Cancer and Sexuality, Part II: Gender, Treatments, and Intimacy

Older woman holding out flowerCancer treatments can have a significant effect on a person’s sexuality and desire to be intimate. Common side effects of chemotherapy include nausea, which may be worsened by sexual activity, and fatigue, which may persist for months after treatment is finished. Chemotherapy also has some gender-specific side effects.

Women’s Sexuality and Cancer Treatments

Depending on her age, chemotherapy may cause a profound impact on a woman’s sexuality because it stops ovarian activity. This causes an abrupt onset of menopausal symptoms: weight gain, hot flashes, insomnia, night sweats, and menstrual cycle changes. The most significant effect is seen on premenopausal women. This includes changes in a woman’s sexual desire (libido), arousal, and orgasm.

Hair loss is another common side effect of chemotherapy and can be particularly distressing to women. One woman described feeling like an “old man” because of her mastectomy and baldness.

In fact, data shows that most women on chemotherapy report no sexual desire. Intercourse may be painful because decreased estrogen levels cause vaginal dryness; water-based lubricants may be used to provide artificial lubrication. Similar effects are seen with estrogen-blocking agents, which include tamoxifen and aromatase inhibitors. Women’s testosterone levels may also fall. Testosterone plays a major role in desire and libido.

Sexual difficulties experienced by women dealing with cancer are primarily determined by:

  • Biological effects of cancer treatment
  • Women’s perceptions of their sexuality
  • Their partners’ reactions
  • The quality of their relationships

These difficulties may persist for many years, despite improvements in other aspects of a woman’s life, such as mood and energy level. Chemotherapy has been consistently found to predict more severe and long-lasting sexual and body image problems for women with breast and gynecologic cancers. The more treatments a woman has, the worse her long-term sexual functioning is, and the more her satisfaction with her sex life after cancer is reduced. This is especially true for younger women who undergo adjuvant chemotherapy in addition to surgery, radiation therapy, or both. Prolonged treatments also have negative effects on energy levels. Fatigue is associated with significant sexual difficulties and especially affects desire and arousal responses.

Men’s Sexuality and Cancer Treatments

For men, the most profound sexual side effect of chemotherapy can be seen during treatment with androgen deprivation (hormone) therapy for prostate cancer. This type of chemotherapy has a global effect on all aspects of sexual functioning, since it essentially deprives the body of testosterone. It results in a decreased libido—typically sexual dreams and fantasies stop completely. Androgen deprivation therapy also affects a man’s ability to have an erection, even though he can still have an orgasm. Other side effects may include hot flashes, breast tenderness and growth of breast tissue, osteoporosis (bone thinning), anemia, decreased mental sharpness, loss of muscle mass, weight gain, fatigue, increased cholesterol, and depression. Typically, testosterone levels return to normal 18-24 weeks after treatment ends.

Some men delay or avoid treatment for prostate cancer because they are unwilling to give up their current sex life. They may see themselves as less of a man if they are unable to have an erection. The thought of losing the ability to have intercourse may be as disturbing as a cancer diagnosis to some men. In fact, they may feel so despondent that they would rather be dead than be unable to function sexually. Many men may equate sexual intercourse with intimacy and closeness. As such, the loss of the ability to have intercourse can threaten the integrity of a man’s relationship with his partner in profound and fundamental ways. This may result in refraining from any form of sexual interaction or any form of intimacy, and potentially withdrawing completely from his partner—which only serves to make the problem worse.

Redefining and Reestablishing Intimacy

Intimacy does not necessarily mean intercourse. If a person had a healthy sexual relationship with their partner before treatment, they will most likely still enjoy some degree of physical intimacy during and after treatment. Hugging, holding, touching, and cuddling may become more desirable than intercourse. Possibly, the couple may need to find new ways to experience closeness.

The key to maintaining a gratifying level of sexual activity or intimacy with one’s partner is open, honest communication.

© Copyright 2010 by Norma Lee, MA, MD, LMFT, therapist in Bellevue, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Violet

    Violet

    August 12th, 2010 at 7:28 PM

    Thank you Norma for broaching a subject that I’ve never heard discussed when cancer has come up. Your article was both sensitive in its approach and helpful. Thanks again.

  • LUKE

    LUKE

    August 13th, 2010 at 2:35 AM

    I think it would be best if the person’s partner is given counseling about what actually happens with the patient and is advised to remain patient and give moral support to the partner with cancer and that he/she should stop expecting normal sexual relations from the partner for quite sometime. I believe this is better than the person actually finding this out himself/herself and being remorseful about it.

  • Christy

    Christy

    August 13th, 2010 at 10:13 AM

    It works wonders to have an understanding partner in such tough times in life.A partner who is understanding and one who is willing to work towards strengthening the relationship rather than just bother about themselves can be a real asset.

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