prescription drug has side effects that affect your sexuality, check with your pharmacist and with your doctor. If this is the case, ask your doctor if there is an alternative medication that may not have this effect.
Cocaine, heroin, marijuana and other street drugs will distort sexual response.
Smoking: Research increasingly shows the direct cause-and-effect relationship between smoking and sexual function in men and women. Nicotine directly interferes with circulation and pathways of the nervous system. Smoking has a negative effect on the sexual organs, clogging small blood vessels and thereby reducing blood flow, including in the clitoral area in women and the penis in men.
Aging Affects Sexual Function
Even without cancer or other disease, as a person ages, sexual function and frequency of sexual contact often declines. Most women experience a decline in their sexual function as their bodies move toward menopause, and a substantial decline as they reach older age. Then there is the fact that the man is more likely to begin having erectile problems as he ages, and probably less sexual desire. As a result, a couple may have less sexual interaction over time.
Female Sexual Dysfunction
Within the context of cancer therapies, female sexual dysfunction (FSD) must be discussed as well. In the last half-century, substantial research has led to a clear definition of male sexual dysfunction, while women’s sexual difficulties were often dismissed as being “all in their heads.” Medical doctors were often quick to tell women to see a psychiatrist when they talked about sexual problems.
Only in the late 1990s and early 2000s did researchers document the spectrum of women’s problems that are caused by physical changes, as well as by psychological problems. The medical community has finally come to recognize female sexual dysfunction as a distinct medical condition.
It is estimated that as many as 43 percent of women suffer from some level of sexual dysfunction. Of women who have been treated for cancer, about two-thirds have short- or long-term sexual dysfunction. For some women, it was treatment that brought on their problems; for others, therapy worsened their difficulties.
Sexual dysfunction is not one problem but a spectrum of different conditions, whether they are the result of cancer therapy or not.
Low Sexual Desire
Women with this problem experience anxiety because they lack sexual fantasies or thoughts about sex. Women with cancer need to remember that fighting cancer may subvert or suppress sexual feelings. Sexual desire vanishes at least temporarily with some treatments. Medications may also cause this condition. A key factor in sexual desire is the quality of the relationship and its history, so problems in the relationship and emotional factors may also be responsible.
As mentioned earlier in this chapter, a woman with low sexual desire may still be able to have a positive sexual experience with a patient and sensitive partner. Gentle caressing, kissing, and sexual touching may get her aroused and ready for more sexual activity. Therefore, a woman who would like to make love should not shy away from sexual activity because she feels no desire. She and her partner need to recognize that the partner needs to take a more active role than before and initiate sex (with her agreement), but she may be able to respond.
Sexual Arousal Disorders
With arousal problems, women find it difficult or impossible to achieve and maintain sufficient sexual excitement and derive sexual pleasure from any part of the sexual activity. In a few cases, women with this disorder may still have genital swelling and lubrication of the vagina.
Orgasmic Disorders
Orgasm problems fall into two types. Either the woman has never had an orgasm, or she has become unable to achieve an orgasm after previously being able to experience it.
Pain During Intercourse
Vaginal or pelvic pain during intercourse may be the result of surgery, radiation, chemotherapy, or other medications that may cause thinning of the vaginal wall or muscle spasms during intercourse. The medical term dyspareunia refers to painful sexual intercourse because of medical or psychological issues. Vaginismus refers to involuntary spasms of the muscles of the vaginal wall, resulting in difficulty with any type of vaginal penetration such as sexual intercourse or even a tampon.
Contributing factors may be age, other diseases, abuse and trauma, or medications such as those taken for high blood pressure.
Any of these problems can cause significant distress. A woman’s partner may pressure her to have sex and be unable to understand why she is either unwilling or lacks enthusiasm. Often, women do not tell their partners that they are feeling pain or that they can’t concentrate on love-making at that moment. Even though they may want physical intimacy, pain or the lack of satisfaction discourages them. Surgery for pelvic cancer and breast cancer is a major cause of pain. Communicating to your partner why you are not up to love-making is essential to keeping the relationship strong.
Sexuality and Cancer
Cancer does not usually cause sexual problems—treatment does. Sexuality-related problems after cancer therapy are very common. The short- and long-term side effects of cancer therapy are now more fully appreciated, thanks in large part to mental health professionals such as Leslie Schover, PhD, and Les Gallo-Silver. Their work has called attention to the higher incidence of sexual disorders due to cancer therapy. Their studies and others show that many women need help, and that they have a good chance of returning to their desired level of sexuality if they receive sexual counseling during and after their cancer therapy.
Effects of Cancer Treatments
Each of the three major treatments for cancer can also have a profound impact on a woman and thereby the couple’s sexuality. Surgery can change a person’s anatomy and result in a changed appearance, while radiation and chemotherapy have side effects of various durations. The consequences of surgery often leave both physical and psychological scars. Chemotherapy may leave the woman tired, nauseated, anxious, or depressed and may lead to low sexual desire. In addition, radiation for breast cancer can cause irritation or swelling in the breast or arm. Radiation to the pelvic areas for gynecological and other pelvic cancers can cause urinary tract irritation, bowel problems, and decreased genital sensitivity.
After cancer treatment, many women find that:
•They have less libido or none at all.
•They take a longer time to be aroused.
•They need more direct stimulation.
•They take longer to achieve an orgasm.
•Their orgasms feel different, and at times they will not have any.
Cancer Means Change
Even before a woman goes into therapy, the mere diagnosis of cancer changes the person’s psychological equation. Her emotional balance changes and she naturally becomes preoccupied with the disease. In this atmosphere, intimacy and sexuality often become submerged under the pressure of dealing with the treatments and the anxieties associated with the patient’s
