In recent years, with the change of medical model and the improvement of women’s standard of living and education, people’s demand for quality of life has become higher and higher. For example, for women suffering from gynecological tumors, they are especially concerned about the quality of their future sexual life after surgery, radiotherapy and chemotherapy. According to some data, about 90% of gynecological tumor patients, especially malignant tumor patients, suffer from sexual dysfunction during treatment, and 50% of patients still have not fully recovered their sexual function after 2 years of treatment. Sexual dysfunction can affect the relationship between husband and wife, or in serious cases, marriage and family, thus significantly reducing the quality of life of patients. Due to the special and insidious nature of this problem, it is often difficult for patients to ask for help, and they do not even know how to ask for help. Therefore, in this article, we will discuss with gynecologic tumor patients about the problem of declining sexual life quality caused by gynecologic tumor surgery, radiotherapy and chemotherapy, and how to avoid this situation.
I. Adverse effects of gynecological tumor surgery on sex life and prevention
1. Adverse effects of gynecological tumor surgery on sex life
Gynecological tumors are divided into benign tumors and malignant tumors, and surgical treatment is the main treatment method. Surgery mainly includes hysterectomy, bilateral tubal oophorectomy and radical surgery of various gynecological malignant tumors. Although surgery can treat the disease and improve the related symptoms, it can affect the patient’s sexual function after surgery and even produce serious damage.
Hysterectomy alone does not produce mechanical and physiological effects in sexual function per se, and sexual dysfunction is often psychological in nature. Some patients believe that after hysterectomy, the pelvic cavity is empty and the vagina is shortened, and they fear that there is damage to the vagina or internal organs during sexual intercourse. Some patients even mistakenly believe that they cannot have children after hysterectomy and that their sexual function will naturally fade, or even that they have become “neutral” and that sex is meaningless, which leads to low sexual desire and even the end of their sex life.
For patients over 45 years old, the ovaries themselves have atrophied or will atrophy, and after surgery it is like going through menopause naturally. If the patient is under 45 years of age, when the ovaries are still in a period of function, try to preserve one ovary if the condition allows. The purpose of this is not to prevent the onset of menopausal syndrome for fear of affecting sexual function. The reason is that after bilateral ovarian removal, the estrogen level in the body will suddenly decrease drastically and affect the function of hypothalamus and pituitary gland, which will easily lead to systemic autonomic dysfunction and other maladaptive menopausal symptoms, thus leading to changes or even disorders in sexual function.
Radical gynecological malignant tumor surgery can cause many effects on patients’ physical and mental health, leading to sexual dysfunction. Some scholars selected 81 cases of women with gynecologic malignancies for postoperative sexual life quality analysis. Among them, 54 cases of ovarian cancer, 19 cases of endometrial cancer, and 8 cases of cervical cancer were treated with total hysterectomy plus double adnexa plus appendix plus omentectomy; 8 of the 19 cases of endometrial cancer were treated with radical hysterectomy plus pelvic lymph node dissection, 2 with extensive hysterectomy plus pelvic lymph node dissection, and 9 with total hysterectomy; 8 cases of cervical cancer were treated with radical hysterectomy plus pelvic lymph node dissection. Eight cervical cancer patients underwent radical hysterectomy plus pelvic lymph node dissection. The results of the study showed that 40.7% (33/81) of the patients with gynecological malignancies still had sexual life after surgery, and 60.7% (20/33) of them had decreased sexual desire. The study compared the sexual life of women after surgery for ovarian cancer, endometrial cancer and cervical cancer, and found that although the surgical methods were different, there were no significant differences between these groups in terms of recovery time, frequency and satisfaction of sexual life. Psychological depression and fear are often important aspects that lead to abnormal sexual function after surgery. Therefore, paying attention to the psychological state of gynecologic malignancy patients, strengthening the explanation of anatomical knowledge, relieving the ideological concerns of these women, and reducing the psychological burden of patients as much as possible will be important to improve the postoperative sexual function of these patients.
Some experts and scholars have also conducted a survey on postoperative gynecological tumor patients and came up with the following points which may be the common causes of sexual dysfunction of patients after surgery.
