Talia Helman, MD, on sexual quality of life in female patients with bladder cancer

In this interview, Talia A. Helman, MD, shares the key findings from the study, “Exploring Female Bladder Cancer Survivorship: Patient Perspectives on Sexual Health Challenges and Resilience When Receiving Bladder Sparing Therapies,” which she presented at the 25th Annual Fall Scientific Meeting of the Sexual Society of North America. Helman is a fourth-year resident at Emory University School of Medicine in Atlanta, Georgia.

Video Transcript:

This study was a pilot study. We had 18 participants that we were able to get ahold of and interview. I personally called women in our database that have had non–muscle-invasive or muscle-invasive bladder cancer that have not received a cystectomy. After informed consent, we went over the interview questions with them. I wanted to make sure that it was an actual interview vs a survey design, because I wanted to hear what these women had experienced and how many years they had been experiencing these symptoms. For a lot of women, they've been dealing with this bladder cancer diagnosis for years, and I wanted to hear their feedback and listen to them. Although our n is low, we only had 18 participants, it was still extremely informative.

From this, we interviewed the patients. We gave the female sexual function index survey for those that were sexually active. Then we also [included] their baseline characteristics, demographic information, tumor characteristics, stuff like that. The data that I am going to focus on is the interview data. There's not a lot of profound statistical data that we can gather from this, because our n is so low at 18.

Of the patients that we interviewed, only 5 of them were sexually active. For the sexual function index, you need to be sexually active in order to qualify to take the survey. One of the first questions it asks is, “Have you been sexually active in the last 4 weeks?” Only 5 women were sexually active, which, if you think about the diagnosis of bladder cancer, it's going to be older women. The main takeaway from those 5 women is that only 1 of the women had sexual dysfunction. It's hard to say [if it was due to] her bladder cancer or other factors such as depression or anxiety. We [did] ask about [these,] but with only 1 woman having dysfunction, you can't [attribute] blame to anything.

After doing a literature review about cystectomy patients and how devastating it is for female sexual function after having a cystectomy, [my main takeaway from this study is that] it seems that women tolerate the intravesical treatments well. They don't [seem to] cause too much disruption to their sexual health. Some of the quotes that we got from women were that at first they were scared or they didn't know what to expect, but then afterwards they realized that it didn’t have as much effect as they thought it was going to, especially on their sexual function.

Some women talked about the urinary symptoms. They had increased urinary incontinence or urinary urgency, which made them a little bit embarrassed when they were having sexual intercourse. One woman said that she just pees before she starts, and that's all she needs to do. [There were] stories like that of female resilience as they're going through a cancer diagnosis, and how to navigate that to have the quality of life that they wanted.

A lot of women talked about vaginal estrogen. Even among the women that were not sexually active or those that [said] bladder cancer didn't affect them at all as far as their sexual activity, many of them touched on the benefits of vaginal estrogen on lubrication and pain. We've seen this with our non-bladder cancer patients in the perimenopausal stage as well.

Some other interesting things that women talked about were this fear of everyone being down there. One woman said, “There’s a lot of people down there; everyone's always in your business.” I really felt that as someone who's had to do these procedures on women. If you have fear of it, or you maybe had a bad experience 1 time, I can see how that affects people as they're getting their treatments.

One woman who it really affected said, "You get afraid of having sexual intercourse. You don't want to disrupt what's going on there. Your partner is nervous too. Everything is too close going down there." One woman said, "It did at the beginning, and then it was okay. It was a shock when you have cancer, no symptoms. That made me not want to have sex, though. But after the surgeries, I take some breaks. I need some time." That was a common theme as well is that women have their cystoscopies for surveillance of their bladder cancer, and then they usually took a day or 2 off of any kind of sexual activity afterwards, just for their own reasons. They couldn't really describe it; they just wanted a break. They felt that their partners were receptive of that as well.

For the other cohort of patients, the ones that were not sexually active, it was [pretty] black and white. [We'd ask], "Are you sexually active currently? Do you wish to be in the future? Do you have any interest in this?" For the women that weren't sexually active, they said, "Bladder cancer does not affect my sexual activity. I'm just not sexually active for X, Y, and Z." Maybe they lost their partner, maybe they're dealing with some health issues. They felt like it was a non-issue for them; out of all things in their life, bladder cancer was not the reason that they were not sexually active.

This transcription has been edited for clarity.