Intimacy is More than Sex
Intimacy has been a hot (sorry, could not resist) topic in my office this week. On Monday, I met with a couple who are trying very hard to be loving and supportive of one another, but are feeling sad by the absence of physical intimacy in their relationship. He completed difficult cancer treatment several months ago, is still very fatigued, and is embarrassed by his lack of libido. We all generally think that men are always in the mood, and it just isn't so.
Yesterday I met with a single woman who is beginning to date again after breast cancer treatment. She is, of course, worried and uncertain when and how to tell any potential partners about her diagnosis, is aware of the physical changes she has experienced, and is especially aware that she now has one natural and one reconstructed breast. Finally, today I met with another woman who told me that she was approached by a neighbor in her condo development. His partner is away, and he clearly was looking for sex, complained that his partner recently completed treatment for breast cancer and "has put on a few pounds and is not ever interested in sex." We agreed that he is a creep.
Almost everyone going through cancer treatment loses some interest in sex. Some people have no libido, others are willing but find that they can’t physically respond, and a few lucky ones have little change in their normal sexual activity. If you are the partner of a cancer patient, this means that your sex life likely has changed—and not for the better. As is true for all issues that couples face, the most important response is communication. Things will only get worse if you don’t talk about them, and you can be sure that your partner, too, is aware that things are different in your intimate relationship. As awkward as it may feel, it is crucially important to bring up your concerns and feelings. Be sure that you don’t sound accusatory or angry; focus on the love between you, and your wish to be as close as possible as you together go through these hard times.
The first step, after acknowledging that there is a change, is to find out what is possible and realistic for someone in your partner’s current situation. Occasionally there are medical reasons why intercourse is prohibited for a period of time. More often, the troubles have to do with side effects from chemotherapy or radiation, recovery from surgery, and, most of all, your shared general mood. When you are depressed, worried, nauseated or feeling bald and unattractive, it is hard to feel sexy.
Assuming that there is no medical reason for your partner to limit sexual activity, it probably will be up to you to take most of the initiative and responsibility. Begin by reassuring her that you find her beautiful and desirable now, that the changes in her appearance do not affect your love or your desire. Don’t make the mistake of saying that you don’t notice the differences; this obvious falsehood will make anything else you say quite suspect. If the patient is a man, be aware that performance anxiety may be a big part of his reluctance; tell him that you don’t need intercourse to feel good. Talk about how you miss being close, being skin to skin, and how much you want to hold and care for him.
Remember that intimacy and sexuality are about a lot more than sexual intercourse. The goal is to feel close, to give and receive love. Suggest that you just snuggle; hold hands when you are walking; kiss the top of her bald head when you walk by the couch. Consider taking showers together, giving foot massages while you watch television, rubbing her back before sleep. Try agreeing that you will stroke and caress one another but will avoid erogenous zones; this can take the pressure off performance and help you remember how good it feels to be touched. Think about using massage oils, playing soft music, dimming the lights. Set the scene for love, but be clear that it is love, not just sex, that you are celebrating.
If none of this works as well as you would wish, be reassured that time will help. As your partner feels better and adapts to life with cancer, it is certain that the two of you will find ways to resume your sexual relationship. It is even possible that living through cancer will sweeten this part of your life as you treasure and appreciate one another even more than you did before.