“I thought it was depression or maybe a relationship problem with my life partner; I had also talked about it for a long time with my psychotherapist to understand what was happening to me and, instead, everything depended on the cancer and the therapies “. To tell how the desire to learn more about sex and cancer is born Amalia Vetromile, cancer patient and promoter of SexandtheCancer® ?, a movement born from the need to break the deafening silence that surrounds a problem that affects 6% of Italian women: sex after cancer. A significant phenomenon of which little is spoken about in Italy because most of the time women themselves do not talk about it. On the occasion of the World Day of Sexual Wellbeing which is celebrated tomorrow, Oncoline addresses the theme to which the Congress’ Sex and the Cancer is also dedicated: what women do not say ”which will take place in Rome on September 15th.
Doctor and patient in interview
To console Amalia and to give her suggestions on how to overcome that impasse was the radiotherapist oncologist who treated her at the Sant’Andrea Hospital in Rome, Vitaliana De Sanctis: “Have you ever tried the vaginal laser? Maybe it could help you ”. Amalia had never heard of it, but out of curiosity she asks some friends who have had breast cancer if they have had any sexual problems. “Their confidences – he says – overwhelmed me like a raging river. Some have also confided to me the impact that the change in their sexuality has had on their relationship as a couple ”. Thus was born Sex and the Cancer, a movement that wants to give voice to the needs of those who in life, despite having to deal with a tumor, do not want to give up sexuality. For over ten years, the movement has been promoting sexual awareness as an important public health issue.
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Sexuality with and after cancer
Today, thanks to advances in scientific research, those who get cancer are living longer and longer. According to the latest report on cancer numbers in Italy, today there are about 3.6 million citizens alive after being diagnosed with cancer, an increase of 37% compared to 10 years ago. At least one in four patients (nearly one million people) has returned to the same life expectancy as the general population and can be considered cured. Therefore, he can enjoy sex life as well. “We must not neglect sexual health, even after cancer”, says Amalia Vetromile who, however, adds: “We are facing a new sexual taboo that is not spoken about, because women themselves are often ashamed to confide it to their doctor, to the partner and even to the closest friends. Many women are reluctant to start discussing their symptoms out of embarrassment and also in the belief that nothing can be done medically ”.
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Of the 3.6 million Italians alive after cancer diagnosis, more than 1.9 million are women, that is 6% of the entire Italian female population. Breast cancer is the most prevalent disease in women, nearly half (43%) of all women living after a cancer diagnosis. About 65% of these are under the age of 74 and therefore are women with an active but often problematic sexuality. In fact, in a survey of nearly 400 cancer survivors, 87% said they experienced sexual side effects, but most also reported that their oncologist had not formally inquired about them, especially from sex patients. female. “When you start the therapeutic path – explains De Sanctis who is a member of the scientific committee of Sex and the Cancer – the doctor and patient’s attention is focused on the fight against cancer, but it is also important to guarantee a good quality of life and sexuality plays a leading role. Fortunately, today compared to 10-15 years ago, patients have less difficulty talking about it with doctors because young women are very motivated to have a good relationship as a couple ”.
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The psychological block
Sexual dysfunction is an unfortunately common side effect of cancer treatment. In 2020, about 55,000 new diagnoses of breast cancer are expected in women. These women – often also very young – in addition to having to face an oncological pathology and related treatments, undergo a new way of living their femininity from many points of view. One of these certainly concerns sexuality, with pathologies affecting the uro-genital system caused by oncological treatments, which unfortunately undergoes profound changes, with an important negative impact on social life (for example, in the relationship with one’s partner). Problems arise, therefore, also on a psychological level: “Especially in the initial stages – explains the oncologist – the patient is very focused on therapies and on the fear of not getting well and even the doctor focuses all his attention on these aspects”.
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Insecurity, shyness and shame
Then there may be the fear of not feeling more beautiful and desirable because, for example, the tumor required surgery that changed the physical appearance. This generates a lot of insecurities and also has consequences in the way we relate as a couple. “Many women – underlines Amalia Vetromile – are reluctant to start the discussion of their symptoms out of embarrassment, in the belief that nothing can be done from a medical point of view. Moreover, often the medical team does not prepare women for these implications of cancer treatment and patients do not talk about it, because women themselves are often ashamed to confide it to their doctor, to their partner and even to their closest friends ”.
Physical pain
But the problems do not only concern the psychological sphere because there are also the side effects of oncological therapies that can act on a physical level, inducing the fear of pain in the woman. “Depending on the type of treatment carried out – explains De Sanctis – slight discomfort may arise in the vaginal mucosa which can then lead to significant pain that prevents sexual intercourse. In some cases, there may also be distant consequences with more important inflammations up to the stenosis of the vagina ”. Following oncological treatments, in fact, the uro-genital system undergoes profound changes: irritation, itching, recurrent vaginal and urinary infections, urinary urgency, painful urination, poor lubrication, vaginitis, vaginal atrophy, vaginal stenosis and pain on penetration (dyspareunia ), decreased libido, with an important negative impact on social life (for example in the relationship with one’s partner). To this is added – taking into account the fact that cancer affects many young women – the important impact on the possibility of having a child. But while with the treatments dated 20-30 years ago, the physical impossibility of having sexual intercourse was a fairly frequent scenario, now with the modern technologies we have at our disposal, radiotherapy treatments often integrated with systemic therapy cause reduced toxicity.
A multidisciplinary approach
Sex and the Cancer was born from these needs of a chorus of voices that is becoming more and more important and that awaits solutions. “This movement – continues De Sanctis – represents a collection of all the professionals involved in the treatment of tumors because it is important that patients are sent by specialists who also pay attention to these aspects. This is why it is important to sensitize the various professional figures to these needs that are beginning to emerge even if too often doctors do not address these “intimate” aspects and only 10 percent of women find the courage to talk about them “. And it is important that the patient can count on a multidisciplinary team according to the problem to be faced: “Sometimes the gynecologist is needed, other times the physiotherapist for pelvic floor rehabilitation gymnastics, at other times the psycho-oncologist or maybe couple therapy because the partner may also need support ”, continues the oncologist.
The solutions
Faced with the problems that can make the sexual life of cancer patients less satisfying, there are now solutions that doctors can offer. “Today it is possible to suggest to patients the laser therapy that stimulates the regeneration of some cells of the vaginal mucosa thus making it more elastic and fighting the typical vaginal dryness of post-treatment”, explains the oncologist. There are also topical therapies such as vaginal suppositories based on hyaluronic acid or estrogen. “The problem is – underlines De Sanctis – that in no case are therapies reimbursed by the health system, but they are completely borne by the patients. The costs of laser therapy are not low, but also those of topical therapies are heavy to bear because they are long-term care ”. In fact, among the objectives of the Sex and the Cancer movement there is also that of providing financial support to widen access to these therapies as much as possible.
A conference on what women don’t say
The second Sex and the Cancer conference is dedicated to all these issues, from the focus on the problem of sex after cancer to the therapies to solve it, finally present (also in hybrid mode): “This is an important meeting that will bring together the greatest experts on the subject ”, explains Amalia who has managed to raise awareness of important scientific societies and numerous institutions. Among the participants, Andrea Urbani, Director General of Health Planning of the Ministry of Health; Enrico Cavallari, president of the Commission for the protection of the territory, emergencies, civil protection, reconstruction of the Lazio Region; Antonella Polimeni, rector of Sapienza University of Rome, Fabio Lucidi, Dean of the Faculty of Medicine and Psychology Sapienza University of Rome, Saverio Cinieri, president-elect of Aiom e Paolo Marchetti, full professor of Oncology at La Sapienza University.
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