Thinking about sexual intimacy after cancer

There has been a lot of conversation about sex and intimacy after cancer in my office this week. It always interests me how topics seem to implant themselves in the fabric or the rug or the art in the room, and multiple patients will raise the same concerns over the course of a few days. This week, the focus from each person has been about trying to recreate a satisfying sex life after cancer.

The summary is that a cancer diagnosis and treatment always impact sexuality and intimacy, but there is usually no reason why that important part of life and love has to end. There are physical changes related to chemotherapy or radiation or surgery, and there are equally important psychological changes related to the trauma of the experience.

Having (or having had) cancer is never a sexual benefit. You will never see a personal ad that says something like: I like red wine, walking on the beach, and, wow, am I a more sexually passionate person since I had cancer?

Some individuals and couples continue a sexual connection during cancer treatment, but many do not. It is always humorous in groups when the conversation turns to libido or interest in sex. When the responses to What would you rather do than have sex? include things like cleaning closets, scrubbing the kitchen floor, or having a root canal, you know there are barriers to intimacy. Even those couples who do manage to maintain intimacy throughout have to adjust to physical changes and bring exceptional tenderness and compassion to the moment. Knowing what to say and where to touch or even where to look can be challenging. One woman told me recently that she and her husband have always had a satisfying and robust sex life. Since her bilateral mastectomies, he has not been able to touch her, and she has been saddened by her inability to bring him pleasure and comfort.

My professional experience has always been that loving couples do, and it can take a long time, find ways to sustain an intimate relationship and that single people can connect after cancer. Singles have another whole set of concerns and challenges; just deciding when to mention cancer can be difficult. Most adults find the dating world to be stressful, and this makes it even harder. What do you say? How do you say it? When do you bring it up? For younger people, there are also the intense feelings and worries about fertility or being able to safely carry a pregnancy.

My standard advice to my patients has been that you don't need to talk about cancer on the first or first few dates, but you certainly need to share the information before becoming physically intimate. My advice goes on to suggest being very specific about how you look and feel. Describe any scars or surprising body parts (or lack thereof). And always remember that everyone accumulates scars during life; some are just more obvious than others. I also remind my middle-aged or older patients that any age appropriate partner no longer has a gorgeous 20-year-old body and likely has some worries about how s/he will appear.

Whatever the relationship status, everyone must deal with a changed body and strong feelings. It often now takes longer to become aroused, and men especially can be sensitive about performance issues. For better or worse, women can always fake it, but men cannot. If there are one or two unsatisfying attempts, it is more difficult to want to try again. If a woman experiences pain during intercourse, she is going to be hesitant about the next encounter. This all underscores the importance of honest communication. If you can't talk freely, you might want to reconsider the advisability of intimacy with this person.

And now for the reassuring part: Over and over and over again, I hear lovely stories about partners, longstanding or new ones, responding in tender, loving ways to these conversations. Couples find their way back to each other, and the homecoming is sweet.