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For Any Cancer Diagnosis

Q. I'm starting chemotherapy soon. Should I avoid having sex?

A.

There are ways to continue to be sexually active while in treatment. Often cancer-related fatigue, changes in your blood chemistry, and/or changes in your hormones can be obstacles. Please be patient with yourself if these treatment side effects prevent you from having sex while receiving treatment. Here are some recommendations for both men and women in treatment who want to retain physical intimacy in their relationships:

  • Ask your doctor or nurse when it is safe for you to be sexually active. This requires that your blood chemistry be at values that ensure you have enough red, white, and platelet blood cells.
  • Always use a barrier when having sex. This most often is a condom but can also be a dental dam that covers the vaginal wall. Barriers also protect both genders from any source of infection and women from pregnancy.
  • Talk with your partner about your desire to continue having sex, and ask for his or her help to find ways to remain physically intimate.
  • Consider couple’s counseling to help you both learn to cope together.
  • Consider different types of sexual expression other than those that requires penetration. Sensual massage that focuses on the whole body as well as the genitals is a safe alternative.
  • If you are a woman having trouble lubricating, ask your oncologist or gynecologist to suggest different lubricants and moisturizers that do not contain any of the forms of estrogen.
  • If you are a man having trouble with erections, ask your oncologist or urologist to prescribe an appropriate erectile dysfunction medication.
  • Remain appropriately physically active — being physically intimate requires energy. In addition, activity can help you manage fatigue. Ask you doctor what kinds of exercise is best for you.
  • Speak with a CancerCare social worker to find information and availability of support groups or couples and/or individual counseling.

For Breast Cancer

Q. I'm 43 years old, married and going to have a mastectomy. I'm insecure about how my body is going to look and being intimate with my husband. How can I maintain my femininity and a positive body image?

A.

When it comes to changes in our bodies, no matter what a woman’s age, those changes will challenge how we see ourselves and our perception of how others see us. This can be especially true for women who have had a mastectomy or bilateral surgery since images in the media so often place a heavy emphasis on how women look. Breast reconstruction has helped many women redefine their feelings about the loss of a breast. You might want to consult with a plastic surgeon about what options are available to you. For women who do not choose reconstruction, the use of a breast prosthesis can be a good alternative. A prosthesis can give a look of symmetry; many of the newer prostheses are made of a lighter weight material and come in special forms that can be used in swimwear and night gowns. It’s important to recognize that this is a loss, and with loss comes grief. Remember that it will take time to adjust and it’s a good idea to reach out for support and guidance during this time.

Treatment for breast cancer such as chemotherapy or hormonal blockers may also have side effects that can produce early menopause, vaginal dryness and a diminished desire for intimacy. Talking with your doctor about products that can reduce symptoms of dryness or discomfort can help. Opening a conversation about your concerns with your partner is an important first step. Many people don’t understand the actual physical basis for diminished desire and feel they are being rejected.

How to Help Your Wife (and Yourself) Through Diagnosis, Treatment and Beyond (Rodale Inc.) by Mark Silver, is one book you and your partner might find helpful. In addition, you may try contacting Living Beyond Breast Cancer.

You can also find additional information and advice in a previous Ask CancerCare that addressed body image and intimacy issues.

Q. I'm trying to prepare myself mentally about having a mastectomy. I don't think I would ever want to look at my body again, much less expect my significant other to ever find me attractive. Not sure what to do...

A.

A surgery that removes part of you is a loss and must be honored with mourning and grief. A loss changes you but also can make you more aware of what you still have. Most people need time to get used to the scars on their body. With patience and caring, couples do enjoy being intimate again. The following suggestions may help:

  • Keep a journal in which you can freely express your thoughts and write down all of your feelings, both good and bad.
  • Reach out to your loved ones. Let them know what kind of physical affection and comforting you need.
  • Give yourself credit. Practice praising yourself about any of the things you like about yourself, such as your intelligence, your faith, your laugh, your kindness and other positive qualities.
  • Be generous to yourself. Give yourself little gifts that give you pleasure such as a new book of poems, a massage, or a spa product.
  • Take relaxing baths. Use music, candles, or flowers to enhance the experience.
  • Adorn the new you. Get new make-up that complements your best features. Choose clothing colors that match your current skin tone. Seek out programs such as Look Good, Feel Better to learn helpful tips.
  • Join a support group of women who have similar concerns. CancerCare offers online and telephone support groups and our oncology social workers can help you locate face-to-face groups in your area.
  • Share information with your partner. Communicating your feelings (and having your partner do the same) is very important as you go forward together.

Q. I have been treated for breast cancer and I just don't feel like being intimate. Is this due to my treatments or did I just change as a person? My partner is concerned and wants to know if we will ever be intimate again?

A.

For many women, treatment for breast cancer has a side effect of reducing their desire for physical intimacy. This occurs when your treatment has affected the amount of estrogen your body produces. There are ways for you to address your partner’s wish for physical intimacy. But one of the issues between the two of you may have something to do with communication. Openly discussing sex may not be typical even for couples who have been together for a long time. Reminiscing about the funny and tender things you have shared together, and your history of how you met and became a couple, can be a comfortable way to begin. Your sexual relationship is a part of being a couple, but there are many other parts to your relationship such as emotional closeness, feeling your partner is there to comfort and support you, affection, and companionship to name a few. Once you have addressed these aspects of being a couple, being physically intimate becomes a natural part of sharing your love with each other.

Being diagnosed with cancer often leads people to reevaluate their lives and sometimes this changes their priorities. If you have been satisfied with your relationship prior to cancer, then I’d expect you would be satisfied after treatment even if your relationship needs some fine tuning. Joining a support group or seeking counseling, whether individually or as a couple, can further help you and your partner.

To find a counselor who specializes in intimacy issues, contact the American Association of Sexuality Educators, Counselors and Therapists.

For Prostate Cancer

Q. I have just had a surgery for prostate cancer. When will I be able to be sexually active? Is there anything I should do and how do I explain things to my partner?

A.

The first step is to talk to your urologist about your concerns. The most common problem following surgery for prostate cancer is erectile dysfunction (ED), or the inability to achieve an erection. ED does not affect your ability to reach orgasm, which is a separate but related process. You should begin to be intimate with your partner when your urologist feels you are appropriately healed. You and your partner’s ability to find other ways to be intimate that do not require an erection can help you on your road to recovery. In the meantime, you can ask to be referred to an urologist who specializes in ED. Some physicians have their patients use an ED medication to help in the recovery process.

Many partners need reassurance that the person with cancer still has an interest in being intimate, and vice versa. Interest is not only about physical attraction but in how you both feel and think about your relationship together. Your partner may be concerned that expressing a wish to be intimate again will be a source of stress and upset for both of you. Being open about these concerns is the best way to examine and explore these feelings together. Talking to other men who have similar concerns may also be helpful. Here are resources to find support group:

You can find a counselor who specializes in intimacy issues, by contacting the American Association of Sexuality Educators, Counselors and Therapists.