Cancer and intimacy

Sex may be far from your mind when you’re first diagnosed with cancer and facing so many decisions.

However, after things settle a bit, you may start wondering how cancer or your treatments will affect the everyday aspects of your life — including sexual activity and sexuality. Sexuality is how you view yourself, how much vulnerability and intimacy you allow, and how you experience the sense of touch.

Everyone is unique in their needs and desires when it comes to sexuality, but it plays a major role in many people’s lives. The symptoms and side effects of cancer and its treatment may impact your sexuality. Issues that may arise include hormonal changes, fatigue, vaginal dryness, painful intercourse and erectile dysfunction. Side effects — such as hair loss, weight gain or scarring from an operation — can affect a person’s self-esteem. Physical changes from surgery or hormone therapy, as well as psychological factors such as fear and stress, can contribute to a loss of libido (sex drive). Recognizing and talking about these problems with your healthcare provider and partner are necessary first steps.

Starting the conversation

If you’re worried or having issues related to sexuality, discuss your questions and concerns with your doctor or nurse. You may find it difficult to begin these conversations, due to embarrassment, discomfort, uncertainty and insecurity. Patients sometimes assume that the doctor will bring up the subject, although some doctors may feel as uncomfortable as their patients about raising the issue.

Other patients, including those in same-sex relationships, may worry that the healthcare provider is not well-informed about circumstances or needs specific to their sexuality. All of these hesitations are understandable, but it is worth forging ahead. If your healthcare provider does not mention sex, you can bring it up. Expect open, honest answers to your questions and concerns, and — if your provider can’t answer your questions — directions to resources that can provide the information you need. If for any reason you are not satisfied with the information given to you by your doctor, request a referral to a counselor who specializes in sex therapy/counseling.

Consider safety

Your top priority is safety for yourself and your sexual partner(s). Talk with your doctor about any physical or emotional issues that are preventing you from having sex:

• Are you at special risk right now for infection, injury, or bleeding?
• Does your radiation or chemotherapy treatment mean that you cannot be sexually active or physically close for a certain period? If so, for how long?
• My partner is the same sex; what precautions do I need to take?
• If you’ve been advised to avoid getting pregnant or fathering a child, what type of birth control is recommended?
• Are you doing everything you can to protect yourself and your partner(s) from sexually transmitted diseases?

If you don’t know – ask.

Practical advice

Here are some practical tips:

• Staying active helps improve circulation, and good blood flow is important for helping both men and women reach orgasm.
• Water- or silicone-based lubricants can make intercourse more comfortable, especially if vaginal dryness or atrophy is an issue. Avoid oil-based lubricants; they may cause infections if used internally, and they can erode condoms.
• There are devices and medications that may help with erectile dysfunction (inability to get and maintain an erection).
• If penetration is painful or difficult, explore different ways to express yourself sexually. You may discover that you find new positions or practices exciting and enjoyable.

In order to find what works for both of you, talk openly with your partner. Share how you are feeling and ask about their concerns and ideas. It may work best to start slowly and plan ahead. For example, choosing a time of day when energy is higher and fatigue is lower may eliminate some of the frustrating barriers to satisfying sexual experiences. Looking forward to this time can build anticipation and intimacy. Give yourselves time to adjust and learn.

Self-care and pleasure are important aspects of sexuality, regardless of whether you have a partner. Cancer and treatment can bring many different changes to your body. Explore what has changed and what feels good to you now. Learning these things will be helpful both now and if you choose to enter into a sexual relationship in the future.

If you decide to start socializing or dating, you may not know how to talk about your cancer with someone who is new in your life. It’s normal to feel self-conscious or nervous about bringing up your cancer experience and talking about how it has affected you. How you talk about it is your decision.

If you’re thinking about sex, it’s time to start talking about it, too. This may involve setbacks and difficult conversations, but it can also lead to rediscovering your sexuality or finding new ways to express it.