Written for Uterus1 by Eliza Shirazi
Sharon Bober, Ph.D is a clinical and research psychologist at the Dana-Farber Cancer Institute and an Assistant Professor in the Dept of Psychiatry at Harvard Medical School. She is also the Director of the Sexual Health Program at the Dana-Farber, a multi-disciplinary program that provides care for survivors of adult and pediatric cancer and the only sexual health program for cancer survivors in the state of Massachusetts.
Dr. Bober’s clinical and research efforts focus on management of side effects of cancer treatment and developing effective sexual health interventions in order to improve quality of life. Dr. Bober currently has funding from the National Cancer Institute to develop a sexual health intervention for young high risk women who undergo prophylactic oophorectomy. In addition to her research and clinical work, Dr. Bober regularly teaches physicians about how to address sexuality after cancer in a straightforward manner.
Dr. Bober became a doctor to try to understand why people do what they do. “Helping people feel a greater sense of choice and personal empowerment, even in the face of serious challenge, is a truly rewarding experience.”
She believes that sexual health is a vital quality of life issues. As a behavioral medicine psychologist, she takes an integrative perspective on human experience. “Sexuality is an experience that really is at the intersection of mind, body and relationship, and cancer treatment can impact all three of those elements,” says Dr. Bober.
Dr. Bober's messages for cancer survivors struggling with their sex life:
You are not alone on this issue.
Sexual dysfunction deserves as much attention as any other quality of life issue.
Sexual issues are not embarrassing or shameful.
There are treatments out there that really works.
Treatments for cancer cause patients to have sexual dysfunction. “All of the major therapies used to treat cancer, e.g., surgery, radiation, chemotherapy and hormonal therapy, all have the potential to seriously disrupt sexual function both in the short term and also over time,” states Dr. Bober. She gives the example of when younger women undergo chemotherapy. Dr. Bober explains that “one of the serious side effects of this life-saving treatment is the likelihood of facing sudden, premature menopause.” The treatment-induced menopausal symptoms can cause an impact on ones sexual life.
Dr. Bober regularly encounters patients who are embarrassed about their sexual issues and many don't know there is help available. Many patients suffer from a change in their sexual function after caner treatment. Furthermore, patients become worried because they are not sure who to speak to. “Despite living in a culture that is saturated with graphic sexy images, we also live in a culture that does not encourage frank and open conversation about real sexual experience. Often people feel embarrassed about these issues and they aren’t even aware that help exists.” For many, the Dana-Farber Sexual Health Program provides relief because it is a place where they can voice these issues.
There are many resources available for those who are suffering. Dr. Bober notes, "We work closely with a team of physical therapists who focus solely on the pelvic floor muscles. Pelvic PT is an incredibly underutilized resource for both men and women who have undergone pelvic radiation and are dealing with tissue atrophy." Many medical providers and patients are not aware of this treatment.
Dr. Bober has high hopes for women having more options for certain cancer-related surgeries. As things develop in oncology treatment, Dr. Bober assumes that it will be helpful for sexual function. "At this point women who are at very high risk for ovarian cancer are advised to have their ovaries removed at a relatively young age because screening for ovarian cancer is still not as good as we hope it will be one day.” Although this is a life saving procedure, it can have an immense impact on sexual function. Dr. Bober hopes that women will have options other than surgical menopause to manage ovarian cancer.
Dr. Bober wants people to become comfortable with discussing sexuality. She finds it difficult to spread the word to patients and doctors that it is okay to talk about sex after cancer, “Often doctors don’t want to bring up the topic for fear of embarrassing their patients and patients don’t ask because they don't want to embarrass their doctors.” Dr. Bober further explains that sexual health is a vital quality of life and should not be ignored.
One of Dr. Bober's more memorable stories includes an older couple. Before the wife was diagnosed with breast cancer, they had a wonderful intimate life, but afterward there was a struggle. “After undergoing a course of coordinated care with myself, our clinic gynecologist and a pelvic physical therapist; their experience was like night and day. This couple was not only able to resume sexual activity pain-free but they talked about feeling young again, like they had a new lease on life,” says Dr. Bober.
She is preparing to start a National Cancer Institute-funded intervention for young women who have their ovaries removed at a young age to mange ovarian cancer risk. "This is a population of women who receive little attention even though they are at risk for cancer and have cancer risk-reducing surgery which causes profound sexual problems for the majority of these young women," says Dr. Bober.
Dr. Bober shares her big message. “Don’t be afraid to ASK for help! Find one person on your treatment team that you are comfortable with, maybe your doctor, maybe a nurse or social worker, and tell them that things aren’t the same with sexual function since cancer and that you need some help.” Even more so, Dr. Bober wants people to know that effective help is out there and not to be scared to look for it. “We have great information on the website of the Dana-Farber Cancer Institute connected to the Sexual Health Program. (www.dana-farber.org) and patients needs to remember that even though their doctor might not bring up the topic first it does not mean that this aspect of their experience does not deserve attention,” expresses Bober.
A final word from Dr. Bober. “I hope folks realize that they are not alone and that sexual dysfunction is a real quality of life issue that deserves as much attention as any other quality of life problem. It is not something embarrassing or shameful; there is treatment out there that really works. It is just a matter of figuring out how to access the resources, and that can definitely be done.”