Let's Talk About Sex...and Cancer

With all illnesses, including cancer, the most important thing is to try to preserve quality of life. Intimacy is an important component of quality of life. However, sexual dysfunction is common after cancer. Women and men can experience lowered libido, arousal, orgasmic thresholds and desire, as well as changes in appearance, mood (e.g. anxiety and depression), scarring, pain, and other physical symptoms (e.g. shortness of breath), and all of which can dampen pleasure associated with intimacy. Men can experience erectile dysfunction, and women can experience vaginismus. A more complete summary of sexual recovery after cancer is here.

Research has recently determined that close to one half of young cancer patients reported sexual dysfunction. Sexual dysfunction can occur at any stage, across cancer types, and up to any age. The good news is that because sexual dysfunction is so common, there has been a recent upsurge in research and development of evidence-based interventions to improve sexual functioning after cancer. Here are some simple strategies you can use to help improve sexual functioning after cancer.

1) Redefine intimacy. Intimacy should not be limited to physical intercourse. Intercourse can be painful or seem overwhelming after cancer and treatment. It may be helpful to work with your partner to redefine intimacy in other ways. For example, you can be intimate through holding hands, through gentle massage, and other ways such as taking a bath together.

2) Speak to your medical providers. It may be helpful to speak to a medical professional about your sexual functioning. Generally, Urologists for men and gynecologists for women can be a useful source of information regarding products to help with a variety of problems, such as low sex drive and libido, erectile dysfunction, or vaginal dryness or narrowing. If you are embarrassed to talk about your sexuality you can write down your questions and concerns in advance and hand them to your doctor. In addition you may also find it helpful to speak to a couples counselor, or certified sex therapist that specializes in helping individuals and couples with concerns about arousal, performance, pain, discomfort, or mismatched interest in sexual intimacy. You can also search online for the American Association of sex educators, counselors, and therapists to find a list of certified checks educators and counselors by state.

3) Engage in small just gestures to show affection such as kissing each other goodbye or holding each other’s hands.

4) Increase positive emotions and experiences with your partner. Try something new with your partner. New experiences can promote bonding and emotional intimacy.

5) Schedule ‘intimacy’ time with your partner. Set aside time that is free from interruptions from children, work, cell-phones, etc. Even if you are not physically intimate, you can make the most of this time by connecting with your partner in other ways.

6) Try these brief tips for improving intimacy:

a. Demonstrate small gestures of appreciation and admiration for your partner

b. Show emotional support

c. Create a positive, loving, accepting environment

d. Refrain from judgment

e. Think about good memories with your partner

f. Listen to your partner

g. Do not go to bed angry

h. Say “I love you” to your partner, often

7) Improve your communication. It is important to communicate with your partner particularly if your sexuality has changed or if intimacy is no longer comfortable. Letting her know about these changes may help avoid feelings of rejection that can result from your lack of desire. Talking about your fears and concerns is the first step towards finding ways to manage them. Open communication can lead to greater intimacy regardless if sexual intercourse is possible. Illness can change relationships for the worse for the better. You may have experienced relationship changes that are not so clear cut. In fact most relationship changes are more complicated and subtle something some good and some bad aspects. Even when relationships are changed much, there can be areas of difficulty.

Communication can be great for strengthening relationships and providing mutual support. It’s difficult to know how to bring up topics of medical fears or sexual problems. Often, both the patient and caregiver are trying to be strong to the other person, so that neither one gets the support that they need.

There are three keys to effective

communication. The first is listening. The second is nonverbal communication. And the third is expressing yourself clearly. Often we think of communication with think of talking. However, the most important ingredient to effective communication is good listening. Listening is not a passive activity. It is an active process. When you’re listening, you’re showing the person you’re hearing him or her.

You can demonstrate listening in several ways. First, paraphrase this means repeating in your own words what the other person has said. Second, ask questions. By asking questions you can understand more fully another person’s meaning. Third, show empathy. Empathy means understanding and identifying with another person’s feelings. You may not necessarily agree with the other person’s point of view, but you are talking to understand his or her perspective. You can show empathy by making facial expressions and mimic the other person’s feelings, or by offering supportive comments like “you seem troubled” or “that must be difficult for you.” Finally, be open to other perspectives. This means setting aside your biases for a short period of time. If you’re busy mentally creating arguments so you can interrupt your partner to win an argument. You are not really listening.

We communicate not just with our words with our bodies as well. We have all had an experience in which another person’s words did not match his or her facial expression or body posture, or gestures. In some cultures, eye contact tells the other person whether you are paying attention or not. Direct eye contact means you’re listening or trying to connect with that person. Our facial expressions tell others what effect their words have on us. Friendly and interested expression makes people want to talk to you frowns are raised eyebrows tell people you disapprove. Gestures underscore what you’re saying. For example, pointing directly at someone can convey that you are accusing or challenging them playing with your hair tapping your foot says you’re bored or distracted. Finally, how you arrange your body can express a lot about your feelings. Sitting upright in an open and relaxed posture can give the impression that you are alert and available to communicate.

In sum, sexual dysfunction after cancer is common. There are many ways to improve sexual functioning after cancer and this can entail physiological interventions as well as improving communication strategies. It is important to speak to your medical team about any sexual symptoms that you may be experiencing after cancer. There are interventions available to improve those symptoms. Sometimes, oncology medical providers may focus on cancer and cancer treatment, that it may not be on the top of their list to assess and discuss sexual dysfunction during follow-up visits. However, many providers are eager to help patients improve symptoms of sexual dysfunction as there are many evidence-based and effective treatments available. Thus, taking a proactive role as a patient to discuss sexual dysfunction with your provider can help you take an active role in improving your quality of life after cancer.