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Understandably, not having a libido and all my bits and pieces has made dating challenging, but I’ve been single most of my life and happen to really like Netflix. As for doctors who downplay the damage, dismiss concerns or don’t have the skillset to respond to their patients’ inherent needs, both Lyman and Syrjala made it clear those physicians are not serving their patients. “In fact, it discourages the conversation and discourages patients talking about it even further.” “None of us are taught how to actually have a conversation about sex,” said Leslie Heron, a nurse practitioner who helps patients deal with all the collateral damage of cancer treatment at Seattle Cancer Care Alliance's Survivorship Clinic.Fred Hutch file photo But doctors aren’t the only ones who don’t talk about cancer’s sexual aftermath.“Sometimes there’s just no intimacy anymore,” said Heron.“Patients and their partners get into more of a caregiver-patient role instead of being in a lover-partner role.But for whatever reason, most of us talk about the mechanics of sex about as readily as we talk about the mechanics of other normal, healthy functions like, say, pooping. Luckily, I’d reached out to other patients so I had an inkling of what was to come.I knew that even a nipple-sparing mastectomy would eliminate two key players on the team, leaving my chest a dead zone — no nerves, no feeling, nothing.I remember my oncologist telling me about hair loss, but did she mention my pubic hair would also fall out? She also brought up hot flashes when I started tamoxifen, but she didn’t say that as soon as I started taking the estrogen-blocking drug, I’d feel like my sexual antenna had been snapped off. While some received great proactive care or had few side effects, many more talked of dismissive doctors, flummoxed partners and their frustration over a new normal that was surprisingly asexual. And not bringing it up, is “remiss.” “Any chemo regimen can lead to problems and the physician has to understand that this is something patients may be reluctant to bring up,” said Lyman.If men were putting out signals, I was no longer able to read them; it was like everyone was suddenly speaking a language I’d somehow forgotten. One patient, thrown into “chemopause” when she started treatment at age 39, put it this way: “I’d only been married for two years when suddenly I was post-menopausal, fat, bald, had a dented boob, no libido and a painful vagina. “It can have a fairly profound impact on their quality of life.

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“It depends on the diagnosis and type of treatment,” said Dr. Most patients wait for their doctors to bring up the whole sex thing but doctors are often too uncomfortable — or too pressed for time — to do so.

But not all breast cancer patients know this going in.

I still hear horror stories about women who have mastectomies then turn to their doctors in puzzlement when their skin and/or nipples remain numb.

Karen Syrjala, co-director of Fred Hutchinson Cancer Research Center’s Survivorship Program, “but in prostate cancer we see sexual dysfunction in over 90 percent of men and in women with breast cancer or bone marrow transplants, we see rates that are around 70 percent.” All cancer treatment zaps your energy, though, and most messes with your hormones — at least temporarily. In a 2010 Livestrong report, 43 percent of the 3,000-plus cancer patients surveyed had physical problems related to sexual functioning and only 13 percent got help for them.

“Survivors may live five to 50 years after treatment,” said Syrjala.

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