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Sexuality and cancer
Cancer and its treatment can affect your sexuality and sexual function. It can also affect your sexual partners and your relationships. For many people, sexuality is a personal subject that is hard to talk about openly, either with sexual partners or with healthcare professionals. But talking openly and honestly about sex offers you the best chance of coping with any sexual changes that cancer treatment brings.
Sexuality is a part of our everyday life, but it’s more than just the act of sex or reproduction. Sexuality includes our need for closeness, intimacy, caring and pleasure, as well as our sex drive, sexual identity and preferences.
You or your partner may even think that sex shouldn’t matter that much right now. It’s true that some people don’t think about sex while they fight cancer. But it’s important to note that sex and all the loving and caring that go with it can be life-affirming.
Understanding sexual response
Knowing how our bodies work sexually can help with understanding where sexual problems can happen.
The phases of sexual response are desire, excitement, orgasm and resolution. Not all experts agree that everyone follows this set pattern of sexual response. Many experts think that women (and some men) may not always feel sexual desire at the start of a wanted sexual experience. They may be looking mainly for emotional closeness at first and the sexual desire comes after.
Sexual desire (which is sometimes called libido), is your interest in sex. Desire can range from being not at all interested in sex to having a very active desire for sex. It varies from person to person and can change over the years.
Many different factors can affect sexual desire, especially our state of mind (for example, feeling anxious, frustrated or depressed). Stress, fatigue, pain and changes to sex hormone levels can reduce our sexual desire.
Excitement or arousal
Excitement or arousal is the body’s response to getting ready for sex. Seeing someone you find attractive, having a sexual thought or fantasy, or having your genitals or other sensitive areas kissed, touched or stroked may arouse you.
During arousal our blood pressure and heart rate increase, and blood is sent to the genital area. In both men and women the nipples may harden and the breasts may become more sensitive. In men, the penis becomes erect and sensitive. In women, the vagina becomes moist and increases in depth and width.
Orgasm is the sexual climax, the feelings of pleasure that are felt in the genitals with a series of rhythmic contractions. Other parts of our bodies may also have these feelings of pleasure and release as well.
In men, ejaculation occurs when the muscles around the base of the penis begin to squeeze in rhythm, pushing the semen through the urethra and out of the penis. In women, clitoral or vaginal stimulation causes orgasm. Some women also experience a small ejaculation.
After sexual arousal and orgasm, our bodies relax. We often feel satisfaction and drowsiness during resolution. Our breathing, heart rate and blood pressure return to normal.
Men usually can’t be sexually aroused again for a while, and the older a man is, the longer it will take him to become aroused again. Women have a shorter resolution time than men and may be able to become aroused again more quickly.
Changes to sex and sexuality
Everyone’s experience will be unique to them. Some people go through cancer treatment without having their feelings and attitudes about sex affected at all. Others find that their sex lives change a lot. These changes can be temporary or permanent.
You may find that you’re not as interested in sex or you’re less able to to relax and enjoy sex because having cancer and going through treatment has affected you physically and emotionally. For example, your sexuality may be affected by:
Changes to how you look – if cancer treatment changes how you look (for example, gaining or losing weight, losing a body part, being scarred from surgery or having an ostomy) you may be self-conscious about having sex or worry about how a partner sees you.
Coping with side effects of treatment – if you’re exhausted all the time or in pain from treatment, you may find that you don’t have much desire for sex. Nausea and vomiting is another side effect that many patients say affects their desire for sex.
Changes to your sexual response – cancer treatment can change your sexual response. Hormone therapy can affect your sex drive. Surgery may change your ability to be aroused or have an orgasm. If you have had pain during sex, you may not want to have sexual intercourse.
Coping with emotions – feelings of fear, anger, guilt, stress, anxiety and sadness are all a normal part of the cancer experience. But they can affect your interest in sex and your ability to feel close to your partner.
Even with challenges you’re facing, sex doesn’t have to stop completely. If you’re willing to try new things, you and your partner can find ways to be close. You may find that intimacy changes during treatment. Hugging, touching, holding and cuddling may become more important, while sexual intercourse may become less important.
Your partner’s concerns or fears can also affect your sexual relationship. If talking to each other about sex or cancer is hard, don’t be embarrassed to ask your healthcare team for help finding a counsellor to help you and your partner talk more openly.
Coping with changes to sexuality
There are many things that you and your partner can do to have a healthy sex life during and after cancer treatment. Most people can still enjoy sex and intimacy after cancer treatment, even if they need to make changes.
Learn about the effects of cancer treatment on your body that could affect your sexuality and what to do if some of these effects cause sexual problems for you and your partner. Don’t be embarrassed to ask your healthcare team if and when it’s safe to have sex, or if you need to take any precautions.
It may take time and a lot of effort to keep or get back the same level of intimacy you shared before cancer. Be patient with each other. If you enjoyed sex before starting cancer treatment, chances are you will still find pleasure in physical closeness during your treatment.
Open, honest communication between you and your partner is an important step to getting started with sex again. Share your feelings with each other – this is often the first step to identifying problems and finding helpful solutions. You both need to talk about your feelings and to listen to each other.
When talking about sex or sexuality:
- Talk about your fears or worries rather than trying to hide or avoid them.
- If you have pain or tenderness, tell your partner. They can then be gentler or avoid areas or activities that cause pain.
- Let a partner know if you don’t feel like having sex and why you feel this way.
- Let each other know when you’re interested in sex or other ways of showing affection.
- You may be afraid or anxious about having sex at different points in your cancer journey. Your partner may also be anxious or scared that they might hurt you. Unless your doctor has told you not to have sex, there is no reason not to have it if you feel the desire.
- Go slowly at first. Start with lots of closeness, hugging and other things that you feel comfortable with. These physical displays of affection can help you and your partner become physically close without having sex.
- Be patient. It may take more time for you to become aroused. Be open to different ways of feeling or creating sexual pleasure.
- If you feel too tired for sex, try taking a nap together first. Try different positions that don’t need as much energy or have shorter sessions of sexual activity. If you’re feeling tired or weak, ask your partner to take the more active role during sex.
There may be times when sexual intercourse isn’t possible for people being treated for cancer. Some people may not want or be able to have intercourse. This can be a chance for you and your partner to learn new ways to give and receive sexual pleasure. Try something new such as exploring your own body, finding areas that give you pleasure through self-stimulation, manually stimulating each other or experimenting with oral sex. You may find that you’re more interested in holding, hugging and touching your partner, and that sexual intercourse isn’t as important.
The good news is that interest in sex and intimacy often returns once you have recovered from cancer treatment and you’re back to your daily routines.
Myths about cancer and sex
There’s a lot of misinformation out there. You may have heard some things about cancer and sex that simply aren’t true. So don’t let these fears stop you from having a fulfilling sex life:
- Cancer is not contagious. You can’t get cancer from kissing, touching or having sex with someone with cancer.
- Having sex does not cause cancer to grow faster, and it does not increase the chance of cancer coming back.
A substance that regulates specific body functions, such as metabolism, growth and reproduction.
Natural hormones are produced by glands. Artificial or synthetic hormones can be made in the lab.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
What’s the lifetime risk of getting cancer?
The latest Canadian Cancer Statistics report shows about half of Canadians are expected to be diagnosed with cancer in their lifetime.