Coping with Sexual Concerns
Roughly 50 percent of women who have received long-term treatment for breast and gynecologic cancers report some type of sexual difficulty at some point during treatment and recovery, ranging from loss of sexual desire to pain during intercourse. Nearly 70 percent of men who have been treated for prostate cancer may experience sexual problems, primarily the loss of sexual desire or erectile dysfunction.
The physical side effects of cancer and its treatment are often cited as the obvious reasons for sexual difficulties, but psychological and emotional factors can sometimes be just as debilitating.
Psychological factors that can impact sexuality include depression, confusion, anxiety, guilt, stress caused by the diagnosis of cancer, and changes in an individual's body image following surgery and treatment for cancer.
The degree to which the resulting sexual difficulties impact an individual's quality of life can vary dramatically from patient to patient. But available medicines and other treatment options can often minimize this impact, if not eliminate it altogether.
It is only in the past few years that many of the sexual side effects from cancer treatment have been researched with fervor. And yet, a surprising number of clinicians still don't discuss sexual difficulties with their patients-or even recognize the symptoms that may be leading up to such difficulties.
For example, a recent study published in the journal The Oncologist found that discussing sexuality with cancer patients is probably the single most uncomfortable topic for the medical profession.
Dr. Richard Penson of Massachusetts General Hospital in Boston and colleagues evaluated how doctors at that facility discussed sexual topics with a series of cancer patients. They noted that since patients do not generally volunteer information about sexual problems, it was incumbent on health professionals to inquire about sexual function.
They found that patients-especially those who had significant apprehensions and emotional problems-often reacted with relief rather than embarrassment. The researchers concluded that a sensitive and informed approach to discussing sexuality provided effective and much-needed emotional support for patients.
Sexuality is just one aspect of our need for closeness, but it is an important one-including during cancer and recovery. Even when sex becomes difficult, the physical expression of caring remains an integral part of the coping process.
As most "cancer couples" already know, sexual desire can wane at various times during treatment due to fatigue, vaginal dryness, hot flashes, and other side effects. Certain surgical procedures can have long-lasting impacts on both sexual desire and the physical act of sex itself. Other stresses on a relationship can include worries about changes in appearance, or anxiety about health, family or finances.
A partner's simple lack of understanding can also affect the sexual relationship. Some may worry that physical intimacy will harm the person who has cancer. Others may fear they might "catch" the cancer, be affected by the drugs, or be exposed to radiation. (All are unfounded.)
Complicating this, many couples are hesitant to talk about sex-even when they are healthy. Yet a crucial part of resuming sexual activity after treatment is honest communication with your partner. Both men and women often react to cancer by withdrawing into themselves. The result is that each partner is left to cope alone, and misunderstandings due to lack of communication can often flare up into major difficulties in the relationship.
No couple gets through a cancer diagnosis and treatment without some anxiety, including sexual frustration. Such issues should be-need to be-talked about openly and regularly.
Some partners may fear that showing sexual interest is selfish, or they may worry that touching the cancer site can bring about a recurrence of the disease. (Not true.) They may simply be nervous about seeing the scar from the surgery, or worry how their facial reaction upon seeing it will be perceived. (It is important to realize that any and all reactions are normal and to be expected.)
After mastectomy, some women fear that their partner will be offended at the sight of an absent breast. Recent studies indicate, however, more openness among couples and greater acceptance of the surgical site by partners than previously thought. In fact, it appears that most men "tune out" their partner's missing breast during lovemaking and focus on the pleasures of the experience.
Sexual problems frequently arise not so much from changes caused by medical conditions or their treatment per se, but from how we feel about and deal with those changes.
Practical considerations like medical bills, home finances, and balancing additional home responsibilities with occupational pressures can drain the energy of spouses. These stresses can lead to feelings of powerlessness that may disrupt the frequency, pleasure and importance of sexual activity for the partner of a person with cancer.
In fact, any number of issues-anxiety regarding the prognosis, fear of causing pain, the stresses of altered roles, the burden of medical expenses-can alter a partner's willingness to initiate sexual contact. Partners may withdraw sexual energy from the relationship as a form of self-protection.
Unfortunately, some pervasive myths regarding sexuality and cancer still abound; most are unfounded, some are based on simple misunderstandings of the disease and the treatments for it.
For example, some patients believe that cancer can be passed from one person to another through sexual contact-or in any other way for that matter. This is not true. A cancer cell simply cannot leave one person and begin growing in another. Not only are cancer cells-and all cells-fragile, but another person's immune system will immediately recognize a foreign cell that is not "one of its own" and destroy it.
After you have undergone radiation therapy, sex will not expose your partner to radiation. In fact, radiation exposure is minimal for the patient, and even then it is specifically targeted only to the cancer itself. Radiation therapy has an immediate impact on destroying cancer cells but does not linger in the body. And it therefore does not expose your partner to any radiation risk.
Similarly, there are no risks to your partner from the chemotherapy drugs you are taking, although during treatment a few chemotherapy drugs can be present in small amounts in semen or vaginal fluids. Ask your doctor if this applies to the chemotherapy drugs you are taking. If so, it may be appropriate to use condoms around the time you are receiving your treatment.
Finally, sex will not make cancer worse. Whether the cancer spreads or goes into remission is completely independent of sexual activity. In fact, the intimacy that derives from sex may actually provide important emotional benefits and support to the person undergoing treatment.
During treatment and recovery from cancer, sexual activity is usually safe. However, there may be times when it will be temporarily painful, or when a period of rest and recuperation from all activities may be called for. Such times may include a period after surgery when the risk of infection is greater. In any case, check with your doctor.
Radiation treatments to certain areas may make skin more tender or susceptible to infection. Different positions during sex, or different ways of achieving orgasm that do not involve the treated area, may be helpful.
At times during treatment a person's immune system may be weakened, especially during chemotherapy or radiation therapy. You may be more susceptible to infections, particularly sexually transmitted diseases. Simple precautions such as using a condom may be called for.
If you are wondering whether sexual activity would cause a problem during treatment, ask your doctor. The answer may vary at different times and for different people. But common sense, and a simple question to your doctor, may be all that is necessary.
Communication, however, is just as important with your partner, if not more so. Sexual desire may fluctuate constantly during treatment. Long periods of time may pass where the desire for intimacy is subdued, followed by periods involving an intense need for closeness. And beyond the physical impact of the disease, anxiety, fears and even depression can impact intimacy.
When it comes to sexuality and cancer, many fears unfortunately still abound. Most of them are unfounded-and all of them should be communicated.
SOURCES:
The Oncologist, August 2000; 5:302-311, 336-344
Journal of Clinical Oncology, 2000; (18)4: 743-753
Journal of Clinical Oncology, 2000; (18)4: 743-753
The National Cancer Institute (http://www.nci.nih.gov)
Abstracts from the Annual Meeting of the American Society for Therapeutic Radiology and Oncology, 1997, Orlando, Florida
The American Cancer Society (http://www.cancer.org)
10th European Cancer Conference (ECCO); Sept. 12-16, 1999, Vienna, Austria
[Table of Contents] [Archived Issues / Search] [The Breast Center]