Cervical cancer. Prostate cancer. Testicular cancer. Rectal cancer… No matter what the malignant invasion on your body, the general advice is: avoid intercourse ‘til the healing is over. Cancer survivors are expected to avoid sex for weeks, if not months, only to be left hanging when it can happen. With physicians generally ill-equipped to handle sexuality matters, survivors are typically given no advice on how to prepare the body for sex or how to renew one’s sex life. As a result, initial sex post-cancer can be painful, embarrassing, and scary – if it happens at all.
Whether grappling with loss of desire, dyspareunia (painful intercourse) anejaculation (absence of ejaculation), retrograde ejaculation (ejaculation is released backward to bladder), lack of orgasm... sexual response can be impacted in numerous ways. Research in the last 20 years has shown that these sexual problems are largely unresolved within the first year or two of survival. Some, in fact, get worse, ultimately affecting one’s quality of life is affected.
The sexual ailments that can crop out are dependent upon your cancer. Any number of physical and psychological factors can impact your ability to be sexually active as you once were:
a. Chemotherapy, radiation, bone marrow transplantation, and stem cell transplantation leave cancer patients feeling weak and tired, ultimately reducing your sexual desire and energy. Chemo-induced menopause is an issue women may deal with, resulting in increased vaginal dryness.
b. The side effects of drugs used during treatment or for pain, depression or other symptoms result in fatigue.
c. Hormonal changes, e.g., the drop in natural estrogen or testosterone levels, impact sexual health and sexual responsiveness.
d. Body image issues are easily bore out of matters like weight loss or gain, the infusion catheters, body scars, skin discoloration, hair loss, or the removal of a breast.
e. Procedures, like a radical prostectomy, can save his life, but leave him grappling with a loss of erection or inability to be as firm as he was pre-cancer. While grateful to be alive, these men are impacted by such troubles with their sexual functioning, influencing how he interacts with his partner, including in non-sexual situations, e.g., withdrawing from intimacy altogether. His perceptions of his masculinity and quality of sexual fantasies are hit as well.
b. The side effects of drugs used during treatment or for pain, depression or other symptoms result in fatigue.
c. Hormonal changes, e.g., the drop in natural estrogen or testosterone levels, impact sexual health and sexual responsiveness.
d. Body image issues are easily bore out of matters like weight loss or gain, the infusion catheters, body scars, skin discoloration, hair loss, or the removal of a breast.
e. Procedures, like a radical prostectomy, can save his life, but leave him grappling with a loss of erection or inability to be as firm as he was pre-cancer. While grateful to be alive, these men are impacted by such troubles with their sexual functioning, influencing how he interacts with his partner, including in non-sexual situations, e.g., withdrawing from intimacy altogether. His perceptions of his masculinity and quality of sexual fantasies are hit as well.
So how to cancer survivors reclaim their sexuality and sex lives? The approach needs to be a holistic one, where the psychological and relationship components are dealt with as well. Survivors should also be mindful in taking care of their bodies, starting at the most basic level with good sleep, diet, and time to recover entirely.
In moving forward, survivors should seek to:
Get an assessment. If your healthcare provider isn’t offering, ask this professional to assess your sexual functioning. If he or she is unable to do so, and adequately at that, ask for referrals.
Find the experts. It may take time and patience, but look for individuals and institutions educating survivors about post-cancer sexual activity. Memorial Sloan-Kettering’s Male Sexual & Reproductive Medicine Program, for example, offers an interdisciplinary team in fielding sexual difficulties of fertility problems impacting about 45 new patients every week. Inquire with professional organizations, like the American Association of Sex Educators, Counselors, whose members counsel cancer survivors about sex.
These experts can offer guidance on options specific to your cancer, e.g., using a dilator to expand a shrunken vagina post radical hysterectomy, or applying a hot water bottle to the genital area for 5-10 minutes to naturally stimulate blood flow and responsiveness. They can also advise you on creams that can enhance sexual arousal, medications that can assist sexual functioning, and vaginal moisturizers and lubricants for vaginal dryness.
