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.
A Love Letter to Aging Bodies and Faces
Do you think aging has made you less attractive? Do you have difficulty seeing yourself or your partner as sexy and desirable?
Then it’s time to challenge your own as well as society’s perception that only young bodies and unlined faces are sexy and beautiful. We need to accept – no, celebrate! – our wrinkles and rejoice in all the pleasure these bodies can still give us.
Let’s join together and practice rejecting society’s youth-oriented view of beauty, keeping ourselves fit so that we feel happy with our bodies, and keeping a loud, buoyant sense of humor!
I love my 71-year-old husband Robert’s face and body. I look into his vibrant blue eyes and I see the young man as well as the older man. The older man is no less sexy than the younger man must have been (I didn’t know him then). In fact, he’s more sexy, because he has learned how to live joyfully and love completely in ways that a young man can’t know until he has lived a full life.
I look in the mirror, where new wrinkles seem to appear weekly. I try to walk my own talk, accepting my own face as I accept Robert’s, telling myself these wrinkles are badges of living, laughing, and loving. I tell myself, this is the youngest I’ll ever be from now on!
I asked my 103-year-old great aunt what it felt like to be more than a hundred. She said, “I’m the same person I always was.”
So are we. Rather than trying to deny our aging — which is futile anyway — let’s celebrate it.
(Photos by Mitch Rice, Robert’s son, on Robert’s 71st birthday)
Condom Sense
Many seniors assume that we don’t get sexually transmitted infections and are not at risk for HIV. They’re dead wrong. Consider this:
- About eleven per cent of all newly diagnosed HIV infections are in people older than fifty, and a quarter of those are older than sixty.
- The risk of AIDS is increasing at twice the rate in people over fifty as compared to the increase in people under fifty.
- Heterosexual HIV transmission in men over fifty is up ninety-four percent, and the rate has doubled in women since 1991.
- An Ohio University study found that about twenty-seven percent of HIV-infected men and thirty-five percent of HIV-infected women over fifty sometimes have sex without using condoms.
- Older women are particularly at risk for blood-borne diseases like HIV or chlamydia because their thinning vaginal lining and lack of lubrication lead to tearing during intercourse, permitting easy access to the bloodstream.
If you’re dating or in a non-monogamous relationship, the issue of safer sex needs to come up early. Some of my women readers write me that they feel uncomfortable asking a new partner to use a condom. They are often newly in the dating game after divorce or death of a spouse. “If I ask a man to use a condom, it sounds like I don’t trust him,” they say. “If I have them on hand myself, he’ll think I sleep around.”
My belief is that if you can’t talk about safer sex with someone, do you really want to invite that person inside your body? But I know it’s hard, especially if you’ve been in a long-term relationship and suddenly find yourself out in that scary world of dating, sex with new partners, and the risks that weren’t a part of our blazing youth.
The Condom Conversation needs to happen before the heat of passion has a chance to melt your resolve. When the sparks and kisses signal that sex is likely in your future, talk about barrier protection. Agree to be prepared when you’re ready for the next stage, whether that means next weekend, weeks from now, or in an hour.
In my single past, these approaches served me well:
- “I always use condoms with a new partner to protect us both.”
- “I’ll buy the condoms — do you prefer a special kind?
- “Do you have condoms, or should we make a run to the store?”
- “Your condoms or mine?”
What if your date refuses? I’ve had occasions when a man refused to use a condom, saying something like, “Sex with condoms just isn’t enjoyable.”
I would reply, “Is no sex more enjoyable?”
At this point, I knew the date was over, and I was glad to know in advance that he didn’t value my sexual health or his own. If he was willing to go to bed with me without protection, then he did that with his last partners, and they did it with their last partners, and so on.
Take a look at Sue Katz’s blog post titled “Seniors Get Infected, Too (Often)” for some startling information about the lack of HIV prevention education for older adults.
What to do when your sex drives aren’t in sync?
“Lonely in Thirties” posted a comment to another post, and what she said is so important that I’m repeating it here so I can address her points. This reader is 38 and has been with her husband, age 42, since she was 17. She writes,
My husband used to want to have sex every day if not more often. I did not want it as often but tried my best to accommodate him for many years. Around the time I turned 35, I noticed a huge jump in my sex drive, I would say 3 times a day, every day, would now satisfy me. All I think about is sex and my orgasms are explosive, usually having multiples back to back.
Her reason for writing is her disappointment with her husband, who no longer wants to have sex as often, mainly only on the weekends. She writes,
I am very frustrated. I thought this is what he wanted all these years, a wife who wanted to have sex as often as he did. He claims he still wants me and wants to have sex but, gives a long list like I used to as to why “now” is not a good time. Is there any hope his sex drive will return?
It seems unfair to give myself to a man all these years and not have him reciprocate. I feel resentful, rejected, and hurt. I have always been faithful to him. However, I admit I fantasize about an affair or even leaving my husband for a younger more virile man. It would be nice to have a man keep up with me, not fall asleep on me. Yet having been with one man so long, I worry that a younger man would not find me attractive, or only want me just for sex. Is this true? Are there sexy men out there in their twenties that want a woman my age?
If I end up staying with my husband I think I should to go back on the pill or something to rid myself of my sex drive. I’d rather not have one then to feel this way. Is this it? If I stay with him will I be subject to years more of frustration?
It’s impossible to say whether her husband’s sex drive will increase again, or whether a younger man would find her attractive (I suspect he would!), but there are a couple of other important issues here besides the obvious difference in sex drives. I wish I could ask Lonely in Thirties these questions:
1. How was communication about sex before your desire changed? Could you each ask for what you wanted? Were you able to talk about what turned you on? How do you communicate about being interested in more sex now? If you have trouble communicating, a counselor could help you break through the barriers and gain a much better understanding of each other and the relationship, as well as this specific desire disparity issue.
2. Have you explored solo sex? Your own fingers and, if you like, a vibrator, would let you enjoy your orgasms, whether or not your husband was in the mood. If you’re considering infidelity, try fantasies and pleasuring yourself first. You may find that you can enjoy yourself with deep satisfaction without risking your marriage.
Lonely, if you return to this blog and read this, I hope you’ll comment again. Although you’re younger than most readers of this blog, your concerns are those that many readers (both men and women) have, and I welcome you to our community.
— Joan