Intimacy After Cancer Treatment

Cancer may affect your intimate life in a variety of ways. What worked well for you before cancer may no longer work. Small difficulties in relationships and problems that began before the cancer may now be magnified.

Since everyone’s experience is unique, you’re unlikely to find the solution to your intimacy concerns in "recipes for better sex" in a popular magazine or self-help manual—or even from well-meaning friends and relatives. However, there are some general considerations for people recovering from cancer that may help you improve your sex life.

The five most common sexual problems experienced by cancer survivors are:

• loss of desire
• depression or anxiety
• physical changes or pain
• fertility concerns
• unresolved relationship issues

Ways to Rekindle Desire

• Have your serum testosterone checked: low testosterone in either sex lowers desire.
• Imagine a time before you had cancer when you were very attracted to your mate. For a period of time each day, remember the way you felt then.
• Start a conversation with your partner and express your desires, worries and fears. Ask your partner how he/she feels and what he/she wants. Be sure to remember to tell your partner what you find attractive about his/her attitude, behavior and appearance.
• Widen your definition of sex. Read a book like The Magic of Sex or A Guide to Getting It On to help you think about new ways of giving and receiving pleasure.
• Plan a time when you’re feeling well and are not fatigued to try some of the things you read about. Sometimes desire returns during the process of getting close. If you wait for specific sexual desire, you may have a long wait.
• Do not focus on intercourse per se. In fact, the two of you may want to agree to forego intercourse for a period of time while you recover desire.
• Remember there is no "normal" level of desire. In every couple, one partner has a higher level than the other. Your partner may need to re-evaluate his/her expectations.
• Consult your physician, nurse practitioner or a sex therapist if the problem persists for more than six months after treatment ends or if it causes distress in your relationship.

Coping With Depression or Anxiety

• About 30 percent of cancer patients develop some amount of depression or anxiety. You will know you’re depressed if you lose interest in things you used to love, feel very negative about the future or are "down in the dumps" for most of the time every day. Waking up very early in the morning for no reason can be another depression symptom.
• You will know you’re anxious if you can’t stop worrying about things. You might startle and cry easily. Some anxious people have bad dreams. Some have a lot of trouble falling asleep at night. Your thoughts may be fearful, and you may believe you’re in constant danger.
• If you have symptoms of either of these disorders, you may have trouble with sexual desire and/or with orgasm. See your health care practitioner.
• Some medicines given to cancer patients for depression or anxiety interfere with sexual desire and orgasm. If this happens, ask your physician to re-evaluate your medication.

Coping With Physical Changes or Pain

• Become acquainted with the appearance, sensations and function of the area of your body that has changed. Use a mirror if necessary. Gently touch the area and name the sensations you feel.
• Write a letter from your old body to your new body, explaining why the change was necessary.
• Write a letter from your new body, describing how it feels. Then write a response to your new body, telling it how much you care for it.
• Some cancer treatments result in physical changes to sex organs (for example, tightening of the vagina or problems with erection). Describing the change to your doctor is the first step. Help is available—virtually all problems can be solved.
• If you have persistent pain, it needs to be managed. There are medical and behavioral methods to help alleviate pain. Pain is a warning, so don’t do anything that is painful unless you have cleared it with your health care provider.

Fertility Concerns

• Many cancer treatments interfere with fertility, so if you wish to have children after treatment it is important to plan accordingly. In some cases eggs or sperm should be banked for later use.
• Cancer treatment is not a form of birth control, even though it may temporarily interrupt ovulation or reduce sperm count. For most people of child-bearing age, birth control should be practiced throughout cancer treatment. Depending on your treatment, your method of birth control may need to change.
• Many cancer treatments cause premature menopause. Menopause symptoms include hot flashes, changes in sexuality, and vaginal and cognitive changes. Symptoms can be successfully managed. Your gynecologist is a good source of information.

Relationship Changes

• Cancer is a crisis that causes changes in intimate relationships. It is a good time to re-evaluate. Go on a couples weekend where you can practice your relationship and conflict resolution skills and learn ways to enhance intimacy.
• Read a self-help book like Men Are From Mars, Women Are From Venus or The Seven Principles to Make a Marriage Work. Do the exercises together.
• When communicating with your spouse, increase the ratio of compliments to negative statements. In other words, let him/her know what you like, approve of and appreciate as well as what upsets you.
• Attend a few sessions of marital therapy to resolve stubborn issues.

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