Sex with Cancer: No Prescription Needed

Shocked by the news. Your heart shatters. You’ve been diagnosed with cancer. You go into a stress response. You enter survival mode. As you begin to cope with the news, you think about every possible scenario. I am wondering…Did you remember your sexual health?

Approximately 40% of Americans are diagnosed with cancer during their lifetime.   Despite this, doctors, patients, and family members are not discussing the impact of cancer on sexual health unless the cancer is present in the genitals, anus, or common socially accepted erogenous zones such as the chest and buttocks. What a disservice, we all deserve pleasure. Not talking about it only makes it worse! 

Why don’t we talk about it?  

Let’s be real. Most of us lack the knowledge and comfort to ask questions or initiate discussions. There is a certain amount of education related to the impact of medications, appointments, societal expectations of being a “cancer patient”, and the mental health changes related to having cancer that one needs to have in order to engage in informed conversations related to cancer and sexual health. Most of us did not learn these things in school and certainly don’t talk about them with family or friends (at least not openly) so we do not feel capable of bringing it up with the oncologist or treating physician.  Learning that each of these topics plays a role in the cancer journey and its ties to sex supports us to have more open and honest conversations with doctors, partners, family members, and friends. 

Another reason we don’t talk about sexual health during the cancer journey is related to the emotions connected to sexual dysfunctions that may show up during sex, either alone or with others. When we engage in masturbation or sex, we tend to know what to expect from our bodies. We develop rhythms or scripts based on what arouses us, peaks our interests, or brings us pleasure and joy. These scripts often reinforce a sense of closeness and intimacy with ourselves or with our partner(s). We may not know what to expect, we can even be shocked or surprised. No one mentioned these changes and now you are discovering them DURING sex! Just when you were seeking pleasure and connection, you found something…else. Hopefully, you have trusting and connected relationships to hold you in these moments, if not an AASECT Certified Sex Therapist may help you or you and your partner(s). 

So let’s talk about the changes you may experience. 

Whether due to medications, surgery, or mood, you may experience changes in desire. Changes in desire may show up as a decrease or an increase in sexual connection. For some, grief, sadness, or anxiety reduce desire or create barriers to believing that pleasure and intimacy are possible. Noticing changes in physical appearance may affect desire. When we do not feel our best self or are adjusting to changes in appearance resulting from cancer treatment, these things can really put a damper on the mood. But what about when desire is present or even increases due to the normal stress response or changes in hormones? We may be faced with the social expectation of being “sick”, “fragile” or “not in the mood”. 

 There may also be changes in arousal. Arousal is the physical and mental response to intimacy. Whether it be touch, flirting, hearing or seeing sexual content, or smelling the scent of a lover that would typically turn you on. Cancer and its associated treatments and impact can decrease arousal even if the desire is normal or elevated. Decreases in arousal are noticeable when erectile tissue does not become as engorged. Penile and clitoral tissue will not experience the same length, firmness, or enlargement as it once did. For those with a vulva and vagina, they may experience a decrease in lubrication and thinning of vaginal walls. Some people may experience conditions called vulvodynia or vaginismus where they experience pain when the vulva is touched or the vagina is penetrated. Sex should never hurt (unless you want it to wink wink). In these situations, it is important for you to speak with your doctor and get a referral to a pelvic floor therapist. Other physical changes may pop up, such as arthritis, inflammation, or exhaustion all of which can impact desire AND arousal. 

Then there are the unknowns, the things outside of our control. Are the changes in your body making it hard to hold onto that beloved sex toy? Is the weakness in your knees making it impossible to mount a partner? These physical changes can be distressing for some individuals, to the point that pleasure or orgasm seems impossible to achieve. I invite you to think of these as invitations. Opportunities to stop thinking about sex for the sake of orgasm and to invite in creativity, discovery, and releasing control. Why allow the feelings around these changes to lead us away from intimacy and pleasure? What would happen if we met them and wondered about the possibilities?  

This is where I come in as a sex educator. I can help you discover the possibilities. Be present for the questions you may not even know to ask. Show you the coolest new sex toy or adaptive device and how to get it or help you try out the lube designed for what your body needs. A sex educator who is knowledgeable about cancer understands what you are facing and can support you with education, recommendations, and accommodations. Recommendations on lubes, toys, and creative positions and new activities to explore, alone or with others, in pursuit of pleasure in new ways, are just part of the conversations we can have with a Sex Educator.  

Cancer is not a death sentence to your sex life, nor should you let it. Pleasure is medicine! Without it, you cannot heal.