Tuesday 14 February, 2023

Sex, Intimacy, and Cancer Treatment

Let’s be real: people think about sex. Yes, some aspects of sex are still pretty taboo, but throw cancer into the mix and you could hear a pin drop. People go mute. So do many doctors. 

It’s important that when you go through cancer, you’re fully informed about how cancer may affect your life, including your sexual function and desire to be physically intimate, regardless of relationship status.

Most oncologists aren’t trained in the area of intimacy – it’s not their speciality. Treating cancer is. So don’t wait for input or advice from them without prompting them (though a multidisciplinary approach to quality of life during and after cancer is the future!). It’s important that you feel you can take control of this area of your life like you always have.

What we’ll cover in this blog:
Sex during and after cancer treatment
How to address physical intimacy and sex with your healthcare team
Intimacy when you can’t have sex
Behaviours that discourage intimacy
Curiosity and patience in the process

Let’s talk sex and cancer 

The majority of people who go through cancer and treatment will experience a change in their sex life. Whether it takes the shape of little to no sex drive, the physical difficulty or inability to have sex, or experiencing a change in body image from, for example weight gain, hair loss, fatigue, a mastectomy, numbness, nausea, or digestive problems. Add on top of that the mental effects of going through cancer, such as depression, anxiety, or loss of identity.

Just like most things, the best way to approach sex and intimacy during cancer is by talking about it. Whether you begin by talking with your partner or sharing your thoughts with a close friend, make sure you find a place to share what’s on your mind. What are your worries? Your fears? Your desires? If you’re in a relationship, see if you can find some common ground with your partner, like what you want and need, and how to communicate. 

If you’re not in a relationship, learn and explore what it is you want to get out of this experience. You always have the option to communicate what you’re going through, regardless of if you’re in a relationship or not. In the end, it’s about making choices that you feel completely comfortable with and are safe for you and others.

How to address physical intimacy and sex with your healthcare team

Knowledge is power. Ask your healthcare team the questions you have. After all, they are your healthcare team – there for your health, which includes a healthy sex life. It may feel intimidating or uncomfortable but it shouldn’t be and doesn’t have to be. The best way to ease your mind and inform yourself of how to go about intimacy, sex, and preparing for how this area of your life may be affected is by informing yourself. Nothing about cancer is common knowledge. It’s a learning curve! There are no dumb questions, and no questions that are off-limits. In the end, the only person who’s losing out not talking about it is you (and potentially your partner). 

Researchers have come up with these fantastic ways of treating cancer, but these treatments can also come with a fair dose of side effects. Ask about what these are before cancer treatment or surgery because it’ll empower you to a.) take control of your treatment by making a better-informed decision on whether you’d like to go down the recommended route with the information you have, and b.) physically and emotionally prepare for what this means for your sex life in the short term and long-term. 

Some questions about sex during cancer that you may want to consider asking: 
  • How will my treatment affect my sex life?
  • Will it affect my sexual function?  
  • How can I manage these effects in the best possible way? 
  • Can I have sex during my cancer treatment?
  • Is it safe for me and my partner to have sex during cancer treatment? 
  • Can my cancer or treatment be passed through body fluids? 
  • Am I fertile during cancer treatment?
  • What side effects are normal to experience in my sexual function during and after cancer? 
  • Is there anything I can do today that will help me? 
  • What about birth control? Fertility?
  • Vaginal dryness? Problems with having an erection? 

The list goes on – these questions are just a few examples. They can vary and are highly dependent on your age, stage in life, what kind of cancer you have or what kind of cancer treatment you’re experiencing, relationship status, etc. Take these questions as a taster of what could be asked or a way to start exploring the subject. 

Make sure you ask about anything that’s on your mind – write them down and bring them to your next appointment. There are so many worries that cancer may introduce to our lives – don’t go around worrying unnecessarily about things you can get an answer to.

Read Tammy’s story about sex and breast cancer treatment. 

Intimacy when you can’t have sex

It’s important to differentiate between sex and intimacy. Sex is a form intimacy, but it’s absolutely not the only way to be intimate with your partner. If you’re looking for ways to keep the spark alive but sex won’t be happening for a while because of cancer, there are so many other ways to connect and remain close during what can otherwise be an isolating or challenging experience. 

