RESOURCES
Cancer and Sexual Health Pocket Guide
Your sex life doesn’t have to end when you are diagnosed with cancer. What’s likely, though, is that it will change, just as it changes with other life events. Cancer has physical, mental, and emotional effects on your sex life. It’s important to emotionally prepare for the changes that may occur and eventually adjust to the change that you have experienced because of cancer treatment. The cancer itself may affect your sexuality physically and emotionally, but often it is the treatment that has the largest impact on sexual function. Erectile dysfunction (ED) is often an immediate post-operative side effect of surgery for prostate cancer that may last 18 to 24 months post-surgery, but it may also happen before cancer treatment. For women, surgery that removes the uterus or ovaries or chemotherapy and other medications, like aromatase inhibitors for breast cancer, that cause menopause affect sexual health. Loss of breast tissue, nipples, and feeling in the breast area following a mastectomy can also impact sexuality. Radiation to the pelvis, surgical scars, gaining or losing weight, and even losing or growing hair all affect how your body feels and how you feel about it. On an even deeper level, Jennifer Bires, MSW, LCSW, OSW-C, executive director of the Life with Cancer and Patient Experience department at Inova Schar Cancer Institute, says fatigue has a major effect on sexuality when you live with cancer. “Fatigue can be crushing at times,” she says. “People with cancer are more likely to be depressed or anxious, which also lowers libido.” If you are taking antidepressants as part of your treatment, you should know that these also can cause changes in desire, arousal, and orgasm. The emotional impact of cancer can include “changes in your relationship, changes in roles for you and your partner, or changes in your interest and capacity to date or form new relationships,” Bires says. “Whether on the emotional side or in physical activity, there is likely to be a pause in sexual activity and a change in how you feel about your body and your sexuality.” “The impression I get from my provider is that I should be lucky to be alive,” says Steve, who is struggling with the physical effects of cancer treatment—but wants to stay connected with his wife. Steve says his oncologist’s view of sex seems to be, “Why would you care about that right now?” Derrick faced a similar attitude from his surgeon. “His attitude was, yes, you will probably have ED, but in your sixties, how much does hat matter?” In fact, maintaining a healthy sex life with his partner was very important to Derrick and not something he was willing to give up. He sought treatment advice from two more surgeons before choosing one who understood the need to treat him as a whole person with cancer, not just a cancer patient. Feeling empowered to search for solutions for changes in sexual health is an important first step in advocating for yourself. This means keeping what matters to you front and center in conversations with your care team. Health-care providers who can help Your cancer care team can include health-care providers to help with sex, relationships, and sexual rehabilitation, including: Because energy and appearance are important to sexuality, you may also consider the following team members: The Maple Tree Cancer Alliance has exercise and nutrition programs specifically designed for people with cancer who are going through treatment. For appearance, Fighting Pretty and Look Good, Feel Better (for women) and Look Good, Feel Better (for men) have helpful resources. “What’s important to you should be important to your healthcare provider,” says Bires. “Shared decision-making is important, especially when treatment will affect your quality of life as much as sexual side effects can.” If your provider makes a gendered assumption about you—for example, that you are interested in fertility preservation but in reality don’t plan on having children—speak up! It’s important that they have all the information possible so that they can tailor your treatment options for your unique needs. You may want to ask your health-care provider some of the questions below: For more examples of questions for providers, see this article on WomanLab. For men, Penn Medicine’s Onco has a guide to sexual health with information on how particular chemotherapy agents can affect sexual partners and a list of questions to consider when speaking to your provider. It’s easy to accept the media ideal of sex as something we constantly desire and are constantly ready for. However, expectations meet reality in many life stages. Consider the following situations: If sex isn’t possible for the short or long-term, what are other ways of exploring intimacy with a partner? Cancer creates an undeniable experience of the inevitability of change, and all change involves some loss. “A lot of sexual health work involves grieving,” Bires explains. “With cancer, your sex life may not go back to where it was before. You need to grieve for sex as you used to define it and grieve your expectations for what sex will be like.” Acknowledging that things have changed and grieving that loss is necessary before you “put your sex life back together,” says Bires. She is clear, however, that a new sex life is very possible. “It will look different, but it could be very satisfying,” she says. “Having cancer and dealing with changes means you have to work with your own body, talk to your partner, and become more aware of what’s important to you sexually.” Should you date? Are you healthy enough, and do you even want to? What do you have to offer a partner—and when do you tell them about the cancer? Marcus solved the problem by responding to one of the dating profile questions—things you can’t live without—with “Velcade,” the name of his chemotherapy drug. He figured that potential partners who responded to his dark humor might be good matches. “I also got a lot of hate mail,” he says. “People who couldn’t believe I’d be so callous or that I was even dating when I’m living with cancer.” Dating and relationship decisions In one study, more than half of the patients who were asked about sexuality during cancer asked for “practical tips.” This section has tools, resources, and tips to help you understand and nurture your sexuality during cancer and treatment. Jennifer Bires has these tips to help you appreciate, rest, and rehabilitate your sexuality:
Bires also has a word of advice for caregivers. “You may want to be sexual and miss your partner’s touch. But you may also be afraid to injure them or tire them out. Don’t ignore your needs—ask them! If you’re caring for them a great deal, they may be happy to do something for you, even a simple massage or kissing.”
Talking about sex can be scary, but communication is key. It is often helpful to have this conversation in a neutral space without distraction—not when someone is trying to initiate a sexual experience. When you are ready to talk about sex with your partner(s), it can be helpful to use a model similar to the one below. Fact: We haven’t had sex since your cancer diagnosis. Belief: I think you might feel you’re not attractive to me right now. Feeling: But I feel sad, and miss being with you sexually. Need: I need to feel close to you physically. Would you be OK talking about some ways to do that again? Using a model like this allows your partner(s) to understand why you may be thinking or feeling the way you do without blaming, and it can help them open up about their point of view without becoming defensive.Fast Facts
SEX AND CANCER
How cancer affects sexuality
The oncologist’s view of your sex life
Ask your health-care provider about sex
Sex will change, and that’s OK
Accepting change and loss
Single, with cancer
Resources
Tips from an oncology social worker
Sample script for talking with your partner about sex
More Pocket Guides and Tools
Website
References
Topics: Behavior & Lifestyle | Cancer | Caregivers
Share This
