PRISM Clinic Helps Female Cancer Patients Thrive

Prism clinic
Photo by David Christopher

Stacy Tessler Lindau, MD, director of the PRISM clinic and associate professor of obstetrics/gynecology and geriatrics, (center) and nurse practitioner Stacey Sandbo, NP, (left) discuss treatment options.

By Allison Horton

Sex doesn’t have to end after cancer. Women who have undergone treatment for cancers that affect sexual organs can participate in an innovative program at the Medical Center that specializes in improving the sexual lives of cancer survivors.

The Program in Integrative Sexual Medicine (PRISM) opened October 2008 to provide care for women and girls who have or had cancer and experience sexual problems such as vaginal dryness, low libido and pain during intercourse. Some of the cancers these patients have faced are breast cancer and gynecological cancers like uterine, cervical and ovarian. PRISM, part of the Department of Medicine, also sees women whose partners have cancer, for example spouses of men with prostate cancer.

“As more people survive and live longer after cancer, there’s more of an opportunity to resume a sexual life,” said Stacy Tessler Lindau, MD, director of the PRISM clinic and associate professor of obstetrics/gynecology and medicine-geriatrics. “For many people with cancer, an intimate or spousal partnership is really the most important relationship in their life.”

During the initial clinic consultation, the health, sexual function and medical history of the patient and her sexual partner are discussed, Lindau said. The initial consultation can be very emotional for patients. Often, it is the first time that they’ve talked about sexual issues with anyone.

Patients can be counseled prior to surgery or treatment on how their sexual function might be affected. During the initial consult after treatment, Lindau said patients are educated about sexual issues and are shown models of sexual organs to demonstrate how their sexual function might have been affected by treatment.

“We let the patient know that she is not alone,” Lindau said. “Other women with her cancer type have had these sexual problems and have been able to recover a satisfying and pleasurable sexual life.”

The second visit includes a detailed physical exam and a treatment plan. Patients are encouraged to participate in the gynecologic exam by using a hand mirror, a map of the vulvar anatomy and by using photography to help the patient see and understand her anatomy and the changes that have occurred. Many women are unfamiliar with this part of their body — it’s physically difficult to see — which can sometimes make it difficult for them to describe and understand their symptoms, Lindau said.

The PRISM clinic is supported by the Comprehensive Cancer Center and works with Northwestern University psychologist Shirley Baron, PhD, and private practice physical therapist Judith Florendo, PT, to provide additional help to patients such as sex therapy, couples therapy and pelvic physical therapy. The clinic works very closely with Diane Yamada, MD, director of the Section of Gynecologic Oncology.

“I am enthusiastic that we have a formal program to offer patients,” Yamada said. “We want to want to help our cancer patients thrive as much as possible after treatment. Restoring sexual function is an important part of that.”

Patients typically have three to four visits at the clinic during a three- to six- month period. The clinic also collaborates with the patient’s gynecologist, oncologist and primary care physician. Patients who also need sex or physical therapy commonly have an additional six to12 weekly visits and then periodic check-in visits. Pelvic physical therapy can be helpful for patients with conditions that require vaginal dilation or therapies to relax and retrain the pelvic and related muscles. Sex therapy engages patients and, if desired, their partners in psychotherapeutic strategies to address sexual concerns.

The PRISM clinic educates its patients to know that, as they age, they may experience relapse or new health issues that can affect their or their partner’s sexual function, Lindau said. Patients are encouraged to re-visit the clinic if the problems reoccur.