Sexual health is difficult to define, but we know it when we see it. As defined by a technical report published by the World Health Organization in 2006, “Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.” Long considered “just” a quality-of-life issue, research points to much broader implications of impaired sexual health than previously understood.

Whereas the value individuals place on sex does vary, sexual health is central for many women in maintaining intimate partnerships and a sense of general well-being, and for some, the socioeconomic consequences of relationship strain can be immense. This concept of sexual health is further complicated in women with a diagnosis of cancer.

Female sexuality remains an element of well-being more likely to be discussed among girlfriends than with one’s physician. Although both physicians and patients indicate that sexual health is important, providers list many barriers to addressing these issues in women with cancer. Barriers include a fear of making the patient and/or provider uncomfortable, lack of adequate time, training or resources to address such concerns, lack of evidence-based solutions to problems that may arise, and/or a feeling that is the responsibility of the patient or another provider to raise these issues.

Despite these barriers to discussing sexual health with female cancer patients, research shows that sex is important to these patients, across age groups and cancer types, and that sexual problems are common. Perhaps most importantly, patients are interested in discussing sexual health issues with a provider, given the opportunity. Simply asking the patient whether she is having difficulties with her sexual function provides an opening to discuss her concerns, and use of a short survey can lead to a productive discussion about options for improvement.

In this issue, Lindau et al present a manifesto on the preservation of sexual function in women and girls with cancer. This clinical opinion details the many ways that sexual health may be impaired by cancer and its treatment, the impact this impairment may have on patients and their partners, and the importance of establishing evidence-based approaches for addressing these issues. Of particular importance is that it may not just be neglectful but indeed harmful to not talk about sexual health concerns.

As providers of gynecological care, our avoidance of conversations addressing the potential sexual consequences of cancer treatment communicates a message to patients that we as health care providers are uncomfortable and ill equipped to discuss these issues. From the patient perspective, the exclusion of sexual health concerns in the global counseling about cancer and its treatment conveys that it is less worthy of consideration than other health issues. The consequence is that patients often feel isolated to cope by themselves with the physical and psychological suffering associated with a change or loss in their sexual life. A particularly valuable aspect of the article by Lindau et al is to encourage us to confront this largely unmet patient need with the tools and resources needed to guide our patients.

Put into context, sexual health after cancer treatment is one of many survivorship issues that may have a profound effect on quality of life and indeed fundamental well-being. Other problems include fatigue, chronic pain, depression, sleep disorders, cognitive dysfunction (chemo brain) as well as the effects on finances, family life, and social relationships. The physician should not feel that he or she must address all of these problems at each visit or have the expertise to manage all of them. Rather, the recognition and the willingness to bring multidisciplinary expertise to assist in managing these concerns will benefit all cancer patients.

The emerging cancer survivorship movement emphasizes that cancer treatment is often just the beginning of a journey to cope with the consequences of the malignancy, beginning with diagnosis and continuing through treatment, surveillance, and hopefully cure. Cancer and its treatment may result in permanent life alterations. This is not to say that cancer cure is not paramount in the minds of our patients, but it is narrow to consider this the only goal. Helping patients to return to their fullest health in all of its facets, including sexual health, should be our goal. Cancer survivorship is more than just surviving cancer.