Helping Cancer Survivors and Their Partners Reestablish Sexual Intimacy
by Mindy R. Schiffman, PhD
A cancer diagnosis is life changing. In addition to the emotional jolt of confronting your own mortality, you may experience physical changes that affect your body image and sexuality. The sexual response is exquisitely sensitive to change even under “normal” circumstances like a new partner, a different room in your home, or a shift in the time of day. Suffice it to say, cancer and its treatments can have an enormous impact on your sexuality. And if you’re in an intimate relationship, your partner may also be left reeling in cancer’s wake.
Who is at risk for sexual dysfunction after cancer treatment?
Those with dramatic changes to their bodies or whose cancer affects a reproductive organ or sex hormones are at greater risk for sexual problems following treatment. Moreover, if your romantic relationship, body image, or sexual functioning was already troubled, cancer may exacerbate those problems. Chronic pain or fatigue, as well as untreated depression or anxiety, can also impede a cancer survivor’s return to a healthy post-cancer sexual life.
What are some common sexual problems men and women face after cancer treatment?
Women are apt to feel less desire to be sexual, as well as decreased sexual pleasure. They may also experience pain during penetration due to a decrease in the body’s natural lubrication. Men are more likely to worry about getting and maintaining an erection, which can lead to avoiding sexual encounters. Men may also experience a decrease in sexual desire, especially if their testosterone levels were affected by cancer treatment.
This means you have to talk to one another – about sex.
What are some things my partner and I can do to reestablish sexual intimacy?
It is important to stay physically close, even when sex is not on the agenda. Continue to kiss, touch, and caress each other. Engage in activities outside of the bedroom that might help nurture your sexual interest. Write each other love notes, do some non-sexual physical activities together (like taking a walk in the park), enjoy a romantic dinner.
You and your partner may also need to reestablish how to initiate sex and redefine what your focus is during a sexual interaction. This means you have to talk to one another – about sex.
Many people think they shouldn’t have to talk about sex; lovers should just know what to do. However, sex therapists have long advocated that communicating your sexual concerns and desires is the gateway to better sex. Talk to your partner about your worries, your wishes, and your needs. Initiate these conversations outside of the bedroom, not in the midst of a sexual interaction, and speak in a non-confrontational, conversational tone.
After cancer, plan some time for sensual interludes that may (but do not necessarily) lead to a sexual interaction.
You may be thinking, “Why do I have to have these potentially awkward conversations when I can just take a pill to help with sexual arousal?” Well, while there are pills for both men and women that may help with aspects of sexual functioning, even with this medical aid, couples still need to talk about their concerns and needs. Pills are not magic bullets.
After cancer, you may also have to change how you think about sexual encounters, specifically when they should occur and what you feel comfortable doing. Many people believe that sexual encounters should be spontaneous. However, after cancer, spontaneous desire just may not be there. Don’t wait to be “in the mood” to initiate sexual or sensual contact. Instead, plan some time for sensual interludes that may (but do not necessarily) lead to a sexual interaction. Before each one, discuss your sexual limits as you work your way back to a more spontaneous, fluid sexuality. For example, you may want to begin with kissing and non-genital touching, then gradually move to increased levels of sexual intimacy.
When you set aside time to focus on intimacy, keep your thoughts on specific sexual images or fantasies. With touch, arousal is likely to follow. If negative thoughts intrude, just gently shift your mind back to the earlier fantasies and try to focus on the pleasurable sensations you’re experiencing during the encounter.
You may also need to reframe your definition of sex. Sex is not just intercourse. Instead, think of sex as pleasing sensual and sexual activities that you and your partner take turns giving and receiving. Try to move the focus of sex to intimacy and pleasure rather than a specific outcome. This will help take the pressure off “performance.” If penetration and orgasm are no longer the goal of sex, but pleasure is, you will have a much greater chance of achieving your goal.
As you become more comfortable with your post-cancer body and begin to reestablish intimacy with your partner, experiment with different positions. During penetration, always use a water-based lubricant, which will enhance arousal and decrease pain. And be sure you are both ready for penetration before proceeding.
You can expect that there may be awkward moments. You or your partner just may not respond as you once did, or as you would like to. Try (really try) to keep a sense of humor. Remember, sex is supposed to be about intimacy and pleasure, not about pressure and proving yourself.
Dr. Mindy Schiffman is a clinical psychologist at the New York University Langone Fertility Center in New York, NY; a clinical instructor in NYU’s psychiatry department; and a certified sex therapist and supervisor in the Human Sexuality Program at NYU Langone Psychiatry Associates. She also has a private practice in individual and couples counseling in Greenwich Village. Dr. Schiffman specializes in helping people cope with the emotional stress of illness, including reproductive loss, sexual dysfunction, grief and bereavement, and interpersonal conflict.
If you find that your sex life isn’t improving, even after attempts to restore intimacy with your partner, talk to your doctor. They can answer your questions, refer you to a specialist, and help you find solutions.
This article was published in Coping® with Cancer magazine, January/February 2020.