Re-establishing intimacy after cancer
October 6th, 2011
07:26 AM ET

Re-establishing intimacy after cancer

Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex on Thursdays on The Chart. Read more from him on his website, GoodInBed.

As a nation, we first observed Breast Cancer Awareness Month - dedicated to increasing awareness of the importance of early breast cancer detection - 25 years ago.

As the years have passed, the campaign’s visibility has grown, making it one of the most successful of its kind. Proceeds from pink apparel make October one of the rosiest months of the year. Charity walks abound. Education regarding self exams and breast cancer symptoms has become part of the public consciousness.

But as caught up as we are in the dual causes of prevention and additional medical research (both crucial), not as much attention has been paid to the sexual aftermath of a cancer diagnosis.

Recently, a study published in the Journal of the American Medical Association showed that sexual performance can be adversely affected in the cases of men who have undergone treatment for prostate cancer. Although the effects vary greatly depending upon a number of variables - age, the severity of the cancer and the quality of the man’s sex life before treatment - the majority of participants in the study reported continued issues with erectile dysfunction and other intimacy-related issues after treatment.

And although prostate cancer is the most common cancer among men in the United States, it’s not the only type that can lead to sexual dysfunction. According to an earlier study published in CA: A Cancer Journal for Clinicians, a large percentage of both men and women (including 95% of women with breast cancer) have experienced some level of sexual dysfunction after being treated for cancer.

Says Anne, a cancer survivor: “During treatment, sex stopped. Now that I think about it, most forms of intimacy between me and my husband stopped as well. It makes sense to me now; out of fear, we both withdrew from one another. But if I could do it over, I would have paid more attention to sex. I would have tried harder to remain intimate. I thought we could set that aside and come back to it when the diseased storm had passed. I thought we could pick right back up in bed when I was healthier. This wasn’t true, though, and we have found it especially difficult to re-establish our sexual relationship.”

Why does this matter so much, especially considering that so much else is at stake? In “Sexy Ever After,” a new book dealing with intimacy post-cancer that’s available for free as a digital download during the month of October, the authors - Patty Brisben and Keri Peterson, M.D. - write, “Your sexuality is a vital part of your health and sense of well-being. To put it under the carpet because you’ve been sick is shutting off an area of your life that is a source of vitality.”

One of the biggest roadblocks to a healthy sex life after cancer is lack of desire. Libido is a complex thing, and libido can be affected by so many different factors: Hormonal therapy and chemotherapy can cause low libido.

But the issue could very well be psychological, too. Your sense of sexual identity may have been compromised, or your body image damaged, due to treatment symptoms like hair loss, infertility or disfigurement. But that doesn’t mean you can’t use those changes as an opportunity to find new ways to enjoy sex even more.

You can’t allow your intimate life to fall victim to the health issues you’re struggling with. It’s not fair to you or your partner. Being proactive about fighting your low libido is important, and if you work hard enough at it, sex will become fun again.

Says Krissi B., a cancer survivor, regarding sex after cancer treatments: “You don’t want to have it. You don’t feel sexy. You don’t feel pretty. You don’t have the energy. I also had an open incision on my chest for seven months because my mastectomy wound did not heal. The very first time I looked at my mastectomy wound, I was in the shower. I said to myself, 'It is so ugly.' My husband came into the shower fully dressed and kissed that area. 'Cancer’s ugly, honey,' he said. 'You can never be.' "

"When you get a mastectomy, you don’t have the same body you had, because you’re missing a breast. You don’t have that muscle tone, because of the chemotherapy. You don’t have your hair. You just don’t feel sexy. But then you realize that true love is about your inner beauty and not your external beauty.”

soundoff (54 Responses)
  1. miamiuhurricances


    October 6, 2011 at 12:26 | Report abuse | Reply
    • teresa


      October 17, 2011 at 21:58 | Report abuse |
  2. D

    I really don't like the tone of this article. What wasn't mentioned was that all of the side effects of certain chemotherapies REALLY put a damper on feeling romantic. For example, extreme gastro-intestinal problems, extreme heavy bleeding, radiation burns. I feel like the article is insensitive and blaming the patients and quoting patients that are blaming themselves. NOT HELPFUL. Maybe if you are not feeling up to it, give it a rest.

    October 6, 2011 at 14:42 | Report abuse | Reply
    • Huck

      D....calm down. As a surviving spouse (my wife and I are in our mid 30's) i can assure you that not everyone has the same experiences. I dont find this article insensitive at all (maybe some thicker skin would be helpful). And i the worst thing you could do is "give it a rest".

