Sex and the Survivor

Editor’s note: As a Psychiatric Mental Health Nurse Practitioner, with years of experience working with adolescent and young adult cancer patients, Amelia Baffa provides the reader with factual information as well as helpful steps to take when dealing with the sensitive issues of sexuality as a cancer survivor.

The Facts

The impact of cancer and cancer treatment can physically and psychologically affect our relationships, this can be especially true when it comes to romance and/or intimate relationships. Whether you are dating or in a committed relationship talking about the possibility of cancer, recurrence/ relapse, physical limitations, body image changes, fertility issues, and your feelings can be frightening, scary, or daunting. Take a few deep breaths and consider being honest with your partner about what you are thinking and feeling. Chances are they have concerns of their own, it’s likely that they have been waiting for just the “right time”, to talk to you about them. By opening up and communicating you are creating the opportunity to work through both of your concerns together. Got team!

The gender challenge:

Female cancer survivors tend to be more affected than their males. According to Dr. Brad Zebrack over 52% of females report experiencing at “least a little problem” in one or more areas of their sex life while 32% of the male survivors reported experiencing issues with their sexual functioning (Zebrack, Foley, Wittman, & Leonard,2010.) Females also report feeling more distress/anxiety regarding their sexual difficulties than males and more sexual symptoms, while males tend to experience more distress related to sexual difficulties.

Survivors: How to talk to your partner

Conversation starters. It’s simple, start communicating and keep communicating. By maintaining open dialogue about what you are thinking and feeling, you’ll know what’s on one another’s mind, which will help you face your concerns as a couple. If you have to discuss a delicate issue and you’re afraid of offending your partner try starting with an “I” statement, such as “I feel sad when I ‘m too tired to be with you.” This take the focus away from your partner and focuses/identifies with what you are thinking and feeling, this opens up the way for them to listen to your concerns without making it personal.

Be truthful. Be honest about your feelings. Good communication is the foundation of any stable relationship. Remember the goal is to get through this together.

Mind Reading. Chances are neither you nor your partner are mind readers. Let your partner know how you feel and what’s on your mind, chances are they are waiting for a clue from you, so they know what they can do to help.

Love and be loved. Practice loving yourself and being loved. Consider your strengths, maybe you make the best brownies this side of the Mississippi, practice random acts of kindness every chance you get, or volunteer at the local animal shelter. Whatever it is, feel the positivity, the sense of gratitude that comes from being in touch with the goodness is present within you.

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Tips on talking to your doctor or nurse

Ask about sexual concerns that could happen after treatment.
Write down questions and symptoms. Knowing what you want to ask ahead of time can conquer any shyness and embarrassment. If you feel too embarrassed to discuss your concerns you can email your provider before your appointment with your questions and concerns, this way they’ll be aware and prepared to discuss at the visit.
Some people find it helpful to bring their partner with them, and that way they can discuss their concerns together.
Be specific. For example “I am having pain during sex, and it’s really upsetting. It could be from all the chemo/radiation therapy I received. Will this get better? What can I do about it?”
If you feel uncomfortable you can practice what you want to say before the visit, or jot down your thoughts.
Lastly it’s normal to feel embarrassed, but here’s the thing, if you don’t talk about your sexual concerns you may not get the help you need. Even if your doctor or nurse don’t have all the answers they can direct to you to professionals who do. Note: there are healthcare providers that specialize in individuals/couples experiencing sexual issues, they are called Sex Therapists.

What can Happen after Treatment for Men

Loss of interest in sex
Trouble getting or keeping an erection that is firm enough for sex ( erectile dysfunction)
Trouble having an orgasm ( climax)
Having orgasms that are shorter, not as intense , dry
Leaking urine during an orgasm instead of semen
Pain in the testicle during sex
Body image changes

What can Happen After treatment for women?

Loss of interest in sex
Trouble getting excited or enjoying sex
Bad thoughts or feelings about sex
Trouble having an orgasm (climax)
Dryness or tightness in the vagina
Pain during sex or when the genitals are touched
Effects of chemopause ( early menopause) such as vaginal dryness, hot flashes, and painful intercourse
Body image changes

Survivors: Taking Care of Yourself

Schedule an Assessment. Don’t suffer in silence, talk to a healthcare professional. They can help you to identify potential causes and treatments, for changes in your sexual health and function.

Take a broader view of sex. Cancer treatment can lessen sexual desire. Yet people with cancer still need and desire physical closeness. Hugging, caressing, massaging, cuddling and kissing can satisfy you and your partner.

Take it slow. There is no need to rush. If you are not ready for sex, don’t feel pressured to be more or less sexual than you want to be. Being intimate can center on pleasure and being together.

Talk with your partner. If your partner is silent or appears withdrawn, it doesn’t’ mean he or she is not concerned about what you are going through. They may be unsure of how to show affection or worry about hurting you or causing you pain. Talk to your partner about any concerns you may have about physical touch and sex. Be honest about what you want and need, what feels good and what doesn’t.

Stay the course. What’s that old saying, “Rome wasn’t built in a day?” Don’t give up, be patient, and above all things maintain your sense of humor.

Change your techniques. Spend more time on foreplay. Try different positions that may be more comfortable or pleasurable. Try different things to get you in the mood.

Talk to your partner about our fantasies and feelings. Communicate with your partner about what feels good and about new things you may want to try. Get creative!

Conclusion

Throughout all that you and your loved one have been through you have built something very powerful… that something is called resilience. Resilience is defined as the ability to recover from difficulties: a toughness. It’s akin to one of my favorite words, grit, which is basically a quality that embodies perseverance and passion. It’s that place within you that says “Dammit I am not giving up!” Step back are reflect on how far you have come, and know that within yourself you have the strength to recover and thrive in all aspects of your life. The good news is, and research supports the fact that the majority of survivors go on to have a healthy sex lives, that means you can to!