Doctors discuss sexual side effects of prostate cancer treatment much more often than they talk about such effects with women undergoing cervical cancer treatment, according to a new study. Both conditions are treated with brachytherapy, in which a sealed radiation source is implanted with potential impact on surrounding tissues in the genital area. This huge disparity exists, and yet, most women would like to discuss sexual health as part of their cancer therapy, earlier research says.
These results were presented this week at the American Society for Radiation Oncology (ASTRO) Annual Meeting. The study was led by Jamie Takayesu, MD, a radiation oncology resident physician at the University of Michigan Rogel Cancer Center in Ann Arbor, Michigan.
The researchers found that, among patients receiving brachytherapy at their center, nine in 10 men were asked about their sexual health, compared to one in 10 women. This is despite the fact that the women were on average younger than the men. The study also found a smaller but similar disparity in clinical trials nationwide by querying the NIH Clinical Trials Database.
Takayesu has experienced this first hand. “In my own clinical experience, I was having many conversations with men about their erectile dysfunction,” she said in her presentation. “I was not having the same conversations with women.”
Each year, roughly 13,000 news cases of cervical cancer and more than 220,000 new cases of prostate cancer are diagnosed in the U.S. Both diseases respond well to radiation therapy and other treatments, and an estimated 96% of patients with prostate cancer and 67% with cervical cancer survive at least five years after their diagnosis. Early-stage cervical cancer rates have gone down thanks to the HPV vaccine—this virus is thought to cause the vast majority of cases. But late-stage disease has increased among women who have not gotten the vaccine.
Between a quarter and half of the men who receive prostate brachytherapy will experience erectile dysfunction. But prostate cancer patients often have multiple treatment options, and sexual side effects are a common consideration when choosing between therapies.
With cervical cancer, however, there are less treatment options. Roughly half of the women who receive cervical brachytherapy experience sexual side effects, most commonly changes to vaginal tissue and dryness that can cause pain and discomfort.
The first part of this study involved a review of consult notes of 201 patients who were treated with brachytherapy for prostate cancer (n=75) or cervical cancer (n=136) between 2010 and 2021. The researchers found that 89% of men, compared to 13% of women were asked about sexual health at their initial consult.
In their assessment of clinical trials nationwide, the researchers found that prostate cancer trials, compared to cervical cancer trials, were significantly more likely to include sexual function as a primary or secondary endpoint (17% vs. 6%, p=0.04).
Treatment options probably play a role in this trend, but physician comfort in talking about sexual dysfunction may also be a factor, said Takayesu. “Culturally, there are differences in how we talk about sexual dysfunction that affects men versus women. We see ads on television about erectile dysfunction, for example, but there’s no equivalent to these for women.”
That may be because there are no FDA-approved medications specifically for female sexual dysfunction, although multiple options—medications, implants and other treatments—re available for male impotence.
“The only tools that we commonly recommend for women are lubricants and dilators, but even these are not great options,” said Takayesu.
Until more research is conducted to find effective medical options for female sexual dysfunction, interventions such as pelvic floor therapy can provide some relief for patients, she said. Sexual function might also be better preserved through modifications, such as optimal placing of the brachytherapy sources or tailoring their radiation doses differently.
