Sexuality and intimate life are integral parts of supportive oncology care. It is important for “oncosexuality” to develop and for intimacy not to be neglected because it is a key driver of quality of life. In this context, dyspareunia is common throughout the care journey for women with cancer. Carine Martin, gynecologist-sexologist at the Hospital Center University De Lille, Lille, France, outlined how to raise the issue and current treatment options at the 16th National Congress of Supportive Oncology Care, organized by AFSOS (Association Francophone des Soins Oncologiques de Support), held October 15-17, 2025, in Lille, France.

Who Is Affected

Dyspareunia and sexual morbidity are common in cancer and involve nearly all cancers and treatments. They are primarily linked to treatments for cancers in the pelvic, urinary, gynecologic, and digestive tracts but also occur with cancers far from these areas.

Brachytherapy, radiation for cervical and rectal cancers, and surgery can lead to fibrosis, stenosis, and impaired healing. Hormone therapy, frequently used for breast cancer, as well as chemotherapy, can significantly affect mucosa and tissues and reduce their elasticity. Ultimately, all cancers and their treatments can negatively affect sexuality and cause pain directly or indirectly, regardless of site, sex, or age.

Diagnosis Timing

Assessment of sexual health and intimate life should begin at diagnosis disclosure and continue throughout care. The topic should be introduced gradually by asking how patients feel about their current intimacy. Some will take the opportunity to open up; others will not, and that should be respected. For those who report difficulties, proceed step by step by asking about pain location and intensity and the presence of vaginal dryness and by performing a clinical exam.

The patient’s experience and the partner’s support are important. Physical and psychological distress can be substantial because cancer disrupts a couple’s dynamics and intimacy — whether due to altered body image or the clinical consequences of the disease and its treatments. Cancer creates significant physical and psychological vulnerability that should be eased. When sexual dysfunction is present and distressing, treatment options are available.

What Are the Treatment Options?

When pain is related to vaginal dryness, first-line treatments include vaginal moisturizers or lubricants in suppository or cream form, which may contain local estrogen, vitamin E, or hyaluronic acid. In cases of vaginal stenosis or fibrosis, some midwives or physical therapists offer manual release techniques to restore tissue elasticity.

Vaginal dilators can also help with home retraining. These kits include tubes of different diameters; women are advised to start with one that is uncomfortable but not painful and gradually progress to a size comparable to an erect penis. If these options are ineffective or insufficient, other approaches can be considered: injections of platelet-rich plasma or hyaluronic acid and sessions of photobiomodulation or radiofrequency therapy to stimulate tissue regeneration.

Role of Primary Care

Sexuality has long been taboo, even though intimacy has a major impact on quality of life. Every professional should be able to address it with tact and discretion. Primary care physicians should feel comfortable asking patients about their intimate lives without waiting for them to raise symptoms — something many hesitate to do on their own. Even if patients do not answer immediately, they will know “the door is open” to talk later.

Clinicians can help reduce the pressure patients often feel to meet their partner’s expectations, or what they believe those expectations are. It is important to accept the body’s temporary silence and recognize that intimacy does not only — or necessarily — mean genital sex. Many assumptions are upended, and sometimes sexuality needs to be reinvented. When situations are complex, referral to a sexologist may be appropriate, and practitioners should maintain a list of specialists for referral when needed.

This story was translated from Univadis France, part of the Medscape Professional network.