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Sex, Intimacy and Cancer

March 19, 2013

I was not at all surprised when my middle-aged patient asked me about intimacy and sex after her cancer diagnosis. Quite the contrary, actually; I wish more of my patients felt comfortable asking these very important questions!

There are many issues surrounding intimacy after being diagnosed with cancer. Sex and sexuality are important parts of everyday life. Feelings about sexuality affects a person's zest for living, her self-image, and her relationships with others. Unfortunately, patients and their doctors often do not discuss the effects of cancer treatment on their sex lives.

Why is intimacy avoided?

Preoccupation with Cancer Treatment

Women often report that they lose interest in sex during cancer treatment. Initially, she is so concerned about her survival that sex is far down on her list of priorities. This is normal. Few people are interested in sex when they feel their lives are being threatened. This loss of desire can be caused by worry, depression, nausea, pain, fatigue, or disturbance of female hormones. Any emotion or thought that keeps a woman from feeling excited can interfere with desire for sex. Thoughts about the cancer and treatment can keep her from getting aroused. Her vagina then stays tight and dry, which can make intercourse painful thereby initiating a vicious cycle whereby sex is avoided. In addition, women with cancer sometimes worry that a partner will be turned off by changes in their bodies or by the cancer diagnosis itself.

Pain

Pain during intercourse is a common complaint. It is often related to changes in the vagina's size or vaginal dryness. These changes can happen after pelvic surgery, radiation therapy, menopause, or treatment that has affected a woman's hormones.

Early-Onset Menopause

Cancer treatment can also cause menopause to occur earlier than normal. This is called premature menopause. Symptoms are often more severe than the slow changes that happen during a natural menopause. When a woman's ovaries are removed as part of a cancer surgery, or when the ovaries are affected by chemotherapy or radiation to the pelvis, the loss of estrogen can trigger hot flashes and vaginal atrophy (a condition when the vagina becomes tight and dry).

Addressing Intimacy Issues

With all of these factors that can affect a woman's desire for and ability to enjoy sex after being diagnosed with cancer, it can be expected that she and her partner may be deprived of this very important part of their relationship.

Women with cancer need to know that it is important to bring up these issues during a visit with their doctor. There are solutions to many of these problems and most health professionals will prescribe the necessary therapy or make the appropriate referrals to address these issues.

When asked, I tell my patients that there are many ways in which they can be intimate with their partners. If penetration is painful or not possible, for example, touch or stroking can bring about pleasure and can also result in achieving orgasms. If she feels weak or tired, she may want to communicate to her partner to take a more active role in touching her. If some part of her body is tender or sore, she can take control by guiding her partner's touches to create the most pleasure and avoid pain. Sometimes, she might just want to cuddle.

If self-esteem or body image is the problem, she can engage in activities that will help her regain her sense of femininity and sensuality. Some of these activities include exercise, yoga, acupuncture, a change in wardrobe, a new wig, or even changing her style of makeup.

Ultimately, I want my patients to know that it is okay to talk about sex and intimacy after a cancer diagnosis. More importantly, they should know that their oncologist cares, and can provide essential guidance and options to help achieve intimacy throughout their cancer treatment. Communication with doctors and partners is key.

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