Dr. Wynn Q&A: Changing Sexual Relations
Question: Why Do Sexual Relations Change Through the Cancer Experience?
Dr. Wynn: Cancer can strain relationships from different directions — so many, it's hard to count them all! Feeling sick, feeling threatened, worrying about finances, losing an active and energetic partner; these are just some of the concerns that come up. One of the hardest to talk about is sex and how sex is affected by cancer.
Illness puts a damper on energy and motivation in general, and sex drive in particular. Cancer can cause pain or changes in breathing, bowel or other functions. Treatments for cancer can also contribute to the problem, because surgery, chemotherapy and radiation therapy can lead to low energy, nausea, pain and loss of interest in life's pleasures. If parts of the treatment have required extended bed rest, your stamina may be at an all-time low.
Our cancer rehabilitation team frequently explains that no matter how you feel, cancer cells make up only a small part of all of you. Most of you is healthy. But the cancer experience is so engrossing it comes to feel like it is all of you, as if all of what you do and all of who you are is cancer. "Now I am a sick person" can feel like "now I am an alien," a scary being from the planet Cancer. This feeling may be reinforced by how others treat you: wary of your illness, fearful of saying or doing the wrong thing, uncertain about how to approach you.
Physical Changes and Your Partner's Perceptions
Treatments may change hair, body shape and muscle tone. Men may have changes in their ability to achieve an erection or ejaculate. Women may have vaginal discomfort or contraction. Surgical scars may leave you feeling unattractive and undesirable. Dramatic changes in the body after surgery, including mastectomy, colostomy or amputation, can leave you feeling you are ugly or somehow not good enough for your partner. Most importantly, such feelings make it hard to talk about these concerns. If you don't talk about them, you just keep believing they're true. And you might be wrong.
Your partner's perception of you is crucially important and needs to be discussed. Sometimes partners don't appreciate how ill or embarrassed you feel and request physical intimacy when you just can't. On the other hand, your partner may overestimate how fragile or uninterested you are. And how does he or she know when you're done feeling sick, unless you say so? You might have a scar that healed long ago, but your partner may think it is tender or fragile. (In fact, some scars heal to be the strongest, toughest and least sensitive parts you have!) Some partners are so sensitive they may approach too slowly — or not at all. Your husband may feel he is protecting you from embarrassment, not realizing how neglected you feel. Your wife may fear putting you on the spot. The only way to find out: ask!
Redefining Sex and Intimacy
It may also be important to redefine "sex." All too often sex is considered too narrowly. Think "physical affection" and you start to imagine all kinds of ways to work around whatever limitations cancer might be imposing. Try cuddling, massage, exploratory play. Remember that the most important sex organ is sitting between your ears. Sex and relationships are all about feeling special, loved, protected and wanted. When you don't have these feelings you need to talk about it.
We're here at Swedish to discuss your relationship questions and problems with you. Your oncologist and nurse can often help with discomforts that get in the way of intercourse, and they can reassure you and your partner about what is safe after surgery or radiation. Our PsychoOncology clinicians can help with the talking, renegotiating and exploring parts — to help you back to the love you started with. Call us today.
John Wynn, M.D., is medical director for the Swedish Cancer Institute Department of PsychoOncology. In this role, Dr. Wynn is responsible for developing programs to help patients and families cope with the cancer experience. He also attends to the educational and emotional needs of professionals working in the highly demanding field of cancer care. Board-certified in both internal medicine and psychiatry, Dr. Wynn also has a private practice in psychiatry and organizational consultation.
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