It is surprising that the care teams of couples facing cancer rarely bring up sexual health during or after cancer treatment.
No One Talks About Sexual Side Effects
No matter how many times we hear it, we are still surprised when a cancer survivor tells us that her care team never felt comfortable enough to talk about intimacy and sexuality while in their care for cancer treatment.
Sometimes we are told that the sexual side effects of cancer and its treatment were either not talked about at all, or somehow minimized.
There may be many reasons for this.
Of course, many people, even doctors, are not comfortable talking about S-E-X. Compounding the issue, 54.1% of medical schools surveyed in the USA and Canada offer only 3 to 10 hours of human sexuality education. Only 42.6% of the schools surveyed offered clinical practice (Solursh et al., 2003).
It is our experience that many health care providers do not have a working knowledge of sexual health or how to discuss potential problems with intimacy. It is important, therefore, that you and your partner become your own advocates in all matters of sexual health. You need to learn what questions to ask. The chances are that you need to bring up and be comfortable talking about the delicate topics, such as vaginal dryness or erectile dysfunction, entailed with cancer and its treatments.
Afraid of Rejection?
Encouraging you to talk about your sexual health is easier said than done. It may be difficult enough to admit to yourself or to speak to your partner about the sexual side effects you are experiencing as a result of cancer and its treatment. Rarely will your doctor go into great depth and at length discuss how cancer treatment affects intimacy.
Most health care professionals will probably not address how you can feel attractive and alive or will help you re-explore couple hood sensations while your roles as a couple center around primary caregiver and cancer survivor.
But without a proper conversation with your doctor, how do you even know if the sexual problems you are experiencing are truly a result of cancer or cancer treatment?
Addressing Common Sexual Difficulties in Cancer Survivorship
Many sexual health issues arise from fear, anxiety, depression, and stress – all common during cancer treatment; but not direct symptoms.
Needed here might be a reframing of expectations and a reassessment of your old arousal scripts. Studies show that being able to make sexual adjustments is a crucial predictor of future sexual health satisfaction of cancer survivors. Likewise, studies suggest that quality of life for cancer survivors can be improved through interventions focusing on physical, mental and communication factors of sexual health (Lotfi et al., 2014).
Have you perhaps been prescribed medication and psychotherapy for depression stemming from a loss of intimacy without receiving education around improving the connection with your partner?
Did you know that certain antidepressants could contribute sexual dysfunction? Perhaps you have been prescribed medication for erectile dysfunction or given estrogen creams for vaginal dryness. These may work for you, but they do carry side effects – talk to your doctor and make sure that she is talking to you about the full range of these effects.
Treating a symptom but not the source is a common problem, especially when it comes to tackling sexual health. You too can learn that intimacy and sexuality are about more than making sure Tab A fits properly into Slot B.
You may have heard that survival should be your only goal as a cancer patient and that everything else comes later.
While we do not disagree with this strategy, doesn’t this approach limit your informed decision-making?
What Else Goes Often Unsaid? Grief.
Rarely discussed among cancer survivors, their partners, and their doctors are the grieving of loss of libido, sexuality, and desire for intimacy.
It is ok to grieve the relationship you once had with your body until you can replace that grief with a new understanding of your body. It is ok to mourn the loss of certain functions before replacing them with new (exciting) patterns for arousal.
The first key here is to move through the grief. Being sad is okay. Being angry is okay. But can you find acceptance?
The second key here is not to shut your partner out of the process. Keep the lines of communication open. Understand that your partner may be grieving too. Support each other.
Scratching the Surface – Only the Most Common Sexual Health Issues in Cancer Survivorship
We offered only a brief overview of the most common sexual health issues cancer survivors had here. Some of the stories about sexual side effects of cancer and its treatments have been truly heartbreaking. Worse yet is the knowledge that many of these sexual issues could be mitigated, and many relationships of couples facing cancer could have been saved, with open communication and the right resources.
Together, Alexzandria Baker PhD(c), MSc, CPSC, and Werner Absenger, PhD, MSc, will bring evidence-based sexual wellness education to cancer survivor groups like those at Gilda’s Club in Grand Rapids, Michigan, and the Johnson Family Cancer Center in Muskegon, Michigan.
New Year-New Talks at Gilda’s Club and Johnson Family Cancer Center
We have several talks coming up after the holidays including Living and Loving After Cancer. Living and Loving after Cancer is a three-part series on sexual health for cancer survivors and their partners. One talk is dedicated to the men, one to women, and a final, third conversation is for both partners. Structuring the discussions in this way will give each partner a chance to get his or her questions answered individually and then come together to learn how to communicate better as a couple on topics intimacy and sexuality.
At the Johnson Family Cancer Center, Alexzandria will engage breast cancer survivors about sexual concerns including changing body image. Alexzandria and Werner will also be talking about how couples facing cancer can integrate mind-body modalities, such as guided imagery, intentional breathing, hypnosis, and relaxation techniques, to reduce sexual issues aggravated by anxiety, depression, stress, and fatigue.
Let us Develop a Program for Your Organization
If you are interested in having Alexzandria Baker PhD(c), MSc, CPSC, and Werner Absenger, PhD, MSc, develop a presentation around sexual health after cancer treatment for your group, either in person or via teleconference, please contact Werner at ACEF.
Alexzandria also offers one-on-one personal coaching for individuals and couples and can be contacted at http://holisticsexualwellness.com/contact-us/.
Lotfi Kashani Farah, Vaziri Shahram, Hajizadeh Zeinab, Sexual Skills Training, Body Image and Sexual Function in Breast Cancer, Procedia – Social and Behavioral Sciences, Volume 159, 23 December 2014, Pages 288-292, ISSN 1877-0428, http://dx.doi.org/10.1016/j.sbspro.2014.12.374
Predictors of Sexual Adjustment in Cancer Patients Receiving Chemotherapy. (2015). Journal of Psychosocial Oncology, 33(5), 488-503 16p. doi:10.1080/07347332.2015.1067278
Solursh, D. S., Ernst, J. L., Lewis, R. W., Prisant, M., Mills, T. M., Solursh, L. P., . . . Salazar, W. H. (2003). The human sexuality education of physicians in North American medical schools. International Journal of Impotence Research, 15(Suppl. 5), S41–S45.