1) Worrying about the prognosis
Many respondents think that sex life may promote tumor recurrence, and they think it is good to have a tumor that can be cured, so they dare not have sex life at all. Especially cervical cancer patients believe that their disease is caused by human papilloma virus (HPV) infection, and they reject sex even in the recovery period, and their subjective repression of different degrees makes their sexual desire significantly reduced.
2) Worry about poor wound healing or injury
Many interviewees think that the collision during the couple’s life will affect the wound healing or damage the healed wound, and they are afraid to start sexual life, or they are worried about the sexual life they have already started.
(3) Difficulty in sexual intercourse and lack of sexual desire
Gynecological tumors, especially malignant tumors, remove the genital organs and change the anatomical structure of local organs during surgery, so the success of sexual intercourse depends directly on the length of the remaining vagina.
4), Sexual partner’s concern
The concept of sexual partners of gynecological tumor patients should not be ignored. Relevant literature shows that 11.7% of sexual partners of cervical cancer patients think that the quality of sexual life is affected after treatment, and they are reluctant or even afraid to have sexual activities with patients. Some of them believe that sex is a consuming activity that only normal people can bear and that they should avoid sexual activity, especially orgasm, because of the disease. 11.7% of the partners refuse to have sex with the patient for fear of contracting cancer if they have intercourse with them. The change of the patient’s image after treatment also made 41.7% of sexual partners feel unpleasant and their desire to have sexual activity with the patient was reduced.
2. Prevention and treatment of adverse effects of gynecological tumor surgery on sex life
As health care professionals, they should take corresponding psychological interventions to eliminate these adverse factors to the greatest extent. Some scholars conducted a survey on the effect of psychological behavior intervention on the quality of sexual life of women after total hysterectomy. 60 cases of women with total hysterectomy were selected and randomly divided into psychological intervention group and control group. 27 cases of patients in the intervention group were satisfied with the relief of symptoms after surgery and 2 cases were basically satisfied; 28 cases of patients in the control group were satisfied and 3 cases were basically satisfied, and the difference between the two groups was not significant. The questionnaire was used to investigate and analyze the recovery time of sexual life, frequency of sexual life and sexual anxiety in the two groups after surgery. The results showed that the recovery time of sexual life in the intervention group was significantly shorter than that in the control group, and the anxiety of sexual life was lower and the quality of sexual life was higher than that in the control group. Therefore, psychological guidance to patients before and after surgery can reduce the occurrence of postoperative sexual life disorders.
The specific practices are as follows.
1）.Pre-operatively, we explained in detail to the patients and their husbands about the physiological knowledge of female reproductive system, so that they could understand that, for example, removal of the uterus is only the loss of reproductive function and does not affect sexual life, eliminating their misconception that sexual function and reproductive ability are considered as one, and telling them that removal of the disease can actually enhance the sexual ability of the patients.
(2) Before the operation, explain to the patient and her husband some necessary knowledge about sex psychology and sex physiology, so that they can understand that the pleasure center of female orgasm is in the brain rather than in the uterus, and the excitation point of orgasm is in the clitoris and the midpoint of the anterior vaginal wall, etc.
3）.Before having sex after surgery, perform the necessary review to eliminate their unnecessary worries about the complications of surgery, such as the fear that the vaginal stump will split open, etc.
(4) Make the patient completely relaxed after surgery. When the patient is in a negative mood, the health care provider can teach the patient some relaxation methods, such as humor, entertainment, and distraction treatments like computer virtual reality technology, or relaxation training or hypnotherapy. A study conducted a 6-week relaxation training and psychological counseling for 53 cases of gynecological malignant tumor patients, and the results showed that the method can significantly reduce patients’ anxiety, depression and other psychological emotions.
