INTIMACY AND INSIGHT: SEXUAL HEALTH AFTER BREAST CANCER

Sexual health after breast cancer is a topic too often left in the shadows, yet it profoundly effects quality of life both during and post diagnosis.

In this episode, Doctor Belinda Yeo and Doctor Virginia Baird open the conversation, sharing insights into how we can better support patients navigating intimacy, identity, and wellbeing after treatment.

“My name is Belinda, and I’m a medical oncologist and a clinician scientist in Melbourne. I work at the Austin and also at the Olivia Newton John Cancer Research Institute, and I treat breast cancer.”

“I’m Ginny (Virginia) Baird, and I’m a GP by background. I’m a trainee breast physician, and I work at the Royal Hobart Hospital, and I have a breast and menopause clinic.”

Sexual health is an important but often overlooked aspect of Breast Cancer Care. Can you explain why it matters so much for patients?

“We can see that it’s important because the data suggests that 90% of our patients have detrimental effects to their sexual health in the setting of their breast cancer, either because of their treatment, or because of the diagnosis,” Belinda said.

“And of course, sexual health is very complicated part of our lives. So, there are many other facets that affect sexual health. It’s like the elephant in the room.”

What kinds of sexual health issues do breast cancer patients commonly face during and after their treatment?

“I see patients in the surgical clinic, and I’ll take the opportunity to ask them about their sexual health. But it might seem totally unexpected to the patient because they think they’re just going to get the results of their recent MRI scan or their mammogram and ultrasound, and they get their clinical breast examination,” Virginia said

“So, I think Belinda really covered it well in the talk today about the sorts of issues in terms of sexual health that people will experience, but what they’re actually going to talk about is a different thing.”

“I think they’ve got physical side effects from treatment, and one obvious side effect is that if they’re on hormone treatment, they have very little oestrogen or we’re hiding the oestrogen from the body and oestrogen is a really important part of sexual health,” said Belinda.

“So things like pain on intercourse, having a low or no libido, and we’re often treating patients at the time when they’re going through or have gone through menopause, and so these are issues that may even well predate their breast cancer diagnosis.”

“And then there’s a psychological element of a cancer diagnosis. How you manage the uncertainty of that fear of recurrence that plays into our sexual health as well. So, it’s complicated.”

“And maybe because it’s so complicated, we just don’t do it very well. Doctors are very good at fixing, one thing, but when you have multiple things feeding into a problem, I think we need some help.”

“And I think often the sexual health is not just about the person in front of you, it’s their relationship with the other person or persons that they have sex with or are used to having sex with, isn’t it?”

“And how you feel in terms of your confidence in a relationship with someone affects your quality of life and you know, your sense of wellbeing,” Virginia said.

“And I think you don’t need to be in a sexual relationship to have, sexual health needs, of course. And sometimes we make assumptions there if our patients are not partnered or not sexually active. But I think that’s wrong, and these are difficult issues for anyone to talk about, but it doesn’t mean we shouldn’t try,” said Belinda.

Do you think there are barriers that exist that might prevent patients from discussing their health, sexual health concerns with their health care providers?

“Well, there’s two things, I think one is that people generally feel that’s private, and therefore not something that they find it easy or comfortable to talk about, particularly in the age group we’re talking about as well,” said Virginia

“Because if you found someone in their early 20s, they might be more willing to tell you what sort of sexual activity they get up to. But the majority of people who are diagnosed with breast cancer, that’s not the case, but then I think they also do detect that doctors are uncomfortable talking about it.”

“And so, it’s potentially going to be a clunky conversation, and they’re not sure what they’re going to get out of it. So, I think that’s a massive barrier. It’s just about that both sides being able to communicate.”

“And I think if they feel they have to bring it up, rather than someone asking them, they’re probably thinking, well, maybe this is just me and no one’s mentioned this to me. It’s not written down anywhere. And so, maybe this is a problem that I’ll just have to deal with myself,” Belinda said.

“And that’s what the data suggests is that most patients are managing these problems themselves. But there is help out there.”

So, if a patient came in and they were experiencing these difficulties, what would you recommend to them? How would they initiate that conversation with their healthcare provider?

“I wouldn’t recommend that they initiate it because I think that’s not going to happen. So, I think it’s about the healthcare providers, or whoever it is to be able to bring it up and feel confident about bringing up the issue,” Virginia said.

“It’s about checking in and saying this is something I ask everyone because the majority of people going through treatment are going to be experiencing some sort of sexual health concern. So, is that something that you’re happy to talk about with me? Let’s have a conversation and see if there’s anything we can do to make you feel better.

“You may not have the answer to their problem and that’s ok, these conversations are ongoing. These problems are going to be ongoing for years. And you have to read the room a bit, and on the first consultation, when someone’s meets me, I don’t think it’s appropriate for me to give them the sexual health questionnaire to fill out, because they’ve never met me,” said Belinda.

“But you know, I think you need to get to know your patient and there’s a team involved here. It’s not just one person’s role, but if everybody thinks someone else is going to do it, it’ll never get done.”

“And coming back to it, we have short consultations with our patients. One of the biggest frustrations with our patients is we have no time to go through everything. And it’s really easy just to focus on, their treatment, you know, how is the tablet going?”

“Because my focus is that they must be taking the tablet, and you think that if we go into other things, maybe that’ll lessen their adherence to the medication. But actually, if you broach side effects of treatments and try to address them as best you can, there’s actually data to suggest that adherence goes up.”

And are there different support networks in place for breast cancer patients who are going through these sorts of things?

“If you use the My Journey app, there’s information through there, and they offer all kinds of resources for people to talk to about. I think Sexual Health Australia is another group as well that are online, and they’ve got information. Cancer Council too, so there’s quite a few resources available,” said Virginia.

What changes would you both like to see in clinical practice and research to better to support the sexual health of breast cancer patients?

“This is outside of breast cancer as well, but in medical oncology training, nobody teaches you this kind of thing. And it shouldn’t be part of our training because as we saw today, like most patients who are diagnosed with cancer, it can have substantial effects on their sexual health,” Belinda said.

“And if the only way you kind of plod through this is to treat more and more patients and start to understand and read the literature, that’s probably the wrong way around. So, I think it should be in training and even if it’s in medical school, that’s a long way, before you end up becoming a specialist in in the area.”

“So, and I think the training should be with lots of different professionals. This is not just the oncologist or the surgeon or the breast care nurse, but I think it’s important to have the physios in there, have OTS in there and things like that.”

“I think when I did that National Certificate of Sexual Reproductive Health, that introduced me to resources about opening the conversation about sex with people, such as who is it you’re having sex with, how many people you have sex with, how do you have sex, just in terms of habits and things like that,” Virginia said.

“But that’s only because I did that specific training, but there are still some resources available on the Melbourne Sexual Health Centre website, for example. There’ll be information on there for practitioners. But I think Belinda also touched on this earlier that there are resources in terms of staffing and personnel who have got time to address these things.”

“And also choosing who in that team is going to be the one to initiate this discussion. But I don’t think it can be just down to one person because I think if more people are asking, then it shows how important sexuality is and sexual health is as part of someone’s overall wellbeing.”

“Because we talk a lot about mental health, anxiety, depression, stress, because a lot of people in the world are experiencing that, not just people with breast cancer, but your sexual wellbeing is another part of you that’s just as important as everything else.”

“That’s so true. I think that as an example, everyone is on the bandwagon of exercise now. You come in with a breast cancer diagnosis and we’re like ‘do you exercise, you need to exercise’. And this is probably the next revolution we need within cancer treatment,” said Belinda.