Conversations – Expert Interviews and More
Cancer and Sexual Health – Mamta Singhvi, MD
“We know that cancer profoundly affects every aspect of life but one particular area that is often overlooked is its impact on sexual health."
It’s probably not the first think that comes to mind when you think about cancer but the impact on sexual function can be dramatic, especially for women undergoing treatment for cervical and other gynecologic cancers. In this Q&A, Dr. Mamta Singhvi talks about common sexual health issues that arise for women with gynecologic cancers and offers some solutions. She also explains that health care providers, patients, and partners all have a role in the process.
Mamta Singhvi, MD, is a resident in Radiation Oncology with the UCLA Health System and a member of ASHA’s Board of Directors.
Q: What kind of physical changes might occur with cervical cancer treatment that can make sex and intimacy challenging?
A: We know that cancer profoundly affects every aspect of life but one particular area that is often overlooked is its impact on sexual health. A significant percentage of women who survive a pelvic malignancy, including cervical cancer, develop long term sexual affects. Depending on the type of treatment administered, new sexual issues may develop during therapy, soon after completion, or even months to years later. These can include orgasmic problems and painful intercourse due to reduced vaginal size, or a lack of adequate lubrication.
Q: What are some things women can do if sex is painful following treatment?
A: Women must remember that sexual problems after cancer are very common and mustn't feel ashamed or alone. It is understandably challenging to openly discuss sexual practices with healthcare providers, and so it is imperative from a physician perspective to be approachable and proactive about broaching the topic with patients. Communication is crucial for the patient as well, not only with her doctor but also with her partner. Depending on the symptom, there are many interventions that may be effective. These may be as simple as vaginal moisturizers, Kegel exercises, or referral to a specialist for a more detailed workup.
Q: What about the emotional aspects of sex following diagnosis and treatment of a gynecologic cancer? Is loss of desire an issue?
A: The ramifications of cancer and its treatment on overall emotional health cannot be overestimated. The diagnosis of cancer may lead to feelings of sadness, stress in relationships, and difficulty with self esteem as one's body changes. For many women this in turn affects their sexual health. Issues such as loss of desire are commonplace and have been documented in study after study. But again, it is important to remember that there is help available as long as the communication channels are open.
Q: What do partners need to know to best support the patient?
A: Often times the diagnosis and treatment of cancer is as difficult for a partner as it is for the patient. Partners should attempt to learn about the symptoms of sexual dysfunction, and understand both the physical and psychological impact cancer has had on the patient. The goal is to communicate freely so that both sides understand desires and limitations, and can therefore set realistic expectations. Open dialogue, sensitivity, and patience are of paramount importance.
Finding Support and Strength: Q&A with NCCC Founder Alan Kaye
In 2011, ASHA and the National Cervical Cancer Coalition (NCCC), an organization that specializes in education and support for survivors of cervical cancer, merged. NCCC founder Alan Kaye shares his thoughts on how to best support women (and their families) in dealing with cervical cancer.
NCCC focuses strongly on survivors. What type of support and information do cervical cancer survivors need the most?
When there is a potential for a cancer diagnosis or a person has received a cancer diagnosis, there are feelings of being so lonely and isolated. And when that cancer has a stigma associated with it as cervical cancer does, these feeling s are heightened. NCCC focuses on women, family members and friends right at this most challenging time when a cancer diagnosis is given or cancer treatments are just getting started. The emotional support, along with accurate health information, options for second opinions, and talking or emailing with other survivors are key factors NCCC helps patients and families with during this time.
How does stigma impact cervical cancer patients and survivors?
Wow, the stigma continues to be a challenge with cervical cancer, vulva, vaginal and vulvar cancers and now some penile and head and neck cancers, too. As we continue to find out more about virus-associated cancers (VACs), we are seeing that some of the viruses may be associated with a sexually transmitted infection (STI) like HPV. At times, in many families, when they hear that a cervical cancer may be due to a STI, there is a feeling of shame, isolation and a sense a person did something wrong. The fact is 80% of all women and men would have tested positive for the HPV virus at least one time in their life by age 50! The HPV virus is common such as the common cold. There should be no shame with having, or having had, the HPV virus.
How do we best address stigma?
The best way to address the stigma is to have the women and men that may have a HPV-associated cancer speak out about the virus, how common HPV is and how a diagnosis can make a person feel ashamed. The virus and its cancers know no ethnicity, political party or region. These cancers can impact everyone, anywhere they may be. Each time a new cancer patient or family member/caregiver speaks out about the stigma, it helps to shatter stigma a bit more. Using evidence-based science and knowledge to speak out with is paramount to reducing the stigma.
What NCCC accomplishment(s) bring you the most pride?
We are proud of both the programs we initiated and the events we worked on to reduce the burden of cervical cancer and HPV, both nationwide and on a global level. We are especially proud of these programs: (1) our PhonePals system linking patients with the same cancer diagnosis to talk with one another; (2) the cervical cancer quilts that have traveled the country to help put a personal face on the fight against HPV and cervical cancer; (3) our online INSPIRE community which allows cancer patients to talk with one another through the Internet; (4) our electronic newsletter that provides timely information on new events on cervical cancer and HPV; (5) our resource center that sends out thousands of pamphlets on cervical cancer annually, (6) our fundraising and chapter development that has created 25 NCCC chapters throughout the United States and (7) our Global Initiative Against HPV and Cervical Cancer (GIAHC) www.GIAHC.org. (8) and our NCCC award-winning web site: www.nccc-online.org and our amazing three annual conferences (and videos and Public Service Announcements) that brought together women nationwide to listen and learn about cervical cancer, HPV and to speak out in their communities.
