Scott Webb (Host): Today, we're discussing pelvic health and intimacy for gynecologic cancer survivors and the emotional and physical effects of cancer and survivorship. I'm joined today by Dr. Clarissa Polen-De. She's a gynecological oncologist with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Host: Doctor, it's nice to have you here today. We're going to go beyond treatment, if you will, and talk about what it means to be a gynecologic cancer survivor. So when you think about survivorship, how do you define it and when does it really begin for your patients?

Dr. Clarissa Polen-De: Yeah. Thank you. That's a really good question. So, we oftentimes think of survivorship as being something that starts after someone is treated or gets surgery or chemotherapy for their cancer. But really, it starts the day the person is diagnosed, not the day that the treatment ends.

Host: Yeah, I think you're right. It's natural for us, right, to just assume, "Well, now we're done. Now is when the survivorship part really kicks in." But it's from diagnosis on. And you as a surgeon, I'm sure the treatment decisions you make, especially around surgery, impact the quality of life for the months or years for these survivors. Maybe you can talk us through that a bit. How do you make those decisions, you know, in the best interest of your patients?

Dr. Clarissa Polen-De: Every surgery, every operation, you know, that we do, especially for patients that have a cancer or possible cancer diagnosis, has to balance two really critical things. So, both providing the best possible cancer outcomes for the patients, but also trying to minimize any lasting effects or lasting cost of that treatment. So, things that we have to decide, including whether or not we can do a minimally invasive surgery. So, say, laparoscopic or robotic surgery through small incisions, or if it needs to be a larger incision, which can take a little bit longer to heal. Whether or not we can do sentinel lymph nodes, which is evaluating and removing just one or two lymph nodes, or if we have to remove all of the lymph nodes to make sure that a patient has a better outcome. And then, other things like whether or not we can keep the ovaries, whether or not we have to take more tissue, all of those things can have a big impact on patients down the line.

Host: Right. Yeah. And it's so good that patients have experts like yourself, because it sounds like a lot to think about and a lot to sort through and making the best decisions for patients and their families. And kind of along those lines, Doctor, like, what are the most common physical or emotional changes that patients experience after treatment that might surprise them?

Dr. Clarissa Polen-De: I think one of the biggest things that surprises patients with and after treatment is how long recovery from both surgery and chemotherapy can take. And it may not be just the physical side of it, it may be the mental side of it, right? May be able to do some of those things like before, you know, you were diagnosed and had treatment, but you can still have an increase in fatigue.

You can have a decrease in like your stamina. You might have neuropathy or numbness and tingling afterwards that's limiting. You could have some brain fog or sleep changes. A lot of things that can linger on after your treatment that we still have to, you know, work on and help you recover with over time.

Host: Right. Yeah, I see what you mean. Like, physical, sure, emotional, mental. Patients are going to go through a lot during this process from diagnosis on and especially into survivorship, like, surviving the surgery and so forth. So, from a surgical perspective, as best you can anyway in audio form here, what actually happens to the pelvic floor during treatment such as bladder, bowel pressure, discomfort? And how can maybe all those things lead to the long-term symptoms?

Dr. Clarissa Polen-De: Yeah. So, the pelvic floor is really a key structure that helps to support all of the organs in the pelvis. So, it's not just one muscle, but it's all of the muscles, nerves, all of the connective tissues, all of that support and structure that helps support the bladder, the vagina, the rectum, the uterus if it's still present. And different treatments that are needed for cancers, for gynecologic cancers can affect them in different ways. Surgery obviously can sometimes weaken those areas, cause changes or scar tissue to form. Radiation can make the tissues in the pelvis sometimes a little bit, like, drier or less elastic, more fibrotic.

And chemotherapy and some of those other treatments like radiation can also induce menopause, which can cause changes in the quality of the tissue and the muscle, make things drier. And so, sometimes those things can result in feeling more pressure, sometimes weakening of the pelvic floor, but oftentimes it's all of those things together that can cause some of the pelvic floor symptoms. And so, a lot of our treatments help to, and a lot of the things that we recommend try to help coordinate all of those things back together, kind of retrain the nerves, retrain the muscles to help with like Kegels, things like that.

Host: Yeah. So, Doctor, maybe a little myth-busting here. Like, which symptoms do patients often think they're going to have to live with, but they're actually really are very treatable?

Dr. Clarissa Polen-De: Often many of the symptoms related to the pelvic floor, like pressure, urinary incontinence, pelvic floor prolapse, even sometimes like fecal incontinence, all of those things, sometimes scarring or pain or issues with urination or having intercourse, all of those things are things that we encourage our patients to talk to us about, talk to their providers about, because we may not be able to completely eliminate all of them, but oftentimes there's things that we can do that will at least help with the symptoms and can help improve the quality of life related to, you know, experiencing those and decreasing those.

