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Sex When You Have Cancer

Keeping intimacy alive during and after cancer treatment.

 Milkos/iStock; used with permission
Difficulties with Intimacy and Cancer
Source: Milkos/iStock; used with permission

For people going through cancer, sex can be a powerful affirmation of aliveness–many patients say it is one of the most important markers for their quality of life. Unfortunately, research shows that only about 14% of physicians talk to their cancer patients about their sex lives. Some patients mistake this lack of communication to mean that their symptoms are beyond hope. Thankfully, this isn’t the case–there are things that you can do to preserve sexual expression during, and after, cancer. Here are some suggestions for four common challenges:

Physical changes. Cancer may jeopardize the sexual and reproductive organs of a person’s body. For instance, a breast cancer patient may not only suffer the devastating loss of one or both of her breasts but often has to take medicines that decrease her estrogen levels, which can change the lubrication and elasticity of her vagina and even throw her into menopause, potentially as a young woman. Seventy percent of prostate cancer patients will likely have damage done to or lose their erections. And almost all cancer patients are plagued with fatigue while on chemotherapy and radiation, making it difficult to find the energy for sex.

Suggestion: Physical therapy can make sex comfortable after vaginal changes and can help mobility during lovemaking for associated lymphedema after lymph node dissection. Consult your oncologist for the possibility of estrogen cream that has recently been approved by the North American Menopausal Society for breast cancer patients. Your urologist may have several solutions for the loss of erections starting with erectile-enhancing medications, even implanted penile pumps. Timing sexual moments to take advantage of the highest energy peak in the day may help counter fatigue.

Functional challenges. Cancer and its treatment not only have a direct effect on body tissue, but it also impacts the distinct stages of the body’s processes during a sexual encounter: desire, arousal and orgasm. Desire is often eclipsed in early cancer by the survival instinct as a person copes with the news of a diagnosis. Both desire and ease of arousal can be diminished by the chemotherapy, hormonal-deprivation, and selective serotonin reuptake inhibitors used to treat cancer-related anxiety and depression. Difficulties with arousal can mean that an aspect of life that was full of joy and play, now becomes work.

Suggestion: You may need to change your expectations about both the length of time needed for arousal as well as the power or type of the orgasmic sensation – whether you’re a man after prostate cancer surgery or radiation or a woman with breast or gynecological cancer. Vibrators, erotic fantasy and medical intervention may be necessary for arousal and should be viewed as legitimate tools. Consult a psychiatrist about depression and anxiety medication that will not have sexual side effects.

Sexual self-image. An integral component of sexual functioning is our body image, serving as a psychic map about how we relate sexually, encompassing our appearance, our physical strength, our energy and our identity, and our seductive power. Mastectomy and erectile dysfunction may disturb a person’s physical integrity, potentially changing the way he or she, if not the world, perceives their sexual identity.

Suggestion: Mindfulness is a powerful way to come to terms with profound loss and change to the body after illness. You can learn the basics of mindfulness via online articles and videos. If you’re interested in going deeper, see if there are any mindfulness classes in your area.

Sexual relationship. Sexuality and relationship are inextricably bound together, so any sexual problems you’re having as a result of your cancer will most certainly affect your relationship.

Suggestion: Therapy can help your partner deal with their own personal grief and loss. It can also help you and partner draw toward each other for comfort rather than withdraw. Your ability, as a couple, to communicate about the sexual changes and feel free to seek support from each other is necessary for a full recovery. Together, you’ll need to accept and redesign a new sexual “normal.”

More from Laurie J Watson PhD, LMFT, LPC
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