Coping with Sexual Dysfunction
For some individuals diagnosed with bladder cancer, the recommended treatment may be surgery to remove portions of the affected organ, such as cystectomy which includes removal of the bladder, and for men it may also include removing the prostate and seminal vesicles. In women, the uterus, ovaries, fallopian tubes, cervix, and portions of the vagina may also be removed. Between 8,000 and 10,000 cystectomies and urinary diversion surgeries are performed annually in the United States and sexual dysfunction following this type of surgery is not uncommon.1
What can cause sexual dysfunction?
Mechanical changes, such as difficulty maintaining erection or lubrication, pose their own problems to intimacy but may also be associated with complex emotional and psychological reactions in both the patient as well as his or her partner which can further impair physical intimacy.2 Both the patient and partner must acknowledge and process their individual and collective grief around this real loss. Additionally, they must become effective communicators with each other and with their health care providers to identify areas of concern and discuss options to improve the situation.
It is common for sexual interest to be low for the first six months after bladder surgery.3 Patients are often preoccupied with recovery and physical rehabilitation immediately after surgery, and may be distracted by concerns of disease recurrence. For some, however, this worry can go beyond normal cares and evolve into depression or anxiety. Further, the physical alterations following surgery (for example scarring, stomas, or incontinence) can negatively impact a person’s body-image and contribute to depression and anxiety, both of which which are commonly associated with reduced libido when left untreated. Therapy is an effective intervention for depression and anxiety, and if medications are recommended be aware that some medications commonly used to treat depression or anxiety can be associated with sexual dysfunction; seeing a psychiatry specialist for medications may help minimize side effects.3
The significant other may also have a reaction to the physical changes in his or her partner which contributes to reduced sexual intimacy. For instance, he or she may be concerned about causing the patient pain with touch. In an effort to avoid burdening each other the couple may be reluctant to bring up these concerns about intimacy.4 It can be uncomfortable to acknowledge the real and present changes in the dynamic, however ignoring the thoughts and feelings often backfires and the partners end up more withdrawn and distant.
Communication with your partner...
Communication is an important skill in any relationship and it is especially important for sexual recovery after bladder cancer treatment.5 It may be necessary to discuss such practical (yet potentially awkward) things such as when sex will take place, what aids may be needed, what positions are comfortable and which are uncomfortable. It is also important to discuss issues of body image and how each partner would ideally like to manage this. A therapist can be a helpful partner for couples who need assistance starting and maintaining this kind of challenging dialogue.
...and your doctor
It is not enough for partners to become comfortable discussing their sexual function just with each other. One study identified that while sexual dysfunction following bladder cancer is common, a significant barrier to obtaining effective treatments is lack of provider inquiry as well as lack of patient reporting! This study reported that 42% of women surveyed indicated a desire to obtain information about sexual dysfunction but only 7% actually raised this question with providers, however, and only one-third of physicians in the study asked about sexual side effects.1 Not only do patients and providers need to be aware of this treatable condition, they also need to be comfortable using the language necessary to discuss this intimate topic. With clear communication between patients, romantic partners, and the health care team, providers can asses if the dysfunction falls into organic, iatrogenic (relating to bladder cancer treatment), psychological, partner-centered, or life-centered categories and refer the patient to appropriate treatment.
Achieving satisfying intimacy
Though sexual functioning after cystectomy may be abnormal compared to functioning before surgery, the challenges are not entirely unique. Even in healthy individuals it is common for sexual functioning and sexual interest to fluctuate with age.1 Couples who are committed to each other and have emotional intimacy learn new ways to keep the passion alive even late in life. They may adopt use of medications, equipment, or other aides to promote sexual function. Positions may evolve and new techniques may be employed as couples explores their changing interests and abilities. By using effective communication with each other and with health care providers, individuals and couples experiencing sexual dysfunction after bladder cancer, too, can achieve satisfying intimacy.