Cancer and Sexuality, Part I: Creating Dialogue

Man holding a bouquet of flowers behind his back, standing beside the hospital bed of a sleeping woman“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

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

  • Leave a Comment
  • Nolan


    July 13th, 2010 at 11:24 AM

    “If partners are hesitant to resume any form of touching after a cancer diagnosis, the couple may grow increasingly distant over time.”
    This statement just goes out to show that there are people out there who think cancer(or other non-STD diseases) can be transmitted through sexual contact.This is nothing but pure ignorance!
    Yes,we will not go around telling everyone about how harmless it is to be close to a cancer patient but the family of those affected should know this for themselves,they need to have common knowledge about the issue!

  • Ian Harvey

    Ian Harvey

    July 14th, 2010 at 2:53 AM

    Most people’s sex lives take a hit with the onset of a medical problem.This is because the person affected and the partner both recoil and sex is the last thing they think about.But in this commotion they forget what sex can do for them-it can heal,it can calm things down and bring them closer to each other,thereby helping the situation!

  • sandy


    July 14th, 2010 at 4:23 AM

    After going through chemo, radiation, and a mastectomy, the last thing that I wanted was to be sexually intimate with my husband. I was bald, having horrible skin issues, and was missing a breast! How beautiful and love- worthy could I feel? And when you don’t feel that about yourself it is very difficult to let someone else feel that way about you, or to accept that he could anymore. I think that this is something that is severaly overlooked when it comes to treating cancer patients. We very much take care oft he physical needs the best that we can but the mental and emotional needs get pushed to the side. People tell you to be happy that you have your life- and you are. But you also miss what was once a part of you, your looks, or maybe something else, and it is hard to get those parts of yourself back again.

  • Kylie


    July 14th, 2010 at 1:38 PM

    ^^ sorry to hear of your condition.hope you are blessed with all that you wish for

    on topic:although sex may be something that is far off for some people dealing with a problem as big as cancer,they should at least try and remember and put use to the use of even simple gestures like a warm hug…it gives a lot of energy and hope and belief to both the patient and his/her partner :)

  • Norma


    August 6th, 2010 at 3:37 PM

    Hi All,

    Thanks for your thoughtful comments regarding July’s article. I have heard from clients over and over again how their sexuality and sexual concerns not addressed in cancer care. Of course, I suppose those who are getting their needs addressed will probably not be coming to counseling. I think that people who are now in the process of becoming physicians are getting better training than those of us who trained a number of years ago regarding dealing with a patient’s emotional and non-medical needs.
    I was surprised to learn that people think cancer can be catching too, Nolan. This certainly speaks to the issue of needing to educate people! Sandy, I thank you for your honesty and willingness to share your experience, which is a very common one. Again, because people aren’t comfortable talking about it with others, they think they are the only ones who feel that way. I hope your post lets others know that feeling that way is normal, and widespread.

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