The proportion of women who have sexual health-related questions after being diagnosed with metastatic breast cancer (MBC), which is stage IV breast cancer, is not equal to the number of women who actually ask these questions.

A study published in The Journal of Sexual Health interviewed 32 women diagnosed with MBC about “the role of sexual activity and intimate touch in their lives, unmet needs about sexual health, and communication with medical providers about sexual concerns.” Researchers found sexual activity was important, but those interviewed felt limited and frequently reported physical and vaginal pain. And when women brought this to their medical provider’s attention, more often than not they focused only on vaginal lubricants, which did little to address patients’ initial concerns.

This lack of knowledge is why few women seek medical attention for their sexual health needs. A separate study published in the journal Cancer found only seven percent of 261 gynecologic and breast cancer patients asked for advice or medical help despite 42 percent reporting their interest in receiving such care.

“A woman's sexuality is affected by both physical and psychological issues after cancer treatments,” Dr. Stacy Tessler Lindau, an associate professor of obstetrics and gynecology at the University of Chicago Medical Center, said in a press release.

What’s more is these issues aren’t in a woman’s head. Here are the five of the more common sex-related issues among MBC patients in the hope it sparks a necessary dialogue regarding satisfying relationships post cancer treatment.