“Alice” is a long-term cancer survivor. She has beaten the odds of dying from stage-four breast cancer many times over the years. She came into therapy because she was feeling stuck and was wondering if she might be depressed.
Several visits into our work together, after exploring how things were going in different areas of her life, she said she wanted to talk about something that was difficult to discuss: her sex life with her husband.
Sexuality and Therapy
The word sex is one of the most emotionally charged words in the English language. Our personal histories, family values, and attitudes play a role in our comfort (or lack thereof) in discussing sexuality. Many of us were taught that we shouldn’t talk about sex and that it is shameful to do so. However, a healthy sexual relationship with one’s partner can be considered a barometer for the health of the relationship overall. Both partners in a relationship should feel their sexual and intimacy needs are being met. For some couples, this means frequent sexual connection; for others, it may mean none, but rather different ways of expressing intimacy. The key is that both partners are getting their needs met.
As therapists, it is important that we have sorted out our own feelings about sexuality, so that when a person in therapy brings it up, we don’t convey negative feelings about the topic, either verbally or nonverbally. All it takes is one brief look of discomfort or shame on our part for the person in therapy to perceive that the topic is taboo.
The Importance of Sexuality and Intimacy for Cancer Patients
Alice said that since her cancer diagnosis a number of years ago, her sex life has changed. Her husband told her it was as if someone flipped a switch in him, which meant he no longer desired sexual intimacy with Alice. Of course, this was devastating to her, not just because she desired a sexual relationship with him and wanted him to find her desirable, but also because he rejected any sort of intimacy, including any physical displays of affection.
Myriad emotions arise around cancer, sexuality, and intimacy for cancer patients and their partners. After the initial shock of the diagnosis and questions about death, other concerns enter into the picture, including what one’s sex life will be like. Yet again, because of the discomfort of discussing the topic, sexual concerns are often not brought up with the healthcare team. Some oncologists are very good at bringing up this topic as part of a normal discussion, but many suffer from the same discomfort that the rest of us do and the topic gets ignored.
Another common reason sexual issues are not discussed is because people think they are the only ones experiencing difficulty. A common theme amongst cancer patients in therapy is the feeling that other people are handling their treatment and recovery better than they are. In fact, it is estimated that 80% of women with gynecological cancers and 50% of women with breast cancer will experience sexual difficulties. Erectile dysfunction is common with prostate cancer treatment. The incidence varies by type of treatment, age, and whether the man had previous issues with erectile dysfunction.
Some people ask why sex is important for couples dealing with cancer. Given that some patients are facing a life or death situation, is sex really necessary? The answer is yes! People combat feelings of fear and anxiety about death by seeking comfort and strength in their connections and bonds within their relationships. Also, common reactions to a cancer diagnosis include an increased desire for physical and sexual intimacy with one’s partner and a deepened emotional commitment to the relationship.
For partners of those with cancer, there may be a sense that the patient is too frail to be physically touched, or that one will contract cancer through sexual contact. One cannot contract cancer through sexual contact. Partners are not exposed to radiation through sexual contact with someone receiving radiation therapy, with the exception of brachytherapy. Sexual contact will not make cancer return. Additionally, gentle massage or stroking of unaffected body parts can be therapeutic and help the patient to relax and feel like their partner is there for them. If partners are hesitant to resume any form of touching after a cancer diagnosis, the couple may grow increasingly distant over time.
Factors to Consider
In general, fatigue, pain, and nausea are common causes of decreased sexual desire seen with chemotherapy, radiation, and surgery. The effects of surgery and radiation therapy depend on the site of the cancer. Surgery or radiation therapy to the pelvic region may anatomically change the functioning of organs involved in sexual responsiveness.
Other factors to consider with sexuality and intimacy concerns with cancer are:
- Pre-illness sexual relationship and sexual functioning
- Type of treatment
- Body image and self-image
- Quality of the relationship
- Lack of knowledge
Part II of this series will look at the effects of treatment, body image and self-image, and partners’ responses on sexuality and intimacy for people with cancer.
© 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.