difficulty recovering their desire for and their enjoyment of sex. Once sex is stopped, it is sometimes easier to continue in a sexless mode than to restart. Yet restarting sex can be an important contributor to returning to physical and emotional health.
Resuming Sex After Cancer: Stressful but Rewarding
There is no doubt that resuming sexual activity after cancer is stressful. Dr. Carl Simonton, who works with patients and couples dealing with cancer, says that sexual readjustment rates 39 out of 100 on the stress scale. It produces more than half the stress of going through a divorce and close to that of getting fired. So resuming your sex life takes work. It is worth remembering, though, that people who make love are happier, and live longer, than people who don’t.
If you are lucky enough to not experience sexual side effects from cancer treatment, you may still find that many sections of this book can help you improve your love life. If you are experiencing sexual difficulties, we hope to provide you with information, thoughts, and tools that will help you navigate the path to recovering the important part of yourself that is a sexual being, and a satisfying physical relationship with the one you love.
There is no one-size-fits-all approach for addressing sexual dysfunction after cancer treatment. You may be young, middle-aged or older; have children or not; have a partner who is supportive or one who does not know how to be supportive; you may not have a partner; you may be sexually conservative, adventurous, or somewhere in the middle. However your situation can be described, we want you to know that there is a path for you and that it is certainly worth the effort - because good loving is the physical expression of emotional intimacy, and there are few humans who do not want or need emotional intimacy.
Chapter 3
Cancer Therapy and Its Consequences
I had a mastectomy and chose reconstruction with a matching augmentation on the other side. Now I don’t get aroused when my husband touches the mastectomy breast because I don’t’ have feeling in that breast. The good news is that I am now a proud C cup woman, and there are many other ways to get me going.
Amanda
Ever since both of my ovaries were removed, intercourse has become painful. I don’t know yet if it will get better with time. My boyfriend is fine with not having intercourse - now we have oral sex. We have gone from one kind of boring to another kind of boring, because we always do things the same way.
Liz
My melanoma is being treated with Interferon. I know that’s one of the most aggressive treatments, but that’s what I need for my aggressive cancer. That thing has knocked the wind out of my sex life. I am not interested at all. I just let my husband do his thing, but it doesn’t do anything for me. It must be hard for him—he loves me so much, he takes care of me, he gives me the shots that he knows hurt and make me feel miserable, and our sex life is reduced to pump and dump. This stinks!
Carol
In some situations, not knowing what to expect can be exciting. But where health is concerned, people naturally become fearful. For a woman with cancer, the diagnosis is often terrifying. That’s because just a few decades ago, a diagnosis of cancer was most often considered a death sentence.
For many people, having cancer in the 21st century means having a chronic disease, much like heart disease or diabetes: one that requires monitoring and management. Unfortunately, doctors often do not talk about what monitoring and management consist of: the ongoing course of tests and treatments that can dominate life for some period of time. They are usually quick to say, “We can treat you.” They less often say, “We can cure you.” There is usually not much talk about how the therapy will affect your daily life, whether you will be able to do everything you did before or what adjustments and compromises you will have to make to cope with your new reality.
Rarely do doctors talk about the impact of cancer on your intimacy and sexuality, a key part of quality of life. When the primary concern is with surviving and getting through the treatment, this is understandable. Thoughts about what life will be like after treatment are not top-of-mind. Staying alive is all that matters. But the fact is that the vast majority of patients will live a long time.
After decades of focusing on diagnosis, treatment, and cures, health care professionals are now more concerned than before with the phase called “survivorship.” Part of this is the totality we call “quality of life.” Quality of life is greatly affected by the choices made in treating the disease. When there are options, it is important that you know the quality-of-life consequences of each option. This chapter will outline various therapy choices for many different types of cancer, with special consideration given to the sexual side effects of various therapies.
Many side effects of various therapies have been well described. This is not the case for the effects on sexuality. The tables presented at the end of this chapter link therapies with their most common sexuality-related biological and psychological effects and the resulting emotions experienced by those in treatment and their partners. The tables only provide highlights, and are designed to be a general reference.
Table 1 lists some common treatment options for many cancers. They are listed here to provide a reference, not as a basis for deciding between treatments. As might be expected, each treatment has both advantages and undesirable side effects. Subsequent tables focus on their impact on sexuality.
Table 2 highlights the sexuality-related biological and psychological effects of different cancers and their treatments.
Table 3 shows the frequency of various sexual side effects.
Table 4 notes major emotions that the cancer patient and partner may experience.
Table 5 presents some common actions of women cancer sufferers and their partners. These actions can have a negative effect on the degree of success and the level of satisfaction that couples can achieve in renewing sexuality after cancer. Being alert to such negative behaviors may enable patients and their partners to conduct themselves differently and instead take the positive actions outlined in the remainder of this book.
Cancer therapies and physical side effects
Understanding how best to achieve the most satisfactory sexual experience after therapy can only occur when a woman and her partner know the effects of the therapy. Broadly speaking, the three major treatments for any cancer are surgery, radiation, and chemotherapy. Each individual being treated for cancer requires one or more of these treatment types (modalities) and may have a host of options to choose from within each modality, depending on the type of cancer and the stage at which the cancer is discovered. (Stage refers to the progression of the disease, from totally localized to diffuse or metastatic.)
Cancer and cancer therapy cause changes in the four Ps: an individual’s physical, physiological, and psychological makeup, and in the partner. The term physiological refers to the functioning of the body and its processes. For example, if a therapy affects an organ that produces a hormone, production of that hormone may increase or decrease, and various parts of the body will reflect such changes.
Table 1 shows the major modes of cancer therapy that may be discussed with a patient: surgery, radiation, or chemotherapy. The oncologist may recommend one or several in combination as being most appropriate, given the nature of the disease, its stage and other factors. The fourth column, Other, notes hormone therapy, as well as less widely used medically accepted therapies such as cryoablation and high-temperature ultrasound.