The adverse effects of radiotherapy on sex life and prevention
1.The adverse effects of radiotherapy on the sexual life of gynecological malignant tumor patients
Radiotherapy is a treatment method to treat malignant tumors by using radiation. However, while radiotherapy kills tumor cells, it also brings damage to normal tissues and causes pathological changes, which can seriously affect the physiological functions of tissues and organs. The basal layer of vaginal epithelium is very sensitive to radiation, while the endothelial cells of small blood vessels and fibroblasts of connective tissue are moderately sensitive to radiation. After radiotherapy, the vaginal small blood vessels are narrowed, occluded, and the connective tissue is proliferated, and the ability of vasodilation is lost, which inhibits vaginal engorgement, lubrication and orgasmic function during sexual arousal; radiotherapy causes the connective tissue to proliferate, which deforms and loses elasticity of the vagina, impairing the physiological response of the vagina to lengthening and expansion during sexual intercourse. The extension and elongation function of the upper 2/3 segment of the vagina will be weakened by the fibrosis and thickening caused by radiation therapy, which can make patients reluctant to have sex due to pain during intercourse, bleeding during intercourse and no orgasm, which makes sexual activity much less enjoyable.
According to statistics, about 66% of patients have reduced quality of sexual life after radiotherapy related to the following factors, including: narrowing, shortening and reduced elasticity of the vagina after radiotherapy, thinning and pallor of the mucosa, reduced function of vaginal mucus secretion, dilatation of small submucosal vessels and contact bleeding. In addition, vaginal adhesions or atresia in a few patients after radiotherapy can cause difficulties in sexual intercourse. It is reported that 3/5 patients have no sex life or very little sex life after radiotherapy, and more than half of the patients have no interest in sex life, and only 1/10 patients have no change in sex life from before treatment.
2. Prevention and treatment of adverse effects of radiotherapy on sexual life of gynecological malignant tumor patients
As health care professionals, the following points should be noted.
(1) The ideal dose of radiation therapy is to cure the tumor without causing radiation damage to normal tissues and organs and causing serious complications. Choose the most suitable radiotherapy dose according to the patient’s condition, try to avoid serious complications, and pay attention to the protection of ovaries during radiotherapy for young patients.
(2) Strengthen the propagation of knowledge about gynecological tumor treatment and sexual life to patients after radiotherapy. Doctors should take the initiative to communicate with patients and their families to solve their questions. They should care about the sexual life of patients in the discharge medical advice and review, and inform the time and precautions of the feasible life after radiotherapy.
(3) Psychological intervention and health education for post-radiotherapy patients should be strengthened to help them resume their social roles as soon as possible. The employment problem of gynecological malignant tumor patients after treatment should be paid attention to so that they can feel the concern of society for them.
As patients should pay attention to the following points when they have sex life after radiotherapy.
1) The time to start sexual life after radiotherapy should be grasped. Because, when the patient receives radiotherapy, the cervical area can have different degrees of tissue reactions such as bleeding, necrosis and edema, and the vagina can also have edema, congestion, stenosis and adhesions. For a short period of time after the end of radiation therapy, radiation reactions may still be present. If patients have sex during this period, it will not only bring them pain, but also aggravate the reaction of radiation therapy and affect the treatment effect. Generally speaking, patients with gynecological malignancies can have sex 2-3 months after radiotherapy, except for those who have special conditions after examination by doctors.
(2) When patients have sex after radiotherapy, if the patient’s vagina is dry, you can first apply some lubricant such as cream inside the vagina or on the male partner’s penis. Patients can add the right amount of vinegar to warm water when washing vagina normally. Be careful not to use potassium permanganate solution to cleanse the vagina. Because potassium permanganate solution is a strong oxidizing agent, it will destroy the acidic environment in the vagina and may cause infection.
(3), radiotherapy makes the tissue thin or estrogen lacking, so that the clitoris becomes uncomfortable. After radiotherapy, the vagina cannot secrete lubricating fluid, so it should be excited by extensive body contact, and the general principle is light, intermittent and rapid contact with skin and mucous membrane.
During sexual life, vaginal and cervical secretions and male semen play a role in lubrication and nutrition of the vagina. In addition, localized vaginal congestion occurs during sex, which, together with the abrasion of the penis on the vagina, is more conducive to the early recovery of the patient’s vaginal mucosa. Although the vaginal douche can reach into the vagina straight to the cervix, it cannot play the role of fully dilating the vagina because the part of this instrument entering the vagina is thin. Therefore, patients should actively engage in sexual life after radiotherapy, which is the same as getting off the floor as early as possible after surgery to avoid intestinal adhesions.
