Abstract
Dear Sir,
I am writing in response to the article “The impact of radiation therapy on sexual health in breast, cervix, and prostate cancer patients” to share my experience with a case of carcinoma rectum and its severe consequences on a young couple’s sexual relationship.
Two months ago, I consulted with a 31-year-old woman diagnosed with stage 4 rectal cancer in 2021. She and her husband, who have been together since childhood, had a satisfying sexual relationship until her diagnosis. Following unsuccessful surgery, she underwent radiation and chemotherapy over the next two years. In 2023, their attempt at intercourse was unsuccessful due to severe vaginal stenosis resulting from treatment. Her vagina had completely closed off, and she could not tolerate dilator use after reconstructive surgery.
Upon presentation to my clinic, she exhibited severe atrophy, dryness, and a barely penetrable vaginal canal, which admitted only the tip of a no. 6 Hegar dilator. Menopausal symptoms, confirmed by her investigations, were severe and directly linked to her treatment. The couple had ceased all intimacy since her diagnosis, and their attempt at intercourse post-reconstruction was their final effort. Unfortunately, they received no guidance on the impact of cancer treatments on sexual function, nor were they provided with resources for restoring intimacy.
Reflecting on this case, I believe that bowel and rectal cancers should be included in discussions on cancer-related sexual dysfunction. The profound effects of radiation therapy extend beyond reproductive organ cancers, severely impacting sexual function by inducing menopause, vaginal stenosis, and atrophy. Currently, there is limited reference in the Indian context on the sexual side effects of cancer treatments, highlighting the need to sensitize clinicians through education and training about these issues.
Comprehensive cancer care should involve a multidisciplinary team including counselors, psychologists, gynecologists, and sex therapists, ensuring patients receive holistic support. In younger women, local or systemic hormone replacement therapy could be considered if genetic tests indicate a low risk for hormone-dependent cancers. Vaginal estrogen, used appropriately, alongside lubricants, moisturizers, dilators, and vibrators, can alleviate genital symptoms. Furthermore, couples counseling focused on redefining intimacy and sexual goals is crucial for restoring relationships and supporting psychological well-being through this challenging period.
Thank you for considering these reflections on extending multidisciplinary care to include the sexual health of patients with rectal and other cancers.
Sincerely,