CANCER AND ITS TREATMENT can have a wide variety of effects on the sexual health of survivors. Sexual health among adolescent and young adult (AYA) cancer survivors is an important yet understudied area of research, says Brooke Cherven, a nurse scientist at the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta, and an assistant professor of pediatrics at Emory University School of Medicine in Atlanta.

“Sexual function and sexual health are vital aspects of quality of life among adolescent and young adult cancer survivors. We know that cancer diagnosis and treatment may negatively impact sexual function,” she explains. Previous reviews of sexual function among AYA survivors have focused primarily on the hormonal and physiological aspects of sexual function, such as erectile dysfunction or vaginal dryness, but there has been less focus on psychosocial factors, such as body image and the formation of romantic relationships, according to Cherven.

Cherven and her colleagues recently conducted a review of 32 studies on a range of sexual health factors affecting cancer survivors between the ages of 15 and 39, which was published in the May/June 2021 issue of CA: A Cancer Journal for Clinicians. She spoke with Cancer Today about what treatment and support for AYA cancer survivors looks like.

CT: Why are AYA cancer survivors more likely to experience sexual health problems than their peers without cancer?
CHERVEN: Sexual function is complex and encompasses a wide range of factors—physical, developmental and psychosocial. Cancer may impact sexual function in a variety of ways. Certain cancer treatments may, for instance, lead to hormonal imbalances, diminish fertility or cause painful scarring. Cancer diagnosis and treatment during childhood or adolescence may interrupt or delay sexual development, meaning that patients may not experience the same sexual milestones at the same times as other adolescents and young adults.

CT: What did you do to study this topic?
CHERVEN: We took a wide lens to the issue of sexual health in AYA survivors by looking at both reports of sexual dysfunction, such as problems with pain, lubrication or arousal, and how these factors impact feelings about sex, body image and romantic relationships.

CT: What did you find?
CHERVEN: Overall, we found that there is a significant burden of impaired sexual function among AYA survivors after completing cancer treatment. The review showed us that there is a complex relationship between sexual functioning, romantic and intimate relationships, and body image—and that all three of these domains may be negatively impacted by prior cancer diagnosis and treatment.

Our research highlights a need to develop and test interventions within this population that could help to improve these outcomes. This will likely involve tailoring interventions by developmental stage, since the needs and priorities of a 15-year-old likely differ from those of a 35-year-old. There’s also a need for specific guidelines that help providers know how and when to incorporate screening [for sexual issues] into routine survivorship clinical care. Since most of the existing research has focused on biological sex, future studies should address sexual health within a diversity of gender identities.

CT: How can survivors approach their doctors about sexual health questions?
CHERVEN: We know from studies that survivors want to talk about sexual health concerns with their providers but can be hesitant to bring it up if the provider doesn’t ask. If this is something you want to discuss, be as open and honest as you feel comfortable being. Whether you’re experiencing pain during intercourse or struggling to form an intimate emotional relationship, ask your provider if it’s something that could be related to cancer diagnosis or treatment. Oncology and survivorship providers want to help patients have the best possible quality of life after cancer treatment.

CT: What treatments and supports currently are available for AYA cancer survivors?CHERVEN: It depends on the problem the patient is experiencing. If the patient’s problems are physical, such as erectile dysfunction or vaginal scarring, then a referral to a urologist or gynecologist may be appropriate. There also are psychologists and sex therapists who can help to address both psychological and physical aspects of sexual health. Ask your provider for a referral to a therapist who specializes in issues related to cancer.

CT: What are some additional sexual health resources for AYA cancer survivors?
CHERVEN: The Scientific Network on Female Sexual Health and Cancer has a list of resources specifically for girls and women after cancer. Sexual health providers who are not specific to cancer can be found using provider lists from the Sexual Medicine Society of North America and the American Association of Sexuality Educators, Counselors and Therapists. There are also AYA-focused organizations such as Elephants and Tea that have good resources and information on the topic.

This interview has been edited and condensed for clarity.