of reconstruction on sexuality and body image. The appendix titled “Reconstruction Options” addresses more questions women ask when they are faced with the decision whether they should opt for reconstruction, such as:
•Who should I consult with?
•Is it a good idea to talk with a plastic surgeon before I have a mastectomy?
•When can reconstructive surgery be performed? Does it have to be done at the same time as the mastectomy?
•What are the various reconstruction options?
•How much do these procedures cost? Will they be covered by my insurance?
•How long will it take for me to recover?
A Cauldron of Emotions—and Hope
Emotions often range widely from the time of diagnosis through treatment and thereafter. Depressed, positive, or somewhere in between, feelings are often volatile and driven by reaction to events or to the side effects of therapy.
The bedroom is a potential domestic war zone. Anxiety over what the future holds co-exists with worries whether the partner will still desire the woman after a mastectomy, or whether the woman with a gynecological cancer will still be able to be a good loving partner, even if she cannot handle intercourse. Post-surgery, nervousness accompanies the woman and her partner into the bedroom.
The emotional stage may be set in the hospital corridors, the treatment facilities, and other places, but it is at home where the drama plays out. Bombarded by the physical and emotional effects of the cancer treatment, it is easy for a couple to feel overwhelmed, lose their connection to each other, and start to drift apart. They may stop talking, stop touching each other, and become more and more isolated from each other, which will make them feel even worse. This is utterly unnecessary and entirely preventable.
The remaining chapters of this book provide you with the tools to overcome the considerable difficulty that cancer treatment can create for your love life. Rebuilding your self-esteem and taking steps to energize yourself are the basis for regaining your balance and being a strong and confident sexual partner and life partner. Some of the things you can do are discussed in Chapter 4. A person needs a good foundation for self-renewal.
The essential tripod of exercise, good diet, and sufficient sleep, along with the motivation for getting and staying well, are covered in Chapter 8. Chapter 5 sheds light on how partners can be helpful, and Chapter 7 has suggestions on how to best get help from your doctor. Chapter 10 has advice and observations for single women. Chapter 11 shows many techniques, exercises, approaches and devices that do not require pills and prescriptions, and Chapter 12 discusses prescription items and supplements that may address sexual dysfunction and you could discuss with your doctor. The very core of the book for couples are Chapters 6 and 9 - the essential question how to communicate with each other, how to regain the magic between you, and how to reinvent loving together.
A good sex life is about a lot more than the release of sexual urges. It is part of being healthy and happy, feeling connected to the person you love, feeling valued and desirable, giving of yourself and receiving love and affection, delighting in all your senses - in short, it is part of feeling fully alive. Isn’t it worth a little effort to get there?
Table 1: Major Cancers and Some Available Treatment Options
| Disease | Surgery | Radiation Therapy | Chemo Therapy | Other |
| Anal Cancer | Wide excision for anal margin tumors. Radical therapy: bdominoperineal resection removal of anus with permanent ostomy for anal tumors where anus cannot be preserved. | External beam or interstitial brachytherapy (seed implants). Radiation combined with chemotherapy to decrease local recurrence rate. | Chemo-radiotherapy has become standard of care for this disease. | |
| Bladder Cancer | Transurethral resection. Cystectomy. Radical cystectomy | External beam. Brachytherapy (interstitial) (seed implants) | Systemic chemotherapy (oral or infusion) | Intravesical immuno- therapy |
| Breast Cancer | Lumpectomy. Mastectomy (with or without reconstruction). Sentinel node (lymph node )biopsy and removal. Lymph node removal not recommended for early stage breast cancer based on recent research. | External beam.Brachytherapy (interstitial) (seed Implants) | Systemic chemotherapy (oral or infusion) | Monoclonal Antibody. Hormonal (selective estrogen response modifiers, i.e., Tamoxifen, or Aromatase inhibitors) |
| Cervical Cancer | Removal of the cervix. Hysterectomy. Radical trachelectomy | External Beam | Systemic chemotherapy (oral or infusion) | Hormone (Progestin).Cryotherapy (freezing) |
| Colo-rectal cancer | Bowel resection (with or without reconstruction). Laparoscopic- assisted. Abdominoperineal resection for anal tumors or low rectal cancer where anus cannot be preserved. Colonoscopy-polyp removal, sessile scraping | External beam. Brachytherapy (Needles, seeds, wires, catheters) | Systemic chemotherapy (oral and IV or IV alone, depending on stage). Chemo given to shrink tumor to try to spare anus. Many chemotherapy drugs are used for colon cancer. | Cryotherapy (freezing). Chemotherapy may be accompanied by a monoclonal antibody |
| Gynecological Cancer - see: Cervical Ovarian Uterine Vaginal | Total pelvic exteneration | External beam. Brachytherapy (intracavitary or interstitial) (seed implants) | Systemic Chemotherapy (oral or infusion). Cytotoxic chemotherapy | Hormone (Progestin). Intraperitoneal chemotherapy (only for ovarian) |
| Ovarian Cancer | Total abdominal hysterectomy, with removal of ovary, tubes and omentum (only for operable disease) | External beam. Brachytherapy (Intracavitary or Interstitial) seed implants | Cytotoxic chemotherapy used adjuvantly and palliatively. Intraperitoneal chemotherapy | |
| Rectal Cancer | See colo-rectal cancer | |||
| Uterine Cancer | Hysterectomy. Radical hysterectomy | External beam.Brachy- therapy (intracavitary or interstitial) (seed implants) | ||
| Vaginal Cancer | Partial or Radical Vulvectomy. Vaginectomy | External beam for those undergoing less radical surgical procedures | ||
| Vulvar Cancer |
Vulvectomy
Vulvar excision surgery
|