A recent call by leading oncologists highlights an often-overlooked aspect of cancer care: the unaddressed and persistent sexual side effects experienced by many survivors, particularly women. Despite advances in cancer treatment and survival rates, distressing symptoms such as chronic vaginal pain and painful intercourse continue to affect the quality of life for thousands, including those whose cancers are considered imminently curable. This troubling issue has come into new focus following a commentary in The Guardian by a prominent oncologist, who detailed the story of a patient whose curable cancer left her suffering years of sexual pain due to lack of adequate aftercare and frank communication.
The narrative, representing a situation common to patients worldwide, is especially pressing for Thai readers as cancer remains a leading cause of death and morbidity in the Kingdom. In Thailand, thousands of women each year undergo treatment for cancers such as cervical, breast, and endometrial cancers—many of which have high survival rates if detected early and treated appropriately (WHO Cancer Thailand). However, while national screening and treatment campaigns have driven improvements in survival, the long-term complications of treatment—especially the impact on sexual health—are seldom prioritized in treatment protocols or follow-up care.
The expert commentary in The Guardian describes how one patient, despite surviving a curable gynecological cancer, endured years of painful intercourse (dyspareunia), leading to distress, impaired relationships, and diminished quality of life. Importantly, her experience is not unique: research suggests that up to 75% of women treated for pelvic cancers report long-term sexual dysfunction, yet few receive information or support about managing these side effects (PubMed: Sexual dysfunction after cancer). The author, an oncologist, emphasizes: “We spend great effort treating cancer, but far less addressing what happens to our patients after the treatment ends. There is a terrible silence around sexual health after cancer, and our patients are suffering as a result.”
Key barriers identified include discomfort and inadequate training among doctors and nurses in initiating conversations about sexual health, cultural taboos that make it hard for patients to voice concerns, and fragmented health systems that prioritize acute cancer care over rehabilitation and long-term wellness (The BMJ: Tackling sexual health after cancer). In Thailand, where topics related to sexuality and intimate relationships are often considered private or shameful, these barriers are intensified. Survivors may feel isolated or blame themselves for their symptoms, while clinicians may avoid the issue entirely, lacking both confidence and resources to help.
Thai cancer care guidelines traditionally emphasize tumour eradication, chemotherapy, and radiotherapy protocols, with less structured attention to survivorship quality of life—and even less so to sexual well-being. According to a senior gynecologic oncologist at a major Bangkok tertiary hospital, “We encounter many patients who, after successful cancer treatment, hesitate to ask about problems related to sex. It is part of our culture that makes these conversations difficult, both for patients and providers.” Furthermore, while international cancer guidelines, such as those by the American Society of Clinical Oncology (ASCO), recommend that sexual health is broached as part of post-treatment care, few Thai institutions have adopted comprehensive policies or workforce training on this issue (ASCO Survivorship Guidelines).
This situation stands in stark contrast with rising global awareness about survivorship and rehabilitation medicine, where sexual well-being is increasingly recognized as a fundamental human right and essential to overall health. In Western settings, multidisciplinary survivorship clinics, counseling services, and physiotherapy resources are being developed to help women and their partners manage the physical and psychological consequences of treatment (Cancer Australia: Sexuality and cancer). By comparison, most Thai cancer patients rely on limited information pamphlets or may resort to internet searches or peer discussions in privacy.
For patients, unrelieved symptoms such as vaginal dryness, fibrosis, or pain can translate into avoidance of intimacy, relationship strain, or emotional distress, further compounding cancer’s social toll. The issue is magnified for younger women seeking fertility preservation or wishing to maintain fulfilling relationships post-treatment. As a senior reproductive health specialist from a Chulalongkorn University-affiliated hospital put it, “Without support, even a cure can feel incomplete. Our healthcare system must embrace the full spectrum of survivorship, including sexual health, if we wish to truly heal our patients.”
Historical and cultural context further complicates the picture. In Thai society, discussing sexual difficulties—especially among women of older generations or from rural backgrounds—has long been shrouded in taboo. The tendency to “keep face” or minimize suffering for the sake of family harmony may silence those most in need of help. Local support groups and NGOs, such as the Thai Gynecologic Cancer Society and the Cancer Patients Aid Association, have called for greater openness and destigmatisation but face an uphill battle in changing longstanding attitudes (TGCS). Integration of sexual health into primary care, cancer nursing, and social work curricula has only begun in recent years, often through pilot projects.
Looking forward, the growing burden of cancer survivorship in Thailand—and the desire of patients to reclaim meaningful, whole lives—suggests a need for major shifts in care approaches. International experience points to several best practices: proactive patient education from the start of treatment, regular screening for sexual dysfunction in follow-up visits, multidisciplinary clinics including gynecology, physiotherapy, and psychosocial support, and culturally sensitive training for healthcare workers to encourage open, non-judgmental discussions (The Lancet Oncology: Addressing sexual health after cancer). For Thailand, adaptation of such models requires collaboration between government agencies, hospitals, patient groups, and public educators to ensure accessibility and cultural appropriateness.
Cancer survivors in Thailand and their families can take important steps: asking their doctors directly about sexual side effects, seeking support from cancer-related NGOs or online communities, and advocating for improved care through patient networks. Clinicians are encouraged to build their knowledge and comfort with these sensitive topics, utilising resources from international bodies and local pilot programs. Policymakers, for their part, can foster improvements by integrating survivorship—and sexual health as a key domain—into Thailand’s Universal Healthcare program and medical education reform agendas.
The fundamental message is clear: surviving cancer is not enough—patients deserve recovery in all dimensions of their lives, including the right to love and be loved free of pain or shame. Society benefits when it recognizes and supports this journey. As the global cancer community moves towards holistic, patient-focused care, Thailand, too, must not leave sexual health behind.
For further reading and detailed resources, visit The Guardian’s original commentary, as well as major guidelines from ASCO, WHO Cancer Thailand, and Cancer Australia.