IMPACT CERVICAL CANCER AND CHEMOTERAPY TO SEXUAL LIFE IN CERVICAL CANCER PATIENT ( Case Report )

Cervical cancer has a second place cancer disease that attacks women after breast cancer. Chemotherapy is treatment for cervical cancer. Symptoms of cervical cancer and chemotherapy can cause to decrease quality of life terms sexual life patient. We reported a case, a woman diagnosed cervical cancer stage III B complained the symptoms of cervical cancer such bleeding, pain, and leucorrhea caused to distrube her sexual life with her partner. In addition, the side effects of chemotherapy such as fatigue also caused to decreased sexual life in these patient.


Introduction
In the world, cervical cancer is a disease has second place after breast cancer that attacks women 7 .Cervical cancer in an advanced stage can cause symptoms such as bleeding after intercourse, bleeding outside menstrual, bleeding after menopause, leucorrhea, pelvic pain and disorders the vital organs in body such as brain, lung, bone and liver.The treatment can be given to patient with an advanced stage cervical cancer is chemotherapy.Currently, the diagnosis and treatment for cancer disease has been developed, but the consequences the result of disease and treatment will affect the quality of life patient 17 .In the quality of life there are many dimensions is important to assessment such as sexual life in cervical cancer patient.Sexual life consists by sexual function, sexual attitudes, sexual behavior, and sexual partner.Cancer and treatment can give effect sexual life patient.Sexual satisfaction can improve quality of life but sexual not satisfaction will decrease the quality of life 14 .

Address respondents: Agus Sutiawan
Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Udayana` University, Bali -Indonesia.E-mail: agus_sutiawan04@yahoo.com

The Case
A mother was thirty five years old, came to obstetrics General Hospital Sanglah with complaints such as pain in the abdomen, bleeding, leucorrhea and post coital bleeding.Based on the results examination the doctor patient diagnosed cervical cancer IIIB and the type of cancer cell is non -ceratinizing squamose cell carcinoma.The results ultrasonography size of tumor mass was 4.22 cm x 5.43 cm x 3.45 cm and result from laboratory tests the level of hemoglobin value was 7.2 gr/dL.It was below normal value (12.00 to 16.00 gr/dL) and made her physical condition became weak and anemic.The action took to prevented the spread of cervical cancer was chemotherapy until 6 series and continued with radiation.Chemotherapy regimen chosen to gave for patient was paclitaxel -carboplatin.The health in cervical cancer patient must repaired before chemotherapy.
The third series of chemotherapy has been decrease tumor mass into 3.00 cm x 2.55 cm x 2.34 cm but the effect was decrease levels of hemoglobin value becomes 10.2 g / dL.
During therapy patients complained her sexual life declined.Sexual life can descrease by cervical cancer and side effect from chemotherapy.Symptoms of cervical cancer such as bleeding, pain and leucorrhea can made patients to able enjoyed sexual intercourse and caused her sexual life became disrupted.
Chemotherapy can caused disruption sexual life patient because side effects chemotherapy was fatigue made intensity sexual intercourse patient with her partner descrease and made sexual life patient and her couple disturbed.

Disscussion
Disease and cancer treatment can impact to sexual life 10 .Normal sexual life depends to patient and her couples 9 .The symptoms of cervical cancer such as bleeding, pain and leucorrhea can caused to decreased sexual life patient.Bleeding can caused the anemia and disturbed sexual intercourse patient with her partner because patient become limp and didn't enough energy for sexual 16 .The reduced levels of hemoglobin that carries oxygen to the body's cells to metabolize glucose, fat and protein into energy may cause the body durability from decreases.In cervical cancer one of the symptoms that mark the presence of the tumor was bleeding.The presence symptoms of bleeding made two sides both patient and his partner became frighten and traumatic in the sexual intercourse.Post coital bleeding was an abnormal state in cervical cancer.Bleeding that lasts a long time caused by cervical cancer malignancy that has reached an advanced stage 3 .Leucorrhea is a symptom that experienced by most patient with cervical cancer 12 .These symptoms can caused problems because made discomfort patients during sexual intercourse with her partner.Leucorrhea was characterized symptom from cervical cancer and sometimes the fluid came out pink, red, brown and foul smelling 13 .
the symptoms such as pain most widely by patients cervical cancer 4 .Disease of cervical cancer was caused by HPV virus and can made to damaged tissue.the disease may invaded other tissues such as the uterus, vagina, rectum, urinary and parametrium tissue 14 .Symptoms pain was a form warning and sensory experiences multidimensional unsettling because the damaged tissue resulting in a discharge substances chemically / mediatory inflammatory distributed as a signal and conducted by nerve fibers nociception not myelin snaps to neurons in cornudorsalis medulla spinal cord then transferred through tractus spinotalamicus in brain, where pain perceived 11 .Pain in cervical cancer patient can disruption sexual life and gave a negative impact on relationships with couple and sexual function.Painful sexual intercourse due to the pain tends to be avoided to caused disruption in sexual intercourse 2 .
In cervical cancer patients, chemotherapy can caused side effects such as fatigue effect from anemia.Administering chemotherapy can interfered with the process of the formation of blood cellular components included RBC (Red Blood Cells) precusor.The platinum group carboplatin used in carboplatin -paclitaxel regimen can caused to disorders iron metabolism.The iron component was important in the formation of hemoglobin 13.Fatigue cause her patient felt limp and not enough powered to affected perception, self concepted and desired in sexual relationships and intimacy caused negative feelings, changes in sexual expression which wasn't gratify herself and her partner 13 .Fatigue can leaded to stress and made depression in the sexual intercourse so that cause a decrease in libido that affect the sexual life 6,10 .In patients of cervical cancer family support in particular emotional affect couples patients because fatigue has a strong relationship to decreased quality of life and often created a negative emotional felt such as depression and can cause loss of sexual life.Based on this research, quality of life such as sexual life was impotant assament with questionnaire EORTC CRX -24 to known about impact the symptome of cervical and chemoterapy in cervical cancer patient.