2023-10-03 07:02:36
On the occasion of Pink October, doctors Léa Barreau and Anna Gosset, clinical heads at Toulouse University Hospital, will give this Tuesday, October 3*, at thePaule-de-Viguier hospital, a conference on sexuality, fertility and contraception after breast cancer. Gynecologist Anna Gosset tells us more.
Why is it important to talk about sexuality, contraception and fertility during the month of October?
Léa Barreau: When a woman is affected by breast cancer, for the vast majority, it is a widely raised question… Young women who will have breast cancer, it is still relatively common. And when we are at the stage of diagnosis and illness, of treatment, we don’t have much time to discuss these subjects in general. We are focused on healing, so often these are subjects we forget to talk about. However, it is important to have some practical information on what is possible or not in terms of contraception and fertility. There are also a lot of preconceived ideas in this area because we have made quite a bit of progress on the medical front. There were things that were not at all possible before that are now being done, for example for the preservation of fertility.
Do cancer and treatments affect patients’ fertility and their sexuality?
It’s different depending on the treatments. Young women will often have chemotherapy. These are treatments that partially alter fertility. That is to say that there are many women who will return to normal periods and ovulation after treatment but often there will be a reduction in ovarian reserve.
We will also have an effect of the duration of treatment in breast cancers which are hormone-dependent, and therefore treated with hormone therapy. It will block the action of hormones on the cells so that the cancer does not come back and this treatment is normally taken for five years. This can therefore delay a pregnancy plan if there was one. And this is also important to take into account when we think about post-cancer and fertility preservation. We think about the toxicity of the treatments and the time the treatment will take and therefore the age of the patient when she has finished.
What is the reaction, in general, of patients when you approach the question of fertility, contraception and sexuality… Is this the final blow?
It depends a lot on where they are in the parental project. There are still many women who are over fifty. Among young women, some have already completed their parental project and are therefore not too concerned with these fertility issues. But for others, it can actually be a bad experience. It is important to talk about it in order to find solutions. Now, we are careful to ensure that there are open doors to adapt the care according to the patients and their projects. For example, we can freeze oocytes or embryos. They have choices now.
Can you have a sex life during cancer?
Quite. We tell them it’s possible. Some put their sexuality on hold because it’s complicated for them to be available for that. But there are plenty of women who continue to have a sex life during cancer. They must be told that effective contraception is still necessary during their treatment.
During chemotherapy or radiotherapy treatment, should we stop contraception?
Not exactly. You have to take it. The treatments are not contraceptive. Even if, in general, they disrupt the cycles a lot, it is absolutely necessary to avoid a pregnancy at this time.
What’s wrong with hormonal contraception after cancer?
Breast cancer is a cancer that is promoted by hormones. Post-cancer patients can no longer have hormones because this can promote recurrence. They can then use a copper IUD or condoms, or if there are no longer any pregnancy plans: permanent sterilization for the woman or partner.
Can the psychosomatic aspect also affect fertility after trauma?
It’s hard to say. I think that there are women who can prevent themselves from having the project with preconceived ideas such as transmitting the disease to their child or who say to themselves “Now, it’s no longer possible for me because I I had cancer. They will be more likely to prevent themselves from having the project. But when he is there and the discussion takes place, I don’t think it affects fertility.
In thirty years, what has changed in the prevention aspect of Pink October?
I think we have moved towards an opening of possibilities and subjects. Thirty years ago, we never proposed preserving fertility. Pregnancy after cancer was taboo, like sexuality. We were focused on treatment. Post-cancer is a recent topic. Many doctors realized that we were getting better and better at treating cancer and that as a result women recovered and then we left them to live their lives without addressing the problems afterward.
* From 3:30 p.m. to 4:30 p.m., in the lobby
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