Alberta Cancer Foundation

Let's Talk About Sex

A cancer diagnosis doesn’t mean your life is over, or your sex life either.
Illustration by Raymond Reid

You or your partner has been diagnosed with cancer. Are you thinking about sex?

Highly doubtful, and your doctor’s probably not focused on how cancer treatment will impact your sex life either. “The first concern is always survival,” says Dr. Kelly Dabbs, an Edmonton surgeon who treats breast cancer and melanoma. “Initially patients and physicians are so focused on the malignancy and treatment that the impact on sexuality is rarely discussed – unless a patient raises the issue.”

Sadly, most won’t, says Dr. John Robinson, a clinical psychologist at Calgary’s Tom Baker Cancer Centre. “Cancer patients worry they’ll be judged as having their priorities mixed up if they ask about sex. And often patients think only below-the-belt cancers bring sexual changes, while treatment affects nearly everyone, regardless of the cancer type. In fact, sexual dysfunction is the most frequently cited top adverse effect.”

It’s important to treat the whole person, not just the tumour, emphasizes Robinson, and sexuality is a big part of who we are. “The tragedy I see is that couples stop being intimate. As they suffer in silence, the relationship bond suffers too. But the good news is sexual pleasure is still possible. It’s been an eye-opener for medical professionals how creative couples find solutions and we need to share those possibilities.”

Over at the Traveling Tickle Trunk, an online and Edmonton-based store that describes itself as “sex-positive,” owner Brenda Kerber is busy doing just that.

Building on her former career as a social worker, Kerber moved beyond the stigma usually associated with the sex-toy industry to create an enlightened adult-toy boutique where both women and men feel comfortable. Its welcoming environment attracts many cancer patients who seek out the Tickle Trunk following a medical referral or for their own curiosity.

“Sexuality is often ignored by health professionals,” Kerber notes. “Often the attitude is you have cancer and there are more important things to think about than sex. But you can’t set sex aside and wait until you’re better when treatment takes months or years. You need to maintain physical closeness, especially through such difficult times. Give yourself permission to accept that this area of your life is important, even during treatment. And give yourself permission to talk about it, without shame or fear.”

So let’s draw back the curtain of quiet surrounding sexuality and cancer with some straight talk from these experts: a psychologist who counsels couples on how to overcome sexual difficulties and a sexuality store owner who offers practical aids many couples have never considered. Interestingly, their perspectives overlap into three basic themes we’ll call the three prescriptions for good sex during cancer – recognize, redefine and relax.

Rx No. 1: Recognize
First, recognize your new reality, and that its cause is usually a side effect of treatment rather than the disease itself. The most common problems are lack of desire, difficulty becoming aroused, painful intercourse for women and erectile dysfunction for men.

These changes may be temporary or permanent, but as Robinson puts it, “Where there’s a will, there’s a way.” Finding the will becomes difficult, however, when treatment leaves patients feeling fatigued, nauseous or in pain. Surgery may also cause pain and reduced mobility.

“The issue becomes how do you have the stamina and interest to even want to be touched when you’re in pain or so sick and tired?” Kerber says.
Hormonal changes add further complications. “Chemotherapy really messes with a woman’s hormonal balance, putting them into early menopause, lowering

libido and reducing natural lubrication,” she explains. Testosterone levels drop for men during androgen-deprivation therapy for prostate cancer, making erections difficult or impossible. Add to this the problem of feeling sexy after hair loss or weight loss or gain following treatment, and it’s understandable that sex drives suffer and rifts develop in relationships.

Because knowledge is power, ask your physician what to expect and share the information with your partner.

Rx No. 2: Redefine
“My most important message is just because sex isn’t the same as it used to be doesn’t mean it can’t be as good as
it used to be,” Kerber notes. “Sometimes it even becomes better, because partners really discuss their needs and take nothing for granted. But you can’t cling to wanting things to go back the way it was, or neither partner will be happy.”