Third, the adverse effects of chemotherapy on sex life and prevention
1. Adverse effects of chemotherapy on sex life of gynecological malignant tumor patients
Chemotherapy is one of the most common treatments for gynecologic malignant tumor patients in addition to surgery and radiotherapy, which is administered repeatedly to achieve partial or complete control of tumor. Chemotherapy for gynecologic tumors usually lasts for 3-6 months or longer. The side effects of chemotherapy have significant impact on sexual function, such as nausea, vomiting and diarrhea, which significantly reduce sexual desire and frequency; hair loss and other physical changes reduce patients’ self-confidence; some chemotherapy drugs may inhibit ovarian function, resulting in lower estrogen levels, causing thinning of vaginal epithelium, atrophy and loss of lubrication, which bring about problems such as reduced sexual desire, difficulty in intercourse and painful intercourse. These serious physical and mental discomforts cause patients and their spouses to have different degrees of sexual fear, sexual repression, sexual indifference and difficulty in sexual intercourse, leading to a significant decrease in the quality of sexual life.
A survey was conducted on the quality of life of chemotherapy patients with gynecological malignancies, and it was found that more than half of the patients did not have any sexual activity after the disease, especially those who were old and had heavy lesions. 28% of the patients’ sexual life quality and frequency decreased compared with those before the disease, and 16% of the gynecological cancer patients could maintain normal sexual life, but only 8% of them could maintain normal sexual life after chemotherapy. However, only 8% of them could maintain a normal sexual life after chemotherapy, and 12% of them had a lower quality of sexual life than before chemotherapy. It shows that chemotherapy and surgery and radiotherapy are important factors affecting the quality of sex life.
2, chemotherapy on the prevention and control of the adverse effects of sex life
(1), try to reduce chemotherapy-induced nausea, vomiting and other adverse reactions. 5-HT3 receptor antagonists (such as toltestrone, ondansetron, etc.) as strong antiemetic drugs can significantly reduce nausea, vomiting and other adverse reactions. Prophylactic use of antiemetics (including the above-mentioned antiemetics and dexamethasone, etc.) can reduce delayed vomiting reactions in more than 60% of platinum-based chemotherapy patients.
2), alopecia can cause psychosomatic problems such as decreased self-confidence, depression, and humiliation in patients. A study on 255 gynecologic oncology patients who received chemotherapy once found that hair loss was the most feared side effect before they received chemotherapy. Although some or even all of the patient’s hair can be lost due to some chemotherapy drugs (in hospitals where it is available, measures such as wearing ice caps during chemotherapy can reduce the occurrence of hair loss), patients can perpetuate their beauty by using wigs, hats, turbans, and scarves, as well as skin care, makeup, and nail care. These methods can be very useful in enhancing the self-esteem of patients who are undergoing anti-cancer treatment.
3) Lifestyle modifications also have a positive effect on the improvement of chemotherapy patients’ sex life. For example, more arginine-rich foods (such as chocolate, peanuts, walnuts), soy-based foods, ginkgo, ginseng, etc. can be consumed to relieve vaginal dryness and thus improve sexual desire.
To sum up, the quality of sexual life of gynecological tumor patients will be decreased to different degrees after comprehensive treatment such as surgery, radiotherapy and chemotherapy. In addition to the anatomical and physiological changes caused by the treatment itself (e.g. removal of uterus or ovaries, vaginal mucosal congestion, edema, narrowing and adhesions caused by radiotherapy, nausea, vomiting and hair loss after chemotherapy), psychological depression and fear are often important aspects leading to abnormal sexual function of patients. Therefore, in addition to taking appropriate remedial measures for the anatomical and physiological changes of patients, we should also strengthen the psychological counseling for patients and spouses, and design reasonable psychological interventions that will help patients’ treatment and recovery and improve the quality of their sexual life.
Finally, we wish all gynecologic tumor patients a harmonious relationship with their spouses and a happy family.