Salt-N-Pepa’s song "Let’s Talk About Sex" is the first thing I thought when jumping into this blog about sex and colorectal cancer: We don’t address this topic the way it deserved to be addressed. Or, if you’re into something with a little more “lights down” feel, I might recommend “Let’s Get It On” by Marvin Gaye. Between the two songs, I think we have the mood covered, and most everyone will know either of the tunes (or both!). Regardless the song, in this blog, we are driving home the subject of sexual health and colorectal cancer because it is a big deal and deeply affects quality of life.

Sex is a Big Part of Quality of Life

While developing the Path to a Cure Report over the past year, one of my absolute favorite discussions was, and continues to be, about survivorship and improving the quality of life for colorectal cancer survivors, and what this means in relationships and all aspects of life. This expansive topic includes the very human and biological experience of sex. The impact of a colorectal cancer diagnosis on sexual health in committed, casual, monogamous or polyamorous relationships, will undoubtedly be different for all ages and gender identities. 

Forty-one percent of all cancer survivors experience a decrease in sexual functioning and 52% experience changes in body image(1). For patients with colorectal cancer, the rates of sexual dysfunction can be even higher given the physiological changes that can result from surgery, chemotherapy, and radiation therapy(2). As the literature suggests, the majority of colorectal cancer survivors will remain sexually active after diagnosis – this is important! We need to address questions and concerns so we can live a happy and healthy life, and that means including sexual health as a part of the discussion. We want you to have great sex! But even good sex is a great thing!

So What’s The Issue? What’s Holding Us Back…And What Can We Do About It?

In the throes of a diagnosis, understandably treatment decisions and survival are typically the priority and leading discussion. Quality-of-life discussions are often overlooked, and there’s an embarrassment factor that looms large when talking about sex.

It is well-documented that patients feel like it’s “inappropriate’ to discuss sexual concerns, "particularly if the treatment goal is patient survival." In a recent study, 74% of survivors said that a discussion about their sexual health was important, but less than 40% of colorectal cancer patients received information from their care team about sexual health(3). Merely asking your oncology provider about sexual health can be a big factor in making sure your questions and concerns are addressed. But the responsibility for bringing up the topic of sexual health isn’t just for patients. Healthcare providers need to recognize the important of bringing up this subject and talking about it. Communication within your healthcare teams includes treating you as a whole person, not just a person with colorectal cancer.

Having open conversations with sexual partners can be difficult. Back to Salt-N-Pepa, who say it best, ”Let’s talk about all the good things and bad things that may be.” Based on a 2020 French study, partner distress negatively affects patients' sexual health. Because colorectal cancer is exceptionally stressful, communication will be key in relationships with patients and their partners. Good communication has a great impact on relationships, too (4). Expert Chelsea Holland talks about how to open up these discussions with sexual partners. 

Let's Get Down to Business

So, yes – now is the time for us to address scars, pain, stomas, and the needs for different positions. Then there’s all kinds of changes to the body, such as vaginal dryness, loss of pubic hair, fatigue, libido changes, loss of blood flow, decreased lubrication, discomfort, and erectile dysfunction, which must also be addressed. Sexual issues aren’t insurmountable, and a healthy and good sex life is not out of the question. Which makes me think of another great, sex positive song S&M by Rhianna, "Na na na come on, come on, come on. I like it, like it." Yes, colorectal cancer survivors can keep it spicy, too!

The next Path to a Cure Think Tank will devote a dedicated plan to prioritizing survivorship care. Sexual health will be a focus of this Think Tank as we further examine priorities for uptake of better patient assessments, stronger clinical implication, and policies to address the two main issues we addressed above, amongst others.

Now, what are your favorite sextastic songs and playlists? I’d love to hear, so please let us know in the comments!

References

1. Traa MJ, De Vries J, Roukema JA, et al. The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals. Support Care Cancer 2014;22:763-72 [PubMed] [Google Scholar]
2. Averyt JC, Nishimoto PW. Addressing sexual dysfunction in colorectal cancer survivorship care. J Gastrointest Oncol. 2014;5(5):388-394. doi:10.3978/j.issn.2078-6891.2014.059
3. Grimmett C, Haviland J, Winter J, et al. Colorectal cancer patient's self-efficacy for managing illness-related problems in the first 2 years after diagnosis, results from the Colorectal Well-being (CREW) study. Journal of Cancer Survivorship : Research and Practice. 2017 Oct;11(5):634-642. DOI: 10.1007/s11764-017-0636-x. PMID: 28822053; PMCID: PMC5602065.
4. Stulz A, Lamore K, Montalescot L, Favez N, Flahault C. Sexual health in colon cancer patients: A systematic review. Psychooncology. 2020 Jul;29(7):1095-1104. doi: 10.1002/pon.5391. Epub 2020 Apr 20. PMID: 32281129.