.  A visit with a specialized gynecologist can be another very valuable part of learning about sexuality after gynecologic cancer.