Even with these wonderful accomplishments, our number one accomplishment is our grassroots, cancer patient focus. It is the day after day, week after week, month after month of talking with each cancer patient and their family as they battle their cancer or precancer that is the most rewarding and helps impact the quality of life when a person hers those words: It's cancer! We are excited to be merging the NCCC and its amazing activities with ASHA. With ASHA's resources and NCCC's ability to grow in helping women and men find out more about prevention through cancer screening and vaccines, we are confident we will further help to reduce the burden of these HPV-associated cancers throughout the United States and globally.
Crowning Achievement: Rachel Dyckman
“Last year, I was diagnosed with cervical dysplasia. As my doctor informed me of the news, all I could think was "why?" I am young and healthy-I should be invincible-yet, that’s where I was wrong. I had no idea that cervical cancer can happen to any woman, regardless of their age or health.”
It’s hard to talk about cancer. Even harder when the topic involves gynecologic cancer. There are plenty of reasons women don’t go for regular cervical cancer check-ups (Pap tests and, for women 30 and older, the Pap/HPV co-test): sometimes it’s just a matter of putting it off in the face of busy schedules and endless days of devoting more time and energy to caring for others for than themselves. For many women, though, fear about going to a medical clinic and being examined is also a huge barrier. And some women just may not be aware they’re at risk to begin with and sorely need these important tests.
Rachel Dyckman is having none of it.
Spurred by her own diagnosis with cervical pre-cancer in 2013, she plans to use her year of service as the reigning Miss Tucson Desert Rose (a prelude to her appearance in the Miss Arizona pageant later in 2014) to educate, motivate, and – just as important- actively support women to protect their health: to accomplish that, the University of Arizona Honors graduate has chosen as her platform Cervical Cancer: Awareness, Education and Early Detection. While sharing the experiences and lessons learned with her own diagnosis, Ms. Dyckman plans to partner with NCCC to drive home a simple message: no matter your age or background, you owe it to yourself to take care of your health and don’t let anything keep you from asking questions and getting the care you need.
NCCC: Congratulations on winning the title of Miss Tucson Desert Rose in January! Tell us about your duties and responsibilities as title holder.
Rachel Dyckman: I am so excited to be able to represent and serve my hometown of Tucson, Arizona this year as the 2014 Miss Tucson Desert Rose. During my year of service as Miss Tucson Desert Rose, I will be supporting my platform of Cervical Cancer: Awareness, Education, and Early Detection. In addition to working with the NCCC AZ Chapter, I plan to discuss HPV and cervical cancer prevention with students in public high school health classes in order to raise awareness about the disease.
Why did you decide to focus on cervical cancer prevention and awareness during your year of service?
In April 2013, I was diagnosed with cervical dysplasia. As my doctor informed me of the news, all I could think was “why?” I am young and healthy—I should be invincible—yet, that is where I was wrong. I had no idea that cervical cancer could affect any woman, regardless of their age or health. Consequently, I could not think of a better issue to support as my platform during my year of service. As Miss Tucson Desert Rose 2014, I endeavor to share my experience with other women so that we can increase awareness, and ensure that the common mindset of “I should be invincible” does not affect their health.
Did you know anything about cervical cancer/pre-cancer when you were diagnosed with cervical dysplasia?
I had absolutely no idea about cervical cancer when I was diagnosed–it all came as a huge shock to me. I thought back to all the health and sexual education classes that I took throughout grade school, and did not recall one class discussing cervical cancer.
Where did you go for information?
We are so fortunate to live in an age where you can Google basically anything and get numerous results; and that is exactly what I did after being diagnosed and talking to my doctor. I started looking at medical websites, the CDC’s website, anywhere that I could get more information from. It wasn’t until I started searching for support groups and ways to help bring awareness to this disease that I found the NCCC.
Talk a bit about the need for support: what do women need from their 1) health care professionals, 2) family members, and 3) partners when they have an abnormal Pap test?
Upon receiving news of an abnormal Pap test, there first needs to be ample support from a woman’s health care professional. In my experience, I feel that simply sitting down one-on-one with the patient to answer all of her questions, explain the test results, and what needs to be the next step in the process will help relieve any anxiety and nervousness. After the appointment, most of us like to do our own research to gain even more information, so I feel that a simple follow-up phone call the next day to answer any lingering questions would immensely help the situation as well. Most important though, I believe that family members and partners should be involved throughout the whole process. Although it may feel awkward to discuss our gynecological health with someone, I believe that talking to someone and letting out our feelings not only helps us overcome tough situations, it provides us with someone else to lean on.
How can people connect with you and support your work?
I would love to be able to connect with more individuals and groups to bring more awareness to this disease. With the “power of the crown,” I know we can make a difference in our community. I can be reached through our pageant’s Facebook page: “Miss Tucson Desert Rose, Old Pueblo & Del Sol Scholarship Pageant”, or directly by email at: email@example.com .