Sexuality and Intimacy After Cancer

When cancer treatment ends and you transition to life as a cancer survivor, there are many things you need to adjust to. This may include resuming a "normal" family life as a cancer survivor, reminding yourself that you can now do things you couldn’t do when you were being treated for cancer, and generally accepting the fact that you’re no longer “sick.” Another issue that most cancer survivors need to face is sexual intimacy. According to one poll conducted by LIVESTRONG, nearly 60% of cancer survivors report experiencing sexual dysfunction after treatment. As many as 85% to 90% of survivors of prostate cancer, breast cancer, and gynecologic cancer survivors report long-term concerns regarding physical intimacy.

Common Emotional Concerns Regarding Sex after Cancer

Post-cancer sexual concerns may be both mental and physical in nature. Emotionally, both partners may feel nervous about having sex after one of them has had a serious illness. A survivor’s partner may be worried about emotionally pressuring or causing physical pain to his or her partner. A survivor may feel nervous about how his or her partner will respond to changes in their physical appearance, which can be considered a “body image issue.” Body image issues after cancer treatment involve your mind (changes in how you feel about your body) and your body (changes in how your body looks.)

Both partners also may worry about having a lowered sex drive and question whether they’ll be able to achieve orgasm. And, many couples experience an adjustment period as they transition away from what may have become a patient/caregiver relationship during treatment back to the romantic partner relationship they enjoyed before the cancer diagnosis.

Physical Symptoms of Sexual Dysfunction

Some cancers and their treatments are associated with specific symptoms of sexual dysfunction. The following symptoms do not affect all survivors but are considered relatively common. Many of these symptoms will go away over time.

Breast Cancer

• Breast cancer patients who had a mastectomy (removal of one or both breasts) may experience loss of sensation, fatigue, and symptoms related to reconstructive surgery (such as feeling discomfort while getting used to implants.)
• Patients who undergo a lumpectomy may experience decreased sensation in their breasts and nipples, and lymphedema.
• Patients who receive chemotherapy, radiation, or hormone therapy may experience menopausal symptoms (decreased sex-drive or libido, vaginal dryness, vaginal atrophy, and mood swings), fatigue, increased scarring and lymphedema.

Prostate Cancer

• Prostate cancer patients who receive surgery may experience erectile dysfunction (inability to achieve or maintain an erection), difficulty climaxing, dry orgasm, and lowered libido.
• Patients who receive hormone treatments may experience erectile dysfunction, lowered libido, hot flashes, and gynecomastia (growth of breast tissue.)

Gynecologic Cancers: Including Endometrial (Uterine), Ovarian, Cervical, or Vulvar Cancers

• Gynecologic cancer patients who receive a hysterectomy may experience loss of sensation, menopausal symptoms, fatigue, lymphedema in lower extremities, and/or prolapse (when the uterus, bladder, vagina, or surrounding structures begin to fall out of their normal positions.)
• Patients who receive chemotherapy or radiation may experience low libido, menopausal symptoms, fatigue, increased scarring, bowel, and bladder issues.

Colorectal Cancer

• Rectal or Colon cancer patients who receive surgery and/or radiation may experience bowel/bladder changes and complications associated with ostomies/stomas.

Communication is Key

As it was before a cancer diagnosis, the key to a healthy and fulfilling sex life after cancer is communicating with your partner. Sharing your anxieties and fears with your partner is the first step toward restoring a mutually satisfying sex life. Discussing issues is healthy and opens up a channel to resolve issues. Often, couples discover that their biggest fears were all in their head.

Sometimes, it can be difficult to begin a dialogue about intimacy. Individual and/or couples counseling is often very helpful. If you’re experiencing anxiety surrounding your sex life, be open and honest with your oncology team or another healthcare provider. They may be able to recommend therapists, and tools and techniques to improve your libido and sexual function.

Strategies for Improving Sexual Desire and Function

Every cancer survivor’s physical symptoms, emotions, and relationship is different. There is no one-size-fits-all regimen for improving your sex life after cancer. But the following are suggestions to consider:

• Focus on getting more/better sleep
• Work on improving your self-acceptance and self-confidence (your partner found you attractive before cancer and may find you even more attractive after you have conquered cancer!)
• Work on relaxing
• Exercise (talk to your doctor about what’s appropriate)
• Talk to your doctor about side effects your medications may be causing (and about re-evaluating medications if needed)
• Consider therapy or medication if you have anxiety/depression
• Use lubricants during intercourse for short-term relief from vaginal dryness
• Use vaginal moisturizers daily for long-term relief from vaginal dryness
• Ask your doctor if estrogen can help with vaginal symptoms
• Experiment with different sexual positions
• Experiment with sexual aids such as vibrators
• Practice pelvic floor (Kegel) exercises to strengthen pelvic muscles

Life after cancer is a marathon, not a sprint! You and your partner have gone through a journey that probably felt at times like a roller coaster ride of ups and downs. Now it’s time to enjoy life on solid ground and rediscover the things you put on the back burner during cancer treatment, including intimacy. Be patient and empathic to each other and don’t hesitate to seek professional help. Your sexual health is an important component of your overall health and quality of life as a cancer survivor!