Sex and Intimacy after Cancer

If you or your partner has been diagnosed with cancer, what part does sexuality play in your quality of life? How will cancer treatment impact your sexuality — physically and emotionally? How do you cope with changes in function, libido, body image, and pain? How can you maintain intimacy in the face of these challenges?

“Sexuality is all about who you are as a man or a woman,” says Sage Bolte, MSW, LCSW, OSW-C, a renowned authority on sex and intimacy after cancer and an oncology counselor at Life with Cancer®, an Inova Health System service in northern Virginia. “It’s a critical part of your quality of life.” Sex and intimacy are key ways to affirm, “I’m alive, I’m human,” and of getting back what was important to you before cancer.

On March 11, 2008, the Leukemia and Lymphoma Society presented a teleconference with Bolte for 1,400 listeners. It was superb. Fortunately, the teleconference will be available as a transcript and MP3 recording sometime in April 2008 at www.lls.org/survivorship.

Forty to 100 percent of people with cancer will experience some form of change in sexual function, says Bolte, which can impact willingness to engage in sexual activity. However, she assures us, “Patience and techniques can help you regain a sense of sexual self and confidence.”

Although Bolte’s message was targeted at the special challenges of cancer, all of her suggestions also apply to living with any chronic or life-threatening illness, as well as the sexual challenges of aging itself. Here are some of her techniques for coping with specific problems:

Vaginal dryness and discomfort: Apply 100% vitamin E oil to the vaginal tissues and clitoris on a regular basis after showering, and use a water-based lubricant as needed during sex. Talk to your doctor about whether an estrogen ring or testosterone patch would be appropriate to regain moisture and restore elasticity of the vagina.

Erectile dysfunction: Tell your physician about this problem and have him/her look at all your medications. Have your testosterone levels checked. If you’re having a harder time maintaining an erection, try finding the positions that is most stimulating for you. Help your partner reach orgasm before intercourse. Devices for men that may help include penile pump; penile injections, suppositories, penile implant, penile rings. But if you’re on blood thinner or have low platelets, you need to consult with your physician before using any of these devices, because they might put you at risk. Viagra and similar medications are not recommended for men who have heart concerns or are taking blood pressure medications.

Pain and fatigue: After cancer treatment, the time of day that’s right for sex might change. If you’re too exhausted in evening, switch to morning or have a special lunch break. Take pain medication 30 to 60 minutes before activity. Get exercise, which can minimize fatigue and assist in decreasing some joint pain. “Remember that we can rest during sex,” says Bolte. “It’s not a marathon.”

Fear of rejection: Consider seeing a couples counselor or sex therapist. Often the problems of miscommunication, misinterpretation, and anxiety get in the way of your sexuality and intimacy. Work on your communication skills. (Note: I’ll be writing more on this topic in another post.)

Difficulties reconnecting with your partner: Communicate your own desires, ask for what you need, and ask your partner to communicate honestly, too. Be affectionate. Take it “slow and easy.” Take time to be together and to connect. Find other ways for both of you to have pleasure.

Redefine your expectations,” suggests Bolte. “Sometimes you can’t get back to the function you had prior to cancer, but that doesn’t mean it can’t be good or pleasurable.” Focus on touch, sensation, pleasurable feelings. Use sex toys. Engage in mutual masturbation. Read fantasy to each other. Touch yourself. Massage each other and cuddle.

“Take more time to get stimulated, talk yourself into sex,” Bolte recommends. Realize that instead of the physiological response coming first and driving the emotional response, it may need to be the other way around, a “mind thing first.” Schedule your sex time – plan it, think about it, fantasize, and work yourself up to the mental excitement that will stimulate the physical excitement.

Don’t let sex feel like pressure to perform. Sometimes practice just touching without the expectation of intercourse. Re-explore alone what feels good to your body now. “Start with self-pleasuring experiences,” says Bolte. “Your body has changed since treatment. You need to be comfortable touching yourself and knowing what feels good now.”

I applaud the Leukemia and Lymphoma Society for recognizing the importance of sexuality to people diagnosed with cancer and Sage Bolte for generously providing her expertise.