Alberta Cancer Foundation

Let’s Talk About Sex

Illustration by Andrew Benson.

Though palliative care is her current topic of focus, Reanne Booker is well-versed in the stigma that surrounds another tricky topic: sexual health. Booker finds it amusing how personal a clinician can be with a patient but can still feel uncomfortable bringing up sexual health.

“It’s funny, we ask a lot more invasive questions of our patients,” she says. “We’ll ask them about the size, consistency and colour of their bowel movements, but there can be apprehension on behalf of both the patient and clinician to bring sexual health up.”

Early on in her career, Booker observed and participated in a lot of conversations with patients.

Often, health-care providers may consider sexual health as taboo or off-limits to bring up with patients. Factors like culture, religion and various life experiences all play into an awkwardness around the topic. But sexual health issues after cancer are very common and should be a normalized part of patient care.

“[Sexual health] is not specifically linked to any particular type of cancer or treatment. It’s relatively ubiquitous,” Booker says.

Interestingly, this hesitancy to broach the topic of sexual health can often come from the clinician’s side. Once a health-care provider steps over that unseen barrier and addresses it, patients are usually more than willing to open up.

“If a clinician brings it up first, patients are very willing to talk about it,” Booker says. “The stigma and barrier really lie with us as health-care providers.”

Cancer, and illness in general, can greatly affect a person’s sex life in myriad ways, which is why it’s so important for clinicians to acknowledge it with patients. Side-effects of cancer treatment, like nausea and pain, can lower sex drive, and many chemotherapy approaches can have serious impacts on fertility for both men and women. Self-esteem and self-image can also take a hit as a person’s body changes from treatment, which can influence a desire to be intimate. Beyond distracting physical symptoms, cancer can put a strain on personal relationships as patients need to prioritize their energy and time for treatment and recovery. Plus, patients may not know how to bring up whether or not they can, or want to be, intimate with a partner, says Booker.

“If their treatment goes on for a year or more, that’s a huge imposition for a lot of people and can be very damaging to their relationships and quality of life,” she says.

To address these unique concerns about sexual health, Booker and several other health-care providers, from a variety of disciplines, secured funding to develop a sexual health program for cancer centres across Alberta in 2016. Now a permanent program, Oncology and Sexuality, Intimacy and Survivorship (OASIS) is offered out of the Tom Baker Cancer Centre, Cross Cancer Institute and Westmount Shopping Centre in Edmonton. The program seeks to better educate patients and health-care providers through specialized sexual health support and treatment.

Through OASIS, which partners with Alberta Health Services and CancerControl Alberta, (and at one time was funded through the Alberta Cancer Foundation) patients can attend workshops on vaginal changes post-diagnosis, access information about erectile dysfunction related to cancer treatment, and much more. Program counsellors offer patient support and can also help direct them to information and resources about a specific area of concern. Online and print materials created by program experts are readily available in cancer centres for patients, too.

As for medical professionals, OASIS provides group training and direct one-on-one support to clinicians who have questions about sexual health after cancer. It also connects health-care providers to resources about cancer and sexuality, including tools for how to broach the topic and relevant research.

All these initiatives are important to dismantling the barriers to an open discussion about sexual health. “Helping to normalize it is the first step,” Booker says.

FAQ on sex and cancer with Reanne Booker

Can I get/catch/transfer cancer during sex?

For the most part, no. While there are some cancers that can be associated with infections passed on by sexual activity (HPV and hepatitis B and C), the vast majority of cancers are not associated with such infections.

Should I stop all sexual activity during treatment?

You don’t need to stop all physical touch and intimacy, but you could consider modifying sexual activity if it is too strenuous and should always consult your doctor beforehand. Different approaches can be perfectly safe throughout treatment.

Will being sick completely wipe out my desire to have sex?

There is a growing body of literature to suggest that many patients have desires, but some don’t. Even those who are really sick may still have a desire to be sexual.

Should I abstain from initiating intimacy with my partner when they have cancer?

Communicate openly with your partner, regardless of the outcome. Often, after the initial shock of diagnosis, a desire to be intimate remains. Help is available for these concerns from your doctor.