Q&A: Sexual Relationships and Cancer
CancerWise - February 2007
By Dawn Dorsey
Cancer changes many aspects of life, including intimacy and romance. Disease and treatment effects – both physical and emotional – can interfere with a couple’s closeness just when they need it the most.
CancerWise consulted Leslie Schover, Ph.D., a professor in the Department of Behavioral Science at M. D. Anderson, who researches and lectures on the impact of cancer treatment on sexuality and relationships.
What is the most important thing I need to know about sexuality during and after cancer treatment?
The key is honest communication between the patient and:
- Health care professionals
- The patient’s partner
Men and women often hope for a simple solution to sexual problems after cancer. Although pills work for some, people need to keep in mind that erections and orgasms are just ingredients in sex, not the whole recipe.
Affection, communication, patience and creativity cannot be bottled.
What happened to my sex drive?
Loss of desire is the most complex and difficult sexual problem to treat. It can be caused by:
- Stress of illness
- Chronic fatigue
- Relationship issues made worse by illness
- Body image changes, feeling unattractive or unable to function sexually
- Painful sex
- Medication side effects
- Feeling ill (pain, nausea)
I’d like to be sexually active again, but I’m nervous. Any suggestions?
Avoid viewing sex as a performance. The goal is having fun and feeling close, not perfection.
You may have to plan ahead more than usual. Think about planning to:
- Take a “minivacation” – a couple hours of quality time set aside for sex and affection
- Choose times when you are not in pain or exhausted
How can I get in the mood?
Identify and promote activities that increase sexual desire, like:
- Physical sports or dance
- Intimate talks, cuddling, romance
Be sure your partner knows what gives you pleasure.
It’s not easy to talk about sex. How can I broach the subject?
To discuss sex with your partner:
- Find a private space and enough time to have a relaxed talk
- Choose one or two goals for change
- Focus on specific, positive requests
- Avoid conflict about the past
- Discuss fears about:
- Survival and quality of life
- Be a good listener
What are the most common sexual problems for women after cancer?
Frequently, women have trouble with:
- Lack of desire or pleasure
- Pain, dryness and discomfort during sex
What cancer treatments can create sexual problems in women?
Treatment for breast and gynecologic cancers can cause problems, including:
- Chemotherapy, pelvic radiation therapy, removal of ovaries or stopping estrogen therapy can trigger menopause symptoms, including:
- Hot flashes
- Vaginal dryness and tightness
- Loss of desire if sex hurts
- Pelvic radiation therapy or graft vs. host disease (after a bone marrow transplant) may cause scarring and pain
- Pelvic surgery may remove the vulva, vagina or other organs
- Breast surgery removes an erogenous zone
Why is sex painful for some women?
The main reasons for painful sex after cancer are:
- Vaginal dryness and tightness from menopause
- Radiation damage to vaginal lining or walls
- Vaginal irritation temporarily from chemotherapy
- Adhesions and scarring due to surgery in genital or pelvic area
What can women do about the pain?
If sex is painful, use:
- Nonhormonal vaginal moisturizers (like Replens®) regularly for a few weeks for full effect
- Water-based lubricants (like Astroglide® or KY-Jelly®) when you have sexual activity
If lubricants don’t help the pain, talk to your doctor about low-dose forms of vaginal estrogen, such as Estring® or Vagifem®.
What are the most common sexual problems for men after cancer?
Men often deal with:
- Lack of desire or pleasure
- Erection problems (erectile dysfunction or ED)
- Pain with erection or climax
What treatments may cause erection problems?
- Damage to nerves and/or blood circulation in the penis can be caused by:
- Radical pelvic surgery
- Pelvic radiation therapy
- High-dose chemotherapy may reduce testosterone
What if I can’t get an erection?
Men with erection problems often stop initiating sex or affection. Partners may be afraid to ask for touch. The result is not only loss of intercourse, but decreased nonsexual affection. Women rate this as more upsetting than the loss of sexual pleasure.
- Men are more focused than women on intercourse
- Many couples enjoy nonintercourse lovemaking
- Most cancer treatment leaves desire, skin sensation and orgasm intact
Medical treatments for ED often help. An urologist can prescribe oral medications, but they may not work well after some cancer treatments. Penile injections, vacuum pumps or surgery to implant a penile prosthesis may be needed.
What if we need extra help?
The American Cancer Society publishes information about sexuality and cancer.
In addition, you might want to:
- Discuss problems with other survivors in a support group
- See a specialist who is an expert in dealing with sexual problems
- Have sexual counseling with a mental health professional
M. D. Anderson resources:
- Sexuality and cancer (American Cancer Society)