Amongst the most common issues reported by cancer survivors, problems with sex ranks third after fatigue and loss of physical fitness. This is a subject that is not talked about enough, so it can feel like you are on your own. You’re not.
You have changed, so sex has changed
Our sexual function sits on four “pillars”.
Sexual function (the parts that control our sexual response and function)
Sexual body (all the functions that support sexuality: smell, touch, taste, vision, mobility etc)
Sexual identity (how we see ourselves sexually)
Sexual relationship (who we have sex with)
Anything that alters one of these pillars will affect how sex works for us. Cancer can affect all four.
Changes in your body
Cancer, and the journey through surgery, chemotherapy, radiotherapy, or medication, can lead to changes in how your body works and feels. This may be the result of induced menopause, or the intensification of existing menopausal symptoms.
The impacts of cancer-induced menopause (and any local surgery or radiotherapy) on the vagina, vulva, and bladder can be huge; a reduction in hormones and blood supply can make tissues more delicate meaning you may lose sensation or lubrication, and you may find you are less able to cope with penetrative sex.
Some medications including antidepressants, (gabapentin, oxybutynin), and those that help with sleep problems and hot flushes, can further reduce lubrication, libido, or delay climax. HRT can be used to manage menopausal symptoms but this is not always an option, especially for those with a hormone-receptor-positive cancer.
So, what can I do when my body changes?
Washing, moisturising, and massaging with a good emollient
Using a skin-safe lube for any penetration (we like “Double Glide” by Yes), with oil and water based lubes used in combination
Trying local vaginal and vulval oestrogens – these are safe for most people in low doses and can be a game-changer. It’s worth discussing these with your oncologist or GP.
Changes in your mind
You are unlikely to feel the same as you did before your diagnosis. Cancer can be the catalyst for a great deal of change, and most of it won’t have been easy. You may not have quite worked out how you feel about this yet, either.
Whenever our identities are forced to shift, our sexual identity will also change. It can take time (and deliberate attention) to work out how you feel about sex, and what place intimacy has in your life and in your relationship. It may feel like a priority, or the last thing on your list!
There can also be trauma – from diagnosis, surgery, or other aspects of your treatment. Trauma generally results from situations where we feel unsafe or helpless. A potentially life-threatening diagnosis disrupts our sense of safety. This can be compounded by losing agency over our bodies for a period too: submitting ourselves to treatment that can be distressing or painful. Our bodies can feel very unfamiliar.
Unprocessed trauma can manifest itself with emotional blocks, or through sudden triggers: you may notice you are transported to a previous moment, or that you feel suddenly overwhelmed with feelings or unable to find your words. To cope, we sometimes develop techniques such as thinking ourselves away from our present situation. This is called dissociation and it can become a reflex, making it hard to focus in situations such as when we are intimate.
Pain may be experienced on returning to intimacy, and this can lead to anxiety about subsequent attempts. Anxiety makes arousal even less likely, setting up a vicious cycle.
If I am struggling with trauma, anxiety, or pain, how can I feel pleasure again?
If you feel you have unprocessed trauma, it can be really helpful to find someone to talk to about this.
Body-based methods like mindfulness, breath-based activities, or yoga can be very effective in reconnecting with the body, and calming anxiety and trauma responses.
When it comes to sex, it can help a lot to explore things on your own first. What touch feels good now? Is there anything that feels uncomfortable? What sparks your interest, and what turns you off?
Think about what you may need in order to feel relaxed, comfortable, and in the right space emotionally for sexuality. We often need to ensure that we are meeting most of our non-sexual needs before addressing our need for intimacy. This means rest, exercise, safety, and having our emotional needs met.
Changes in your relationship
When one of us changes, we force a shift in the other as they adjust around us. Many couples feel closer than ever after facing illness but the adult-to-adult dynamic of the relationship may have altered for a period into patient and carer. Sexual currency – the anticipatory, flirty chat between lovers – may have been lost for a period, and it can feel very hard to rediscover.
How can I reconnect with my partner if intimacy has been lost?
It can help simply to talk. In many couples, the conversation can feel hard to start but when one partner is afraid of some aspect of intimacy, avoiding this can mean that all touch is lost for fear of it being seen as a “green light” for sex. Communication can make a huge difference.
Use “I” statements, as these are less likely to provoke a defensive response. Explain how things are for you. Talk about what you fear. What you miss. Look for the shared ground. What did intimacy mean to one or both of you? What do you want more of? How can you find that?
Sometimes it helps to agree what you don’t want to do for a while, in order to signal that other forms of intimacy are still welcome. Keep touching – especially non-intimate touch, as this helps build connection and permission for non-verbal expression between you.
Getting back to sex can take time, so in the meantime agree to widen what counts as quality intimacy: sex is a buffet, not a three course meal.
Our three top tips for sex after cancer
Communicate, communicate, communicate. Talk about what you miss, what you fear, what you want back.
Prioritise vulvar and vaginal care. Treat your vulva like your favourite cashmere jumper. Moisturise and massage regularly. Ask about low dose oestrogens – they can really help.
Remember sex is a buffet, not a three course meal. Don’t let fear of one aspect of sexual connection stop all connection. Agree what is ok right now, and what is not. Keep touching and connecting in non-sexual ways. Widen what counts as intimacy.
Dr Angela Wright
MBChB MRCGP DFSRH Dip. Pall Med, FECSM (Fellow of the European Committee of Sexual Medicine), Clinical Sexologist (Psychosexual Therapy Diploma Trained & Graduate of ESSM Advanced School of Sexual Medicine), Committee Member of British Society of Sexual Medicine, Education Committee Member Primary Care Women’s Health Forum, Faculty Member Contemporary Institute of Clinical Sexology
Contact here: https://spicedpearhealth.co.uk/
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