Look for educational resources. Currently, there are very few treatment programs designed or tested for cancer patients/survivors. Upcoming Internet-based cancer sexuality education and therapy programs include CAREss: Counseling about Regaining Erections and Sexual Satisfaction, which was developed from American Cancer Society grant. Still be tweaked, it involves weekly homework and online counseling support. Tenrils: Sexual Renewal for Women After Cancer is a National Cancer Institute Grant due online in 2011.
Seek holistic treatments. Approaches to better health, like acupuncture, may alleviate some of the side effects impacting your sexuality. They can also boost your overall sense of well-being, having a domino effect on your sexual circumstances.
Join a support group. Sexual difficulties can leave survivors feeling sad, isolated, lonely, vulnerable, ashamed, and disconnected from the self. You may grieve your old sex life. In dealing with any emotional struggles during this time, including those affecting your sexuality, turn to others who understand your situation.
Maintain touch. Partners need to be affectionate and communicate how they’re feeling during this time. So be sure to talk about your fears, concerns and preferences, never underestimating the value in human touch. Sensate focus exercises are a great way to maintain sexual intimacy without all of the pressures that come along with performance goals.
Use a vibrator. In cases of diminished sensation, this powerful sex toy may be just what the doctor should order! Such sex toy use is especially important for individuals dealing with anxieties concerning response. Take the time to become reacquainted with yourself sexually-speaking, being open to new ways to reclaim your pleasuring.
Aim for variety. In being sexually active, expand your repertoire of ways to enjoy sexual intimacy and feel in control. Being sexually active entails a whole host of acts and behaviors, so don’t restrict yourself in thinking sex needs to be a certain way, especially in being fulfilled.
Seek counseling. Whether you’re a single longing to avoid the dating scene or a couple dealing with the stress, to yourself a great service and talk to a counselor or therapist who can empower you to get to a better place.
Protect your fertility options. With cancers that cause infertility, persons longing to be parents need to be given information on how cancers may affect their reproductive functions. Men should be given information on storing semen, epididymal aspirate, testicular aspirate, and testicular biopsy, whilst women be counseled on how to store their ovarian tissue, ovarian follicles, and embryos.
Consider participating in a clinical trial study. The National Cancer Institute is currently seeking participants for supportive and palliative care trials concerning sexuality and reproductive health issues.
Ultimately, do not allow yourself to be defined by cancer. Don’t allow cancer to define your sexual self or sex life. Research out of the University of Southern California and Yale University found that mind over matter is the key to realizing sexual satisfaction. The study focusing on cervical cancer survivors who had both ovaries removed found that, after 6 years, most had rebounded in their sexual desire and enjoyment.
For further inspiration, the following works can help you come out on top:
Ellsworth, Pamela. One Hundred Questions & Answers about Erectile Dysfunction.
Sudbury, MA: Jones and Bartlett Publishers, 2003.
Foley, Sallie. Sex Matters for Women: a Complete Guide to Taking Care of Your Sexual
Self. New York, NY: The Guilford Press, 2002.
Kahane, Deborah H. No Less a Woman: Femininity, Sexuality and Breast Cancer. 2nd
rev. ed. Alameda, CA: Hunter House, 1995.
Katz, Anne. Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care
Professionals. Pittsburgh: Oncology Nursing Society, 2007.
Katz, Anne. Man Cancer Sex. Pittsburgh: Hygeia Media, 2010.
Katz, Anne. Woman Cancer Sex. Pittsburgh: Hygeia Media, 2009.
Laken, Keith. Making Love Again: Hope for Couples Facing Loss of Sexual Intimacy.
Sandwich, MA: Ant Hill Press, 2002.
Schover, Leslie R. Sexuality and Fertility after Cancer. New York: John Wiley and Sons,
1997.
Schover LR, Jensen SB. (1998). Sexuality and Chronic Illness: a comprehensive
approach. NY: Guilford Press.
Schover LR. (1995). Sexuality and Cancer: For the Woman Who Has Cancer, and Her
Partner. New York: American Cancer Society
Schover LR. (1995). Sexuality and Cancer: For the Man Who Has Cancer, and His
Partner. New York: American Cancer Society