      October 6, 2011 at 17:07 | Report abuse |
  3. D

    Another thing not mentioned here is depression. I could have written a better article myself.

    October 6, 2011 at 15:00 | Report abuse | Reply
    • Elizabeth

      You should write something from your perspective. My husband has colon cancer with hernias and other problems. His gut is very uncomfortable all the time, and he does "give it a rest." But we kiss and hold each other, and that is very important. Some of the chemo he takes also causes problems, and he has low platelets. What shouldn't happen is distancing. We need to feel close to eachother, because we do not know if he is improving or getting worse, and everything around us feels like quicksand.

      October 7, 2011 at 01:07 | Report abuse |
  4. B

    It's great that prostate cancer was mentioned; I had hoped there would be more about that since my wife and I are struggling with this issue since my treatment for PCa 4 years ago.

    September was Prostate Cancer Awareness month, it seems like there could have been something published here last month–I'll check Kerner's website; maybe he published something on the subject there?

    October 6, 2011 at 15:30 | Report abuse | Reply
    • Judy

      We are also struggling with prostate cancer and it's devastating side effects. Without his testosterone down to zero, it has changed him and our intimacy. Although he is treated at one of the premier cancer centers, no one prepared us for this. We ha ve had to struggle and adjust. I am very grateful for the few other wives near me who are going through the same thing and we can talk. The good news is the treatment is working, but we have lost a lot.

      October 16, 2011 at 06:47 | Report abuse |
  5. pg

    I agree...I could have written a more informing article. Nothing was mentioned about instantaneous menopause when receiving chemotherapy. For women who have not yet reached perimenopause or menopause, this is a devastating side effect. Most women ease into menopause-it sometimes takes ten years to go through the entire process. Your body can slowly adjust. My periods stopped and my ovaries died immediately after my first chemo infusion. Five more infusions finished me off. Besides having to work 40 hours a week during treatment and having to endure the gamut of surgery, chemo, and radiation side effects, the last thing I needed was hard core menopause. This aspect of cancer treatment seems to be ignored. We cannot take hormones to help us. Even though I dragged myself through six chemo treatment and 31 radiation sessions, the instant menopause has been the worst. Treatment only lasted 8 months--this nightmare of menopause is going strong after 7.5 years.....

    October 6, 2011 at 17:57 | Report abuse | Reply
    • Elizabeth

      Make your oncologist and gynecologist talk to each other. Also ask them if some of the supplements like fish oil might be O.K. I'm sorry to hear it; I had a total hysterectomy in 2003, but didn't get all the bad effects, because I hurt less than I had before it. But there are other things that can cause pain, such as adhesions. And if there is necrotic tissue there, a good gynecologist can remove it in a laparoscopy. I'm amazed sometimes by what doctors think that women can and should endure; get a better doctor.

      October 7, 2011 at 01:14 | Report abuse |
  6. Afflicted

    Tried to post yesterday, and it never showed up. PG, I agree with you on the stress and trauma and horribleness of instant menopause, and although the possibility that it would happen was raised, and I knew the effects of the hormone suppressants, all of that was glossed over as very secondary and manageable. It is NOT secondary! For me, it was the single most traumatic thing that happened to me. And I do not appreciate hearing (even from other survivors!) "it would have happened anyway". For one, it would have been years from now, and for another, it would not have been like hitting a brick wall while going 80 mph. I think everyone responds to menopause differently, however. For some, it's not so much of a problem. For me, it triggered an even worse auto-immune condition, so I can definitely testify that the brick wall effect was not the worst thing that could happen to me. Unfortunately.

    However, PG, there is hope, even without hormonal recourse. There are steps you can take to keep yourself more elastic and moisturized. It takes work and it takes maintenance. There are books available (I mentioned one by name yesterday when I tried to post, so I am thinking they won't let me do that). There is one website I know of that is extremely helpful and evidence-based (in contrast with the hundreds out there with poor information or scary stories). I wish I could post the names, but I don't think that's allowed.

    October 7, 2011 at 12:09 | Report abuse | Reply
    • Abbie Scott

      Tell me what is the name of the website that has good info on what we can do the help us with elasitcity and moisture struggling two time breast cancer surviver off tamoxifen now and not getting much help from mds ... don't they get it? It hurts and i love my man and wannna do it but alas the pain HELP

      October 8, 2011 at 23:55 | Report abuse |
    • Afflicted

      Abbie, yes I know it hurts! And I know you still want to! Google No Surrender and breast cancer, you should find it.

      October 15, 2011 at 03:42 | Report abuse |
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