How can sexual health and wellness be better supported in women living with cancer? Lori Seaborne, PA, is dedicated to ensuring sex is not left out of the cancer treatment conversation. PA Seaborne works at the University of Wisconsin Breast Center and was one of the creators of the Women’s Integrative Sexual Health (WISH) Program, where she and her colleagues Joanne Rash, PA, and Megan Peterson, NP, tend to the sexual health concerns of women diagnosed and being treated for cancer. Doximity interviewed PA Seaborne on the nuanced experiences and needs of women living with cancer and how clinicians can have “the talk” with them.

Doximity: What does optimal sexual health and wellness mean to you? 

Lori Seaborne, PA: Mental, emotional, and physical health are intertwined with sexual health. And when it comes to sexual health there are two areas. One is sexual function, which for women [can be asking], “Are you able to have penetration without pain? Are you able to have arousal? Are you able to reach orgasm?” 

Sexual function is “can you get your body to do the things you want it to?” and sexual well-being is “do you have comfort with your sexual self?” It’s the mental and emotional parts of sex. Do you feel comfortable in your body? Are you comfortable communicating with your partner? Can you say what you need? Do you get pleasure? Are you comfortable allowing yourself to get or give pleasure? Does it feel like your sex life lifts you up as opposed to being something that takes energy — or something else — away from you? 

Dox: How has your training/experiences as a PA prepared you for this kind of work? 

LS: When I took my first job at a cancer center, I didn’t go there searching to become a sexual health provider or expert. The women brought this to me. 

For 11 years, I worked in gynecologic oncology. My patient population was women who had been diagnosed with ovarian, uterine, cervical, vaginal, and vulvar cancers. The treatments that they received were hysterectomies, pelvic radiation, chemotherapies that rendered younger women postmenopausal, etc. Those kinds of treatments very directly impact sexual organs. 

I wasn’t there long before women started asking me questions like, “When can I expect my sex drive to come back?” They felt like they had more space and time in their visit with me to bring up these issues. I worked with some very caring physicians, and I think sometimes the patients saw them as the person who cured their cancer. Whereas with more time and space with APPs like PAs and NPs, they will bring up things that they wouldn’t bring up with their doctor. And you know, with sex, people are timid. It’s private. It’s embarrassing. A person has to feel safe in bringing it up. 

Now I work with breast cancer survivors. And it’s the same situation. They have different reasons for their sexual health problems. They’re not having genital surgeries, but they are having mastectomies and reconstruction surgeries, which can render their entire chest and abdomen to have numbness and changes in sensation. They’re taking aromatase inhibitors that can sap out the estrogen in one’s body and cause sexual function changes like extremely dry and thinning tissues and bleeding. Now I ask all of my patients if they have sexual concerns; they don’t have to ask me. I bring it up to them because patients may think it’s not important nor worth my time. I do think NPs and PAs have a special opportunity here.

Dox: What are the unique sexual health challenges women living with cancer face across different life stages? 

LS: There’s a big difference. Let’s say I meet a 52-year-old woman who’s already gone through menopause who is diagnosed with uterine cancer and has her ovaries and fallopian tubes removed. She’s already maybe experienced vaginal dryness and may have already incorporated lubricant into her sex life. And her fertility is not an issue or a question anymore. 

Cervical cancer is one of the gynecologic oncologic malignancies that sometimes happens in younger women. And for those women, they are blindsided by the changes. For instance, cervical cancer is sometimes treated with pelvic radiation therapy, which is disastrous to the health of the vaginal tissues. It will create stenosis and can cause agglutination which will make penetration almost impossible for some. So for that young woman, she suddenly has a vagina that doesn’t work. 

Or there’s the 29-year-old woman who’s never had babies and doesn’t know if she ever will because for the next 10 years she has to be on an endocrine therapy to stay alive, and by the time she’s done she won’t know if her ovaries will still work. Fertility and rapid sexual changes are the two things that I think about in a younger patient. 

Older women already have some understanding of menopause, so that itself is not necessarily something new, but for them, potential issues are with self-worth and self-esteem. And worries about mortality. 

Dox: How do you support self-love and beauty among your patients?

LS: When I’m talking to women and they mention to me, “I don’t feel beautiful anymore” or “I don’t think my partner finds me beautiful anymore,” I tell them, “You have to look in the mirror and say affirmations to yourself because you are a worthy person.” 

I have suggested [to patients] standing in front of a mirror with a light on and looking at your body and saying things like, “This is my new, beautiful, healthy body.” And to touch your scars and let tears come if they come. Scars are evidence that you are stronger. 

Dox: What advice do you have for clinicians who are wary of talking about sex with their patients living with cancer?

LS: My advice is to do it anyway. There are sexual health resources everywhere and more programs like the WISH program popping up around the country. And there are online resources. The Scientific Network on Female Sexual Health and Cancer is a fabulous resource. The American Association of Sexuality Educators, Counselors, and Therapists is a great organization with sexuality counselors and sex therapists in every state. 

The number one thing is to treat [sex] like any other part of their health. You ask people, “Are you having neuropathy from your chemotherapy or nausea, pain, etc?” It’s easy to add in the midst of that list, “Are you having sexual function or sexual health concerns?” You don’t have to have all the answers, you just have to have a few resources. 

This interview was conducted by Angelica Recierdo, MS, BSN, Doximity Editor.