A Woman’s Guide (Big Think Media, October 2006), refers to concerns about sexuality and intimacy as “the elephant in the room that no one talks about but that affects almost every woman treated for cancer.” The many physical and emotional changes that follow a cancer diagnosis can affect sex and intimacy. Openly addressing these changes with your partner and your healthcare team will help resolve problems that may arise and will allow you to continue to experience the joy of positive intimate and sexual relationships.
Cancer can entail a range of physical and emotional responses, but two of the most common sexual concerns expressed by women after a cancer diagnosis are libido loss and vaginal dryness. According to Dr. Kydd and her coauthor, medical writer Dana Rowett, there are steps women can take to deal with these and other concerns.
“Loss of libido can stem from fatigue,” says Rowett. She notes that women often face a range of demands in their lives even before a cancer diagnosis. When cancer and cancer treatment are added to the challenges of family, home, and work, it’s not surprising that sex sometimes falls to the bottom of the list. One solution, explains Rowett, is to schedule sex for the time of day when you have the most energy. Similarly, if you’re taking a medication that interferes with libido, you may want to schedule sex for when the medication is least potent.
Another important step is to retrain your mind to think sexually. “A woman’s biggest sexual organ is her mind,” says Rowett. “If you can get your mind thinking about it again, the rest will come.”
“Sometimes libido comes back,” says Dr. Kydd, “but I think one needs to encourage it.” Part of that process may involve reevaluating what pleases you sexually. If you’ve had breast surgery and reconstruction, for example, you may no longer have sensitivity in your breasts. It’s also possible that types of sexual contact that you enjoyed before cancer may no longer be pleasurable. “Women can reach orgasm,” says Dr. Kydd, “but they have to find out for themselves what is pleasing—and then they need to teach their partners.
“One of the biggest passion-killers,” she notes, “is painful intercourse. Women need to learn how to ensure that sex is no longer painful.” For many women who have had cancer, a common source of pain during sex is vaginal dryness. Menopause, cancer treatment, or a combination of the two can reduce vaginal moisture. Natural or induced menopause is also linked with reduced fat around the vagina and a thinning of the vaginal walls. Dr. Kydd recalls talking to one woman who said that her vagina “felt like tissue paper.”
Liberal use of vaginal lubricants can help dramatically. You may need to try different products to find the one that works best for you. Warming lubricants, for example, may not feel good if you are already experiencing vaginal burning.
Whatever your concerns about sexuality or intimacy, overcoming them requires open communication with your partner. “Communication is absolutely the key,” says Dr. Kydd.
Rowett agrees, noting, “What happens is kind of a cycle: The woman has changed, whether it’s her body or her mind. She may have withdrawn because she has focused on not dying. Then, after that, her partner is sometimes afraid to approach her about intimacy because he doesn’t want to hurt her. And when he doesn’t approach her, she feels rejected.”
Women need to talk with their partners about their desire for intimacy and for specific types of sexual contact; they must communicate about what feels good and what doesn’t. Both Rowett and Dr. Kydd hope that their book will help with this process. The book includes a chapter for partners, and Rowett hopes that women can hand the book to their partner and say, “Read this.”
If you are single, an additional challenge is when to tell a new partner about your cancer. Bringing up the topic in the heat of passion is not the optimal time. Instead, suggests Dr. Kydd, try broaching the subject “on a walk or in a restaurant, when you’re talking about all of your life.”
Making the effort to maintain or reestablish intimate relationships after cancer can contribute greatly to quality of life. “It’s about feeling close and alive with another human being,” says Rowett. “Aspects of sexual intercourse may change after cancer, but intimacy is still highly valuable.”
Dr. Kydd, who has had cancer herself, explains: “A sexual, intimate relationship is something you don’t share with the rest of the world. It’s something special with one person. If you lose that special relationship, it’s a huge loss.”
If you enjoyed positive intimate relationships before cancer, you will very likely be able to enjoy them again. You and your partner may need time to adjust to the “new normal” of life after cancer, but open communication about your concerns and desires will speed the transition.
For many women intimate relationships are an important part of feeling alive and whole; don’t let cancer take that away from you.