The Silent Burden of Cervical Cancer: What Clinicians Need to Know

As palliative care clinicians, we’re trained to care for the whole person, not just the physical effects of the disease and treatment. We routinely assess physical symptoms, psychosocial distress, and spiritual concerns. But each serious illness has its own distinct challenges—and cervical cancer is no exception.

For our patients with cervical cancer, the impact of treatment can be both physically intense and deeply personal. Radiation, surgery, and chemotherapy can all leave lasting effects—from pain, fatigue, and bowel or bladder issues, to effects on sexuality and intimacy. Since these topics can be difficult for a patient to bring up, the emotional toll of their illness may not always surface during routine assessment. That’s why it’s especially important that we understand how cervical cancer uniquely affects our patients, and how to support them in ways that feel safe and validating.

Close to 14,000 people in the U.S. are diagnosed with cervical cancer each year—most frequently in women aged thirty-five to forty-four with the average age being close to fifty. Many cases are caught in the early stages, thanks to preventive screenings like Pap smears and HPV testing. These measures have helped cut the cervical cancer mortality rate in half since the 1970s.

Palliative care teams often consult on more advanced cases, which may include patients who have not had regular access to preventative gynecologic care because of financial barriers, lack of insurance, geography, or other disparities. That said, advanced cancer also occurs for patients who did receive preventative care. Regardless of the stage, it’s essential that we are prepared to support all our patients with the full range of tools that we can provide—from symptom and pain management to psychosocial and emotional support.

Palliative care clinical practice guidelines recommend that clinicians assess the impact of serious illness on sexuality and intimacy. While many patients want to discuss these concerns with their care teams, the topic is often overlooked in routine assessments.

For people living with cervical cancer, the effects of treatment on sexuality are both common and under-acknowledged. Radiation delivered to the pelvic region can cause a range of physical side effects—irritation to the skin of the upper vagina and uterus, vaginal stenosis, and changes in bladder and bowel function that may lead to diarrhea, pain, or incontinence.

These side effects can influence sexual function, libido, and the ability to engage in or enjoy intimacy. Some women may find the idea of sexual contact unthinkable during or after treatment, especially if they're coping with pain, soreness, or gastrointestinal issues. Others may want to resume sexual activity but feel anxious about how their bodies will respond, or whether they might experience pain, awkwardness, or even disappointment from a partner.

Even when patients want to talk about intimacy, they may not bring it up on their own. I’ve found that by normalizing it, patients are more willing to open up. You can ask questions that invite conversation without presumption and make the conversation feel more routine, such as:

• “Do you have any concerns about sex or intimacy that you’d like to talk about?”
• “Has cancer or treatment affected your close relationship(s)?
• “Are there ways of expressing intimacy and affection which seem difficult for you while you are going through treatment?”

Based on their responses, I begin to formulate some practical strategies to help. For example, if they express distress about changes in their body, their sexuality, or relationships, they may benefit from counseling. I usually start by calling in my team’s social worker or chaplain to speak with my patient or make a referral to a behavioral therapist. I also often share community-based organizations that provide support for women with cancer, and their families. If a patient shares something related to pain with intercourse, I may consider referring them to pelvic floor physical therapy.

For some patients, there’s an added layer of existential regret and grief—especially if they haven’t gone for regular screenings or received the HPV vaccine when they were eligible to receive it. Some patients may blame themselves for developing an illness they believe could have been prevented. This extends beyond themselves because cancer is not just affecting them, but also their loved ones.

In those moments, we can acknowledge and validate our patients’ feelings while also encouraging them to work through this regret. I may say something like, “While we can’t change the past, you can control today. You have control over the choices you make now, which includes keeping all your appointments, communicating openly with your care team, spending time with your family and your friends, and more.”

Sometimes, I offer a quiet reminder that there are no guarantees, and even if they had received the vaccine or had regular screenings, there’s a chance that they still may have developed cervical cancer. This helps release the illusion that everything is in their control.

If you feel like your patient needs some extra support, call in your team’s chaplain or social worker or refer them to a therapist.

Ultimately, the palliative care team can be both a sounding board and a trusted source of information for people living with cervical cancer. By helping patients acknowledge the full impact of their illness, we can help them with the tools we have and make recommendations that will make a difference.

These conversations may feel delicate. But they matter deeply. And when clinicians make space for them, patients often feel more seen, more supported, and more empowered in their care.

Edited by Melissa Baron. Clinical review by Andrew Esch, MD, MBA.