Sexual wellbeing is a central component of quality of life. Cancer can result in significant disruption of sexuality. This disruption is one of the most negative influences on social/sexual wellbeing, not only for the patient but also for the partner.
These changes are most obviously noted with cancers that directly affect the sexual or reproductive organs, that is prostate, testicular, breast, cervix, uterus, ovaries and external female genitalia..
- Erectile performance in men.
- Vaginal dryness, sexual dysfunction, or body image changes in women.
There is also sexual impact in a wider range of cancers secondary to treatment and its side effects.
- Lung
- Kidney
- Colorectal
- Head and neck
- Leukemia
- Lymphoma
- Melanoma
Particularly in cancers of the sexual organs, the most successful strategy in reestablishing sexual wellbeing is redefining sex. What does that mean? That means moving from a definition of normal sex as penis-vagina intercourse to definitions such as intimacy and noncoital sex (outercourse). Intimacy includes cuddling, kissing, nongenital touching, massage, spending time together, and caregiving. Noncoital sex includes the sexual practices of oral stimulation of the genitals, mutual masturbation, and the incorporation of sexual aids such as vibrators and lubricants.
Well, how does a couple navigate these challenges? As in most situations of life, there are three rules: communication, communication, and communication. Effective strategy begins with honesty, openness, and being nonjudgmental. Talk about the loss of coital sex, whether because of vaginal dryness and pain or erectile dysfunction. Allow one’s partner to ask anything, communicate needs and desires, and talk about a variety of sexual acts that might interest one or the other.
Not surprisingly, those couples with good sexual communication skills prior to cancer navigate the challenges better than those who lack a history of effective sexual communication. This reminds me of the story of the patient who asked her doctor if she could play the piano after surgery. He replied that of course she could. Her response was “thank goodness, I could never play it before!”
The take-home message? It is possible to restore sexual wellbeing while living with cancer, without emphasis on the performance of the penis and/or vaginal penetration. Expand your horizons, there is a wide range of “normal” sexual and intimate practices that are pleasurable and satisfying. Your sexuality will return, your sexual enjoyment will grow with exploration and change.
Resources
Cancer Nursing, Vol. 36, No. 6, 2013, Renegotiating Sex and Intimacy After Cancer; “Human Sexuality in the Cntext of Cancer;” Perz et all.
Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer 2013 13:270; the New York Times, Susan Gubar, August 27, 2015, Living With Cancer: Collateral Damage.