First off, there’s physical intimacy and it is a critical aspect of feeling close, even if it doesn’t mean sleeping together. If you can’t have sex, there are so many other ways to be physically intimate that also release oxytocin (the hormone that, under the right circumstances, is released during sex that causes pro-social emotional responses such as trust, empathy, and connection). This includes holding hands, kissing, hugging, cuddling… any form of loving physical contact breeds connection.

Besides physically, the kinds of intimacy that we humans experience are far and wide – emotional, intellectual, creative, spiritual, recreational… There’s even such a thing as work intimacy, where you feel a closeness in sharing common tasks. Cool, right?  

Find ways in which you can nourish a variety of forms of intimacy. Create something together. It can be as easy as making a tasty dinner, or going out for one if that’s how you connect. Share a story from your childhood that brings you joy. Or picture albums. Watch a documentary or TED talk or read a book for intellectual intimacy. Do you bond when walking and talking, playing games, watching your favorite series? Engaging in these moments brings you closer – queue intimacy! 

There are so many ways to connect and get our romance on but we get stuck (partly due to nature and partly due to culture) thinking that intimacy depends on sex, expensive gifts, weekend getaways. Instead of getting discouraged, remember that you always have the power to write your own story, whether that’s redefining your understanding of what romance is or taking action to create intimacy. Don’t let things happen to you, happen to them. Go dance in the kitchen – that’s creative and physical intimacy at the same time! 

Behaviours that discourage intimacy

Just as there are ways to actively encourage intimacy and grow together, there are also behaviors that block intimacy. Keep in mind that the following make you feel further away from your partner that you probably want to avoid: 

  • The blame game – not a fun (or constructive) game.
  • The cold shoulder – this will isolate you or your loved one even more. However uncomfortable it is, however angry or frustrated you may feel, punishing your partner in this form (or any other form) eliminates the possibility to reconnect and experience intimacy. 
  • Too much togetherness – read more about how to create a healthy environment for both you and your loved one to thrive in when experiencing cancer. 
  • Thinking intimacy will drop from the sky: Nope, intimacy is vulnerable, and vulnerability takes work. Watch Brené Brown’s talk on intimacy here. 
  • Ignoring your own physical and mental health – here are a few tips on both during and after cancer.

Be curious and patient in the process

Every experience in life impacts us – it informs and shapes our present and our future, how we think about ourselves and the world around us, and makes us aware of what it is we value in life and who we are. The same goes for cancer, sex, and intimacy. Regardless of if you go through cancer or not, intimacy and sex manifest themselves in a variety of ways during different stages in life. That’s okay. We’re not meant to stay the same. Be curious about these changes, aware, and loving in your awareness. Don’t judge yourself or your partner, and be patient in the process.

In the end, enjoying sex doesn’t have to change. But maybe the way you enjoy it does. Whether that’s momentarily or long-term, you can find a way to manage that change and adapt accordingly so that you can reap pleasure and live intimately during and after cancer treatment. Knowledge is power, ask ask ask, and be open and vulnerable in your exploration, whether that’s with your partner or someone whom you trust.

Know that support is out there

Lorraine Grover is a Psychosexual Nurse Specialist who specialises in helping people who have experienced sexual issues because of cancer. In particular, she has worked with prostate cancer patients (and their partners) to help them overcome challenges that going through cancer has created. 
She knows first-hand the impact cancer can have, not only on a person’s sexual well-being, but on their emotional well-being too.

“I would say that patients and partners can underestimate the emotional impact that a diagnosis of cancer can bring. I always encourage people to communicate how they are feeling. It can be helpful in dissipating any fears, anxieties and maybe false understandings they may have especially around sexuality and intimacy.” 

Sex is nothing to be ashamed of, nor should you be ashamed if you feel your views on sex shift following a cancer diagnosis. Lorraine also shared the following advice with us:

“There can be shame and taboo around the words ‘cancer’ and ‘sex’ and there really should not be, let’s normalise the discussion. Everyone should be able to enjoy sexual pleasure and be able to recover and discover themselves irrespective of their sexual orientation, relationship status or age.”
She offers clear advice for men and women and has worked with a number of UK cancer charities talking about how cancer can impact sex and what support is out there.

Sex after cancer can be a struggle for both physical and mental reasons, and Lorraine works with patients on both aspects. She runs ‘Erection Connection’, a service for men that helps them better understand what support is available following cancer treatment.

She is also a Treasurer and Trustee of the Sexual Advice Association. This charitable organisation aims to improve the sexual well-being of men and women, and raise awareness of some of the common sexual conditions that impact the general population.

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