Monday, July 13, 2015

Let's Talk About Sex (After a Cancer Diagnosis)

“If you’ve had chemotherapy, your sexual function has been impacted.” -- Dr. Sage Bolte

Most of us are pretty reluctant to talk about sex and intimacy in the wake of a cancer diagnosis. We think we should be focused on getting rid of cancer, or staying alive, so quality of life issues often take a back seat to the urgency we feel to be well. During active cancer treatments especially, sex is probably the last thing on many of our minds.

But at some point, most of us want to touch and be touched again.

I talked to one friend recently, who was diagnosed with breast cancer when she was twenty-five. She is in remission, but takes ovarian suppression medications as well as an aromatase inhibitor. She isn't even thirty and she's in menopause.

She described it as “life-altering,” to go from being a 25-year old with a healthy sex drive to basically not thinking about it for long stretches of time, and then only because she would start to feel twinges of guilt for physically ignoring her live-in boyfriend (whom she describes as a saint).

"It's never addressed," she said. "Oncologists don’t typically bring it up, unless you have the courage to talk about it first, and it’s hardly a comfortable topic. It’s mind-boggling."

Dr. Bolte, who spoke at the conference I attended at AstraZeneca about intimacy issues and about depression and anxiety after cancer, says this hesitance to discuss our sexual selves with our care team is unfortunate, because there are solutions.

One of the primary reasons patients give for not bringing up intimacy with their doctors is they fear there's no way around the loss of it during (and even after) cancer treatments. But sexual dysfunction is one of the top quality of life issues concerning cancer patients. And according to Dr. Bolte, the incidence of altered sexuality can persist for years.

Obviously, my experience is with breast cancer, treatments for which can cause a litany of side effects, including:
  • mouth sores
  • fatigue
  • dry, cracked skin and mucous membranes
  • often, loss of or damage to a major sexual organ (breasts) due to surgeries and radiation
  • vaginal stenosis (narrowing) due to chemically-induced menopause
  • hair loss
  • weight gain (or loss)
Other cancers can lead to similar side effects, and my guess is that no one who's been through cancer treatments has been left unscathed.

In addition to debilitating physical effects are the pschyo-social and emotional ones. Partners often take on the role of caregivers, and it can be tough to transition between the caregiver/patient and lover relationships. It can also be tough to maintain a sense of peace about your body when you might feel it betrayed you by "letting" cancer happen. Or you might be self-conscious about a new appearance.

After active treatment ends, for those of us who are lucky enough to be able to move on to targeted therapies, sexual function may lag behind. According to Dr. Bolte, most of us want healthy, active sexual relationships, but many are reluctant to bring up the topic with our healthcare providers. Not helping is that most oncologists are just as reluctant to bring it up with us, their patients. 

So what can you do? What are the solutions?

  • Discuss your concerns with your doctor. If not your oncologist, then maybe your gynecologist who may be able to recommend strengthening exercises or non-hormonal lubricants that can help. There is also this, which "can be done in lunchtime." How's that for innuendo?
  • Talk to your partner about expectations. Sex during chemo is probably not a priority, but maintaining intimacy should be. Hold hands or cuddle during marathon episodes of Orange is the New Black. Make time for date nights (or afternoons, since us cancer patients are often exhausted by the end of the day.) Dr. Bolte said one couple she knows of started reading erotica to each other and arrived at their next therapy appointment with shit-eating grins on their faces.
  • Communicate about desires and needs. This seems so straightforward, but things change so much after a cancer diagnosis. I'm noting it again because it is so true for me: we are often exhausted at the end of the day. Rethink when you might be more willing to connect. And certain areas might be too sensitive or painful to touch. Share these things with your partner before you're fooling around so that feelings don't get hurt if you recoil when your scar tissue accidentally gets grazed. 
  • Go back to some of the basics. Make out like you're in your parents' basement in high school. Wear pretty lingerie if that's your thing. Write each other love notes. Take a bath together. The goal doesn't need to be sex as you once knew it. 
For additional resources, Dr. Bolte recommends the following books: Men Cancer Sex, Women Cancer Sex, and Sex Matters for Women: A Complete Guide to Taking Care of Your Sexual Self.


  1. Love this post. It is a topic I have a hard time opening up about myself. That laser treatment though! OMG, I think I am going to try it.

  2. This is such an important topic! Thank you so much for writing about it. I've been working on a post to talk about my personal issues with this and having a hard time with it. I have seen a sex therapist (sadly my insurance did not cover all the visits) and she suggested some exercises for me -- Kegel exercises -- and they helped a little but I forget to do them and go back to a painful experience or none at all. This has been an issue for me for years now since my diagnosis.

    It's an interesting point you brought up, about our guys becoming our caregivers, how the transition becomes difficult for them. I think this is def. a reason why neither of us are interested in sex, sadly. He was and continues to be my caregiver.

    Thank you for sharing that article -- interesting about the laser treatment. I am looking into this. Sex is so important for our health and there has to be a way to get your groove on back. We are still young! (I am sorry about your friend -- too young to go through this too.) xo

  3. Thank you for writing about this very important topic. Between talking about our breasts, our vaginas and our sex lives, we should all be best friends by now!

  4. I think you are doing a great job, thank you so much!it inspires many people on doing kind things, and i`m also inspired, thats why i write articles, my last one is about sex also!