How cancer affects intimacy and relationships

Cancer can put a strain on intimate relationships. Treatments for cancer and the disease itself may cause changes in sexual desire and function. If your physical appearance has changed, you may feel less attractive or desirable. At the same time, your partner may feel helpless, fearful or unsure of how to support you. Any of these issues can form barriers to intimacy.

The causes of sexual dysfunction are often both physical and psychological. Cancer and its treatments, particularly those involving the genital or reproductive organs, may directly affect sexual functioning and desire. The side effects of cancer treatments (e.g., fatigue, nausea, vomiting, constipation, pain) may also decrease sexual feelings.

In addition, you may feel anxious or depressed, which may impede sexual desire and functioning. These feelings may become amplified if your physical appearance changes, due to surgical scars, hair loss, weight gain/loss, etc. These physical changes may make you feel unsexy or insecure.

Sexuality issues for women with cancer

There are notable differences in the issues men and women face regarding sexuality and intimacy during cancer treatment.

For some women, cancer and its treatments may cause a range of symptoms that interfere with sexual function and physical intimacy, such as:

• Loss of libido (sex drive)

• Painful intercourse

• Loss of sexual function or sensation

Vaginal dryness is common for some women with cancer, making sex painful. Often, vaginal dryness and discomfort are caused by declining estrogen levels. Some cancer treatments may also trigger the onset of menopause, resulting in hot flashes, mood swings, decreased libido, and vaginal dryness or tightness.

In addition, some types of pelvic surgery (e.g., removal of the uterus, ovaries or bladder) may decrease vaginal lubrication and sensation, contribute to loss of vaginal elasticity, and cause pain. Breast cancer surgery may cause reduced physical sensation, so the breasts may not be the source of pleasure they once were. Radiation therapy to the pelvic area may cause changes in the vaginal lining, making intercourse painful.

A woman should discuss her concerns with her doctor, who may recommend medical treatments (e.g., estrogen replacement therapy), vaginal dilators, vaginal lubricants or estrogen creams to make intercourse more comfortable.

Counseling may also be recommended, since body image issues may cause psychological and emotional distress. If a woman wants to have children in the future, she should discuss her options since some cancer treatments may cause infertility.

Sexuality issues for men with cancer

For some men, cancer and its treatments may cause a range of symptoms that interfere with sexual function and physical intimacy, such as:

Some treatments for men with cancer may interfere with the ability to have an erection, ejaculate or reach orgasm. Some surgeries, such as for prostate, bladder and colorectal cancers, may damage nerves and blood vessels and result in erectile dysfunction (ED), and cause problems with ejaculation and orgasm.

Radiation therapy to the pelvis may damage the arteries that bring blood to the penis, causing problems with getting and keeping an erection, as well as incontinence. Chemotherapy may interfere with testosterone production in the testicle, which may impact sexual functioning. Hormone therapy for prostate cancer may decrease a man's hormone levels, reducing the ability to achieve an erection or orgasm.

A man should discuss any concerns with his doctor, who may recommend nerve-sparing methods during surgery to preserve erectile function. Other treatment methods may include medications, injections, vacuum devices, implants or testosterone replacement.

Counseling may also be recommended, since physical changes may make a man question his masculinity, causing emotional distress. If a man wants to have children in the future, he should discuss his options since some cancer treatments may cause sterility.

Balancing cancer and intimacy

Intimacy means different things to each of us and can be expressed in various ways. When cancer impacts your life, roles and relationships change. For many, an intimate connection with a partner is an important part of feeling alive and whole during cancer treatment. And while it may take persistence and teamwork to maintain intimacy in your relationship, it can be done.

Tips for rebuilding intimacy during cancer care

Give yourself time. You and your partner will need time to adjust to the physical and emotional changes cancer causes. Be patient with yourself if certain side effects, such as stress, pain, depression or fatigue lower your desire for sexual activity. Also, give yourself time to come to terms with changes to your body.

Communicate with your partner. An important tool for building intimacy is communication. You may be anxious about resuming sexual activity after cancer treatment, fearing that sex will hurt, you won't be able to perform, or your partner will no longer find you attractive. Your partner may be anxious about putting pressure on you by initiating sexual activity. Talk openly about your feelings so you understand each other's needs and preferences.

Make necessary adjustments. After cancer treatment, some sexual positions may hurt and certain activities that once gave you pleasure may not any more. For example, for some women, pain during intercourse may be relieved if the woman is on top, controlling the level of penetration. Try to be a guide for your partner and explore your expectations together.

Validate each other's feelings. It is likely that you and your partner will have your own questions and concerns. It's important to listen to each other's feelings and point of view without interrupting or being dismissive. Empathize with your partner and try not to take things personally. Avoid statements like, "Everything is going to be great." Instead, say things like, "Although I can't fix it, I am here for you."

Get reacquainted. You and your partner may have disconnected from each other over the course of the cancer journey. Emotional closeness and companionship are important to your relationship and may help rebuild physical intimacy. Start out slowly, by cuddling, kissing and touching. Learn to touch, hold hands and simply relax together. Each day, make a point to say, "I love you," to your partner.

Experiment with other forms of intimacy. Even if you can't have sexual intercourse, you can still maintain intimacy through loving affection and touch. Dim the lights and put on romantic music. If you feel self-conscious, get creative with lingerie. Give your partner a massage. Focus on the sensual, not the sexual. Even going for a walk, watching a movie, swimming or reading together can create intimacy.

Plan ahead. Levels of sexual desire vary during cancer treatment. It may help to plan sex for when you have the most energy, or after you take your pain medication, etc. Also, your partner may have moved into a caretaking role, making it difficult to feel sexy around each other. Try to clearly separate time for caregiving and time together as a couple.

Talk with your doctor. Many doctors won't talk with you about your sex life during cancer treatment unless you ask. Although it can be an uncomfortable discussion, it's an important one to have. Your doctor can clear up any concerns, including the impact of cancer treatment on sexual function. Also, let your doctor know about sexual dysfunction you experience throughout treatment.

Seek professional help. For some couples, a professional counselor can help facilitate communication. You may also find value in talking with a social worker, nurse, chaplain or friend. In addition, support groups can give you both a place to voice your fears and concerns. By talking openly about issues, you can come up with new ways to build intimacy in your relationship.

Work as a team. During cancer treatment, it is especially important to work together with your partner. The closeness and companionship that comes from teamwork may help you feel more secure and in control. By communicating effectively and making an effort to maintain intimacy, your relationship can flourish in the face of cancer.

NOTE: This information is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to making decisions about your treatment.