Along with the fatigue, nausea, and brain fog that often accompany treatment for breast cancer, many women face another issue as well — changes to their sexual function.
“The most common type of breast cancer is hormone-positive, and those patients are on long-term medications that lower or block estrogen,” says Ashley Arkema, FNP-BC, MS, a nurse practitioner in the Division of Surgical Oncology at the University of Colorado Department of Surgery. “People going through chemotherapy can have some of these issues. There can also be body image issues secondary to the treatment or the surgery that they receive.”
That’s why Arkema recently launched S.H.I.N.E. (Sexual Health Information and Navigation Through Empowerment), a sexual-health clinic where she meets with patients — and often their partners — to talk about cancer treatment side effects such as vaginal dryness and irritation, pain during sex, lowered levels of desire and arousal, body image issues, and hot flashes.
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Four members of the breast cancer team in the CU Department of Surgery were included in 5280 magazine's Top Doctors list for 2025: |
“Typically, we'll do an assessment, sometimes a vaginal exam, and then prescribe things like nonhormonal lubricants, moisturizers, vaginal dilators, or local vaginal estrogen, which is localized and, in most cases, safe to use with a history of breast cancer,” she says. “It depends on what the issues are. We can also refer people to pelvic floor physical therapy, a psychologist, or a sex therapist through the university.”
Arkema also prescribes medications to increase libido and arousal and answers questions about navigating dating and relationships while undergoing treatment for breast cancer. For women who have undergone complete or partial mastectomies, she works on issues around body image and loss of sensation. Most people come in for at least two appointments at the clinic, which is located in the outpatient pavilion at UCHealth University of Colorado Hospital.
“Sex is definitely part of people's quality of life,” she says. “There are patients who discontinue some of their cancer therapies as a result of these side effects, so it's important that we address them. Not just for their quality of life, but also to improve medication adherence and prevent recurrence.”
Sexual health can be a difficult issue for patients to talk about, Arkema says, but she wants women with breast cancer who are experiencing such issues to know they’re not alone — and that there is help available.
“The majority of patients are dealing with these issues, but they're not bringing it up unless their oncologist brings it up or asks them first,” she says. “We're putting out flyers in the waiting room, and the medical oncology nurses and providers are telling patients, ‘If you're having these issues, this is a common thing that a lot of people with breast cancer experience, and we have this clinic if you're interested.’
“It's important that we as the clinicians bring it up, but it's understandably difficult for oncology providers to have a full conversation about all of this because they have many other things to cover during the visit,” Arkema continues. “We just want to give these women a space where they can come and have these issues addressed.”