Survivorship

Coping with Sex

Frequently Asked Questions

by Dr. Sylvie Aubin, Ph.D., clinical psychologist at the Seattle Cancer Care Alliance

Cancer survivorship is associated with adaptation to changes in multiple areas of your quality of life. To the majority of cancer survivors and their partners, couple and sexual relationships are important aspects of their quality of life and are thus significantly bothered by any negative changes, especially if irreversible. To some, these changes may even trigger or contribute to emotional distress such as depression or anxiety. Fortunately, there are many ways or interventions that are available to help you redefine and achieve satisfying couple, intimate and sexual relationships.

Regardless of your diagnosis or treatment, you may expect some changes in your sexual response, frequency and quality of sexual activities as well as overall couple intimacy. In addition to the changes in your sexual response, a number of ongoing treatment side effects may also negatively affect your couple and sexual life. These may include fatigue, low energy level, mood disturbances and physical changes altering your body/self-image. Issues of weight gain, asymmetry/growth of breasts, hot flashes, decreased urinary control and loss of muscle mass not only challenge your perception of self as an attractive and desirable partner but also your ability to experience sexual desire and pleasure.

A number of effective interventions are available to address sexual as well as relationship changes after cancer. Interventions may be tried individually or as a couple. However, for a more satisfying outcome, it is best to involve your partner. The majority of couple and sexual strategies are part of a learning process with a series of trial and error consisting of mutual adjustments accomplished mainly through communication.

Regarding sexual function changes of the erectile, vaginal and orgasm response, strategies may include PDE-5 inhibitors (Viagra ™, Levitra ™, Cialis ™), injections, vacuum devices or penile implants for erectile dysfunction and lubricators (short/long acting), vaginal dilators or hormonal gel/creams for vaginal dryness/atrophy. Problems in the orgasm response may be alleviated by the use of vibrators, pelvic muscle exercises (Kegels) and for premature ejaculation, the intake of an SSRI type of anti-depressant medication (Paxil ™, Prozac ™). Used in combination with the above, other strategies found particularly helpful by partners to increase sexual desire and arousal include the practice of sexual fantasy before and during sexual activities as well as the use of erotic literature (visual/written), sexual toys (vibrators) emphasizing sexual play and experimentation.

However, enhancing couple and sexual intimacy starts with setting aside or planning time together, an exercise often experienced by couples as a date night. Ideally, it may consist in a weekly 3-4hr block of time where partners are engaged in a relaxed, mutually enjoyable activity that may or not include sexual activities. Paramount to re-establishing couple and sexual intimacy is partners' willingness to re-connect on a non-sexual, intimate level and to expand their definition of sex to include non-performance focused sexual activities. For example, mutual sensual caressing or erotic massage alleviates the pressure of performance and allows for the learning of new, alternate sources of sexual pleasure. Other key ingredients to greater couple closeness may include partners' commitment to share sexual advances, engage in mutual disclosure and active listening of concerns, fears, especially about the changes in their sexual preferences and needs.

In conclusion, a number of treatment options are now available to address changes that may have affected you personally as well as your couple, sexual relationships. It is thus important to become educated about these interventions either by talking to your care team or by consulting available resources.

Frequently Asked Questions  

Q. Is treatment available for cancer survivors dealing with sexual problems?

In general, a wide variety of treatments are available for patients with sexual dysfunction after cancer. Patients can learn to adapt to changes in sexual function by reading books, pamphlets, and internet resources or listening to and watching videos and CD-ROMs. Health professionals who specialize in sexual dysfunction can provide patients with these resources as well as information on national organizations that may provide support. Some patients may need medical intervention such as hormone replacement, medications, medical devices or surgery. Patients who have more serious problems may need sexual counseling on an individual basis, with a partner or in a group. Patients and their partners should discuss treatment options with their doctor or other qualified health professional.