Mental health and cervical cancer

Mental wellness

While the psychological impact of cervical cancer on a person’s well-being depends on their own circumstances, there are common concerns and patterns identified amongst cervical cancer patients. In a study by De Groot et. al, major concerns amongst women and their male partners were identified as communication with the treatment team, treatment-related concerns, prognosis, sexuality, cause/risk of transmission, relationship with their partners and relationship with others [15].

In the same study, females were more impacted than their partners by the onset of fatigue caused by cancer and its treatments. Fatigue is an often overlooked symptom in in cancer patients. Notably, both women and their partners also reported that the greatest disruption was in the domain of intimacy defined by their spousal relationship and sex life [16].

Self-esteem, body image and stigma

Cervical cancer and its treatments can affect a woman’s self-esteem and body image as well because of how cancer or cancer treatments change the body such as [17]:

Cervical cancer and its treatments can also alter how patients view their bodies and gender, especially after procedures like a hysterectomy or pelvic exenteration. A patient may feel less like a woman or less feminine because she no longer has a uterus or has undergone vaginal reconstruction. Feelings of self-consciousness, embarrassment and frustration may also arise because of altered urination or bowel movements after a pelvic exenteration. Changes to the body, whether temporary or permanent, can cause considerable distress to cervical cancer patients, even though the effects of treatment may not always be visible to others. Some patients may fear exposing themselves to others in fear of rejection. Seeking out counselling or group support may help patients improve their self-esteem and body image. 

The psychological and physical impact of treatment

The impact of cervical cancer on sexuality

As cervical cancer is a gynecological cancer, it can have a distressing impact on the sexuality and sex life of the affected individual. Cervical cancer treatments can affect fertility, bring on early menopause and cause side effects that affect sexual activity [18].

Sex and cervical cancer

The interest in sex, maintaining or resuming a sexual relationship with their partner will be dependent on where a person is in their cancer journey. It is fairly common to have a lower sex drive for many around the time of diagnosis and treatment [19]. Some cancer treatments can make sex painful or difficult: radiation therapy for cervical cancer can be quite intensive and can cause fibrosis and the narrowing of the vagina, vaginal dryness, pain when having sex, and delicate skin inside the vagina [20].

It is certainly possible to resume a normal sex life within a few weeks of finishing radiotherapy or having surgery. It is also important to remember cervical cancer itself is not infectious. While cervical cancer is linked to HPV, which can be passed onto your partner, it is important to remember not everyone who has the virus develops cancer [21].

Anxiety and fear about resuming sexual activity is common amongst patients who have finished treatment. Feelings of anxiety or depression are likely to limit any desire for sexual activity. It can take time for partners to feel comfortable with each other again [22]. Being patient, open and honest with yourself and your partner will make it easier to work out what is best for both of you. Some women and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

Early menopause and cervical cancer treatment

If the patient has not yet had menopause, the treatment may bring on an early menopause. This will happen if you have:

Sometimes the surgeon may suggest leaving the ovaries behind if the menopause has not yet occurred, but that is not always possible. The removal of the ovaries will cause an immediate menopause.

Radiotherapy will cause early menopause because it stops the ovaries from working. It is the ovaries that produce sex hormones, the ovaries stop producing these hormones at the natural menopause. The symptoms of a menopause that is related to cancer treatment are no different than those of a natural menopause, but they can be more intense if it comes on suddenly.

In some cases it may be possible to move the ovaries out of the area where you are having radiotherapy (the radiotherapy field) and prevent an early menopause. This can be performed with a keyhole (laparoscopic) surgery. This may help prevent you from going through an early menopause.

Losing fertility

If the early cervical cancer is not at an early stage, treatment for cervical cancer will mean that the patient may no longer have children. Even if you were not anticipating having any (or any more) children, this can be quite a shock. It is the end of a phase of life, all of which has to be dealt with on top of a cancer diagnosis. Naturally, many patients feel very upset if they need to have a hysterectomy, even if the patient has gone through menopause. It may take some time to get over these feelings. Seeking out counselling or just someone to talk to may help you deal with feelings of grief, frustration or anger.

Pre-cancer treatment and pregnancy

Unless you have a hysterectomy, treatment for pre-cancerous changes will not affect your ability to become pregnant. For most women, treatment will not cause problems during future pregnancies. But with cone biopsy and LLETZ (large loop excision of the transformation zone) , there can be a small increase in risk of giving birth early, or having a low birth weight baby. This may seem worrying, but bear in mind that the risks are small. Laser ablation is not linked to any pregnancy risks.

[24] Information taken from Cancer Research UK, read more here

Cancer Research UK – Your sex life and cervical cancer
Cancer Research UK – Fertility and cervical cancer


 

Reference 

[15] De Groot, J. M., A. Fyles, S. Winton, S. Greenwood, A. D. Depetrillo, and G. M. Devins. "The Psychosocial Impact of Cervical Cancer among Affected Women and Their Partners." International Journal of Gynecological Cancer15.5 (2005): 918-25. Ovid. International Journal of Gynecological Cancer, Oct. 2005. Web. 20 Aug. 2015.
[16] ibid.
[17] "Supportive Care for Cervical Cancer." Canadian Cancer Society. Canadian Cancer Society, 2015. Web. 20 Aug. 2015.
[18]"Your Sex Life and Cervical Cancer." Cancer Research UK. Cancer Research UK, 10 June 2014. Web. 20 Aug. 2015.
[19] "Supportive Care for Cervical Cancer." Canadian Cancer Society. Canadian Cancer Society, 2015. Web. 20 Aug. 2015.
[20]"Your Sex Life and Cervical Cancer." Cancer Research UK. Cancer Research UK, 10 June 2014. Web. 20 Aug. 2015.
[21] ibid.
[22] "Supportive Care for Cervical Cancer." Canadian Cancer Society. Canadian Cancer Society, 2015. Web. 20 Aug. 2015.
[24] "Fertility and Cervical Cancer." Fertility and Cervical Cancer. Cancer Research UK, 10 June 2014. Web. 20 Aug. 2015.