The Lovin' Ain't Over for Women with Cancer. Ralph Alterowitz
with low sexual desire may still be able to have a positive sexual experience with a patient and sensitive partner. Gentle caressing, kissing, and sexual touching may get her aroused and ready for more sexual activity. Therefore, a woman who would like to make love should not shy away from sexual activity because she feels no desire. She and her partner need to recognize that the partner needs to take a more active role than before and initiate sex (with her agreement), but she may be able to respond.
Sexual Arousal Disorders
With arousal problems, women find it difficult or impossible to achieve and maintain sufficient sexual excitement and derive sexual pleasure from any part of the sexual activity. In a few cases, women with this disorder may still have genital swelling and lubrication of the vagina.
Orgasmic Disorders
Orgasm problems fall into two types. Either the woman has never had an orgasm, or she has become unable to achieve an orgasm after previously being able to experience it.
Pain During Intercourse
Vaginal or pelvic pain during intercourse may be the result of surgery, radiation, chemotherapy, or other medications that may cause thinning of the vaginal wall or muscle spasms during intercourse. The medical term dyspareunia refers to painful sexual intercourse because of medical or psychological issues. Vaginismus refers to involuntary spasms of the muscles of the vaginal wall, resulting in difficulty with any type of vaginal penetration such as sexual intercourse or even a tampon.
Contributing factors may be age, other diseases, abuse and trauma, or medications such as those taken for high blood pressure.
Any of these problems can cause significant distress. A woman’s partner may pressure her to have sex and be unable to understand why she is either unwilling or lacks enthusiasm. Often, women do not tell their partners that they are feeling pain or that they can’t concentrate on love-making at that moment. Even though they may want physical intimacy, pain or the lack of satisfaction discourages them. Surgery for pelvic cancer and breast cancer is a major cause of pain. Communicating to your partner why you are not up to love-making is essential to keeping the relationship strong.
Sexuality and Cancer
Cancer does not usually cause sexual problems—treatment does. Sexuality-related problems after cancer therapy are very common. The short- and long-term side effects of cancer therapy are now more fully appreciated, thanks in large part to mental health professionals such as Leslie Schover, PhD, and Les Gallo-Silver. Their work has called attention to the higher incidence of sexual disorders due to cancer therapy. Their studies and others show that many women need help, and that they have a good chance of returning to their desired level of sexuality if they receive sexual counseling during and after their cancer therapy.
Effects of Cancer Treatments
Each of the three major treatments for cancer can also have a profound impact on a woman and thereby the couple’s sexuality. Surgery can change a person’s anatomy and result in a changed appearance, while radiation and chemotherapy have side effects of various durations. The consequences of surgery often leave both physical and psychological scars. Chemotherapy may leave the woman tired, nauseated, anxious, or depressed and may lead to low sexual desire. In addition, radiation for breast cancer can cause irritation or swelling in the breast or arm. Radiation to the pelvic areas for gynecological and other pelvic cancers can cause urinary tract irritation, bowel problems, and decreased genital sensitivity.
After cancer treatment, many women find that:
•They have less libido or none at all.
•They take a longer time to be aroused.
•They need more direct stimulation.
•They take longer to achieve an orgasm.
•Their orgasms feel different, and at times they will not have any.
Cancer Means Change
Even before a woman goes into therapy, the mere diagnosis of cancer changes the person’s psychological equation. Her emotional balance changes and she naturally becomes preoccupied with the disease. In this atmosphere, intimacy and sexuality often become submerged under the pressure of dealing with the treatments and the anxieties associated with the patient’s future health. Some people have great difficulty recovering their desire for and their enjoyment of sex. Once sex is stopped, it is sometimes easier to continue in a sexless mode than to restart. Yet restarting sex can be an important contributor to returning to physical and emotional health.
Resuming Sex After Cancer: Stressful but Rewarding
There is no doubt that resuming sexual activity after cancer is stressful. Dr. Carl Simonton, who works with patients and couples dealing with cancer, says that sexual readjustment rates 39 out of 100 on the stress scale. It produces more than half the stress of going through a divorce and close to that of getting fired. So resuming your sex life takes work. It is worth remembering, though, that people who make love are happier, and live longer, than people who don’t.
If you are lucky enough to not experience sexual side effects from cancer treatment, you may still find that many sections of this book can help you improve your love life. If you are experiencing sexual difficulties, we hope to provide you with information, thoughts, and tools that will help you navigate the path to recovering the important part of yourself that is a sexual being, and a satisfying physical relationship with the one you love.
There is no one-size-fits-all approach for addressing sexual dysfunction after cancer treatment. You may be young, middle-aged or older; have children or not; have a partner who is supportive or one who does not know how to be supportive; you may not have a partner; you may be sexually conservative, adventurous, or somewhere in the middle. However your situation can be described, we want you to know that there is a path for you and that it is certainly worth the effort - because good loving is the physical expression of emotional intimacy, and there are few humans who do not want or need emotional intimacy.
Chapter 3
Cancer Therapy and Its Consequences
I had a mastectomy and chose reconstruction with a matching augmentation on the other side. Now I don’t get aroused when my husband touches the mastectomy breast because I don’t’ have feeling in that breast. The good news is that I am now a proud C cup woman, and there are many other ways to get me going.
Amanda
Ever since both of my ovaries were removed, intercourse has become painful. I don’t know yet if it will get better with time. My boyfriend is fine with not having intercourse - now we have oral sex. We have gone from one kind of boring to another kind of boring, because we always do things the same way.
Liz
My melanoma is being treated with Interferon. I know that’s one of the most aggressive treatments, but that’s what I need for my aggressive cancer. That thing has knocked the wind out of my sex life. I am not interested at all. I just let my husband do his thing, but it doesn’t do anything for me. It must be hard for him—he loves me so much, he takes care of me, he gives me the shots that he knows hurt and make me feel miserable, and our sex life is reduced to pump and dump. This stinks!
Carol
In some situations, not knowing what to expect can be exciting. But where health is concerned, people naturally become fearful. For a woman with cancer, the diagnosis is often terrifying. That’s because just a few decades ago, a diagnosis of cancer was most often considered a death sentence.
For many people, having cancer in the 21st century means having a chronic disease, much like heart disease or diabetes: one that requires monitoring and management. Unfortunately, doctors