Host: Right. Yeah. And I'm sure, Doctor, intimacy, sexual health, I'm sure these are things on people's minds, right? Patient's minds. So, what do you wish every patient knew before treatment about how it may affect or change intimacy and sexual health for them?

Dr. Clarissa Polen-De: Yeah. I think that one of the biggest things is that, you know, when patients are diagnosed, it might not be necessarily the thing that's at the forefront of their mind. Sometimes patients are worried to ask about it, but it's important, right? So people should feel comfortable asking about it. I want patients to know that intimacy may change after a cancer diagnosis and treatment, but it does not have to disappear. It may be somewhat different. If you're still able to have intercourse, intercourse may be slightly different. We can help get people back to a place that they were, but that intimacy might not have to be the same. It can mean a lot of other things outside of just the intercourse sexual function part of it.

Host: Sure. Yeah. And it sounds to me, doctor, like a big part of this, this whole journey, if you will, through survivorship, is really about speaking up, right?

Dr. Clarissa Polen-De: Yes.

Host: And I'm sure many patients feel embarrassed talking about pelvic floor symptoms. Not always an easy conversation to have. So, how do you encourage them to speak up, and what sort of language do you recommend they use to start that conversation?

Dr. Clarissa Polen-De: So, I agree. I think it's something that we talk about all the time, right? But patients oftentimes aren't gong to necessarily feel comfortable and don't want to be embarrassed about something. But talking about any symptoms or any concerns, we try to ask questions about are you having any issues with like leakage, any pressure, any changes in bowel movements? Are you having intercourse? Are you having issues with vaginal dryness? To be able to have patients be able to talk to us about those things. But we always encourage our patients to feel comfortable talking about it. Sometimes it's when they have the opportunity to meet with one of our APPs, like our supporting staff, that they might feel more comfortable, and then we are able to then again have a conversation when we meet.

Host: Yeah. And I'm sure, Doctor, that body image and we've talked a little bit about the mental emotional side of this, but I'm sure emotional recovery, you know, these are huge things and probably not talked about enough, though we are talking about them right now. So, what are the most common emotional or relationship changes you see, and maybe what helps people to move through them?

Dr. Clarissa Polen-De: Yes, gynecologic cancers definitely affect parts of the body that women hold close to their femininity, their fertility, their sexuality, right? Sometimes their identity. It's very private. Some patients go through almost a grieving of the loss of fertility and of those organs.

Other things like hair loss can be really significant to patients, and that can be one of the harder things they deal with. But being able to openly talk to us, you know, the concerns, the fears that they have about that being able to talk to our therapists and counselors, being able to talk to their partners or if their partners have specific concerns and questions.

And like you said, being open about those feelings and allowing us to help people understand that it's okay to have those feelings, right? And you're allowed to grieve the loss of those things. It's not a failure at all, and it's very common.

Host: Yeah, I hadn't thought of it from that perspective. Again, good that we have experts like yourself because the way you explain it there, of course, it would be natural for them, for patients to suffer some grief and grieving the loss of hair and other things, and it's so good to hear that there's counseling available, that there's folks they can talk to, right?

Dr. Clarissa Polen-De: Yeah. Yes, definitely.

Host: That's great. I feel like we're just scratching the surface here today, doctor, but hopefully this helps folks who are listening. Just want to finish up here and give folks a sense, patients or family members, you know, friends, whomever, they want to feel like themselves again. What next step look like, and who should be a part of their care team?

Dr. Clarissa Polen-De: Yeah. So bringing up questions, concerns to their primary care doctors, their GYN oncologists, their gynecologists, and starting with the thing that is bothering them the most, right? What can we focus on first to help you feel like yourself again? And what might those next steps be? Might that be therapy or medication or physical therapy to help get you back to where you want to be.

Host: Yeah, it's like you want to just let's go for that low-hanging fruit, so to speak. You know, let's check off a couple of the easier ones and get them on the right road to recovery and full survivorship, right?

Dr. Clarissa Polen-De: Yes. Start that journey, right, one step at a time. It can be a little bit overwhelming if you start looking at kind of all of the things. But trying to do one step at a time, focusing on what pieces we can help with, and then making little improvements to get you back to rebuilding strength, trust in your body and your confidence.

Host: That's great. Well, I sure appreciate your time, your expertise, your compassion today. Thank you so much.

Dr. Clarissa Polen-De: Thank you so much. I really appreciate it.

Host: And for more information, go to summahealth.org/cancer. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.