Robinson encourages couples to reframe expectations by thinking about their sex drive as an appetite. “We’re not always hungry enough to want the full-meal deal, but that doesn’t mean we can’t enjoy eating. Sometimes you only want an appetizer, and nibbling is completely satisfying.” This approach reduces the pressure on partners and opens the door to redefining sex as mutual pleasure, rather than the traditional act itself.

“We put so much emphasis on penetration as the only way to have sex,” Kerber agrees. “But there are so many other ways to be physically intimate. You don’t have to shut everything down if one approach no longer works.”

Think of your body as the new and improved string of Christmas tree lights, Robinson adds. When one bulb doesn’t work, the others still do. “Men can still become fully aroused and have orgasms without an erection, or even a penis. You can still light up.”

Rx No. 3: Relax
Expand your sexual repertoire by using whatever works for you as a couple – including sexual aids. “Sexuality stores aren’t necessarily whips and chains,” says Robinson. “There’s nothing dirty or taboo about exploring options. Experiment to find what works.”

Shun old-style sex shops and look for those with products tested for safety, ease of use and durability. Avoid phthalates, a known carcinogen, and look for latex-free labelling if allergies are a problem. Although ordering online offers anonymity, Kerber finds she can assist most couples after in-person or email conversations to help her match product to particular needs and preferences.

What’s out there may surprise you: tasteful, attractive styling designed for ergonomics and partner-friendly use. “Vibrators aren’t a penis substitute, but a powerful tool for arousal,” Kerber explains. “They get the blood flowing, stimulating circulation and desire. They’re also good for massage and reducing scar tissue.”

Vaginal dilators and wands, (far prettier than the name suggests), reduce vaginal atrophy and pain during intercourse. Constriction rings and vacuum pumps help maintain

erections and are far less invasive than drug or surgical solutions. The new generation of lubricants to ease vaginal dryness don’t irritate like glycol-based products such as the old K-Y standby, thanks to water- or silicone-based formulae—and they last longer too. Special pillows and supports like Love Bumpers make sexual positions more comfortable and reduce fatigue.

“Sex is such a life-affirming activity when a person is facing cancer,” says Robinson. “Often couples who try new approaches and communicate more openly tell me they wish they’d gone this route before cancer forced them to, since sex is much better for them now.”

Like for Gloria* a middle-aged Edmonton woman diagnosed with breast cancer in 2007. Gloria is back at work and doing well today, after a lumpectomy, four rounds of chemotherapy and radiation treatment. Since she’d already been through menopause, she didn’t experience radical hormonal changes from chemo, but it had other unsettling effects. “It took away my energy and ability to focus, and even affected my hearing.” Gloria lost her hair, but her husband constantly reassured her that he loved her bald head. Still, she felt a growing distance.

“We’ve never had sex frequently—that was always the story of my marriage—and we tried a couple of times unsuccessfully while I was in treatment. But what really bothered me was seeing how my husband felt he always had to be the ‘strong one.’ He would never discuss how my cancer was affecting either of us emotionally. That made my cancer journey very lonely for him. It was like a big bruise on his soul.”

Once Gloria felt better, her interest in sexuality returned, but it took a lot of patience before she and her husband truly reconnected. “We’re more intimate now, but I regret that he suffered in silence for two long years.”

It takes courage and some creativity to stay close, but couples find the effort pays off. Kerber says one of her most memorable cases was helping a woman get her groove back following years of breast cancer treatment. “Her relationship suffered during that time and she didn’t know how to get back on track. We talked about simple things, then the conversation branched off into more areas. When she left, she said, ‘‘I have hope now.
I believe things can change.’ And later I received an email saying things were improving.

All she needed were ideas on how to start again. The need to be physically intimate never goes away. You just need to stay open about figuring things out together and a willingness to try.”

Rx No. 4: Resources
Counselling and courses
Individual, couple or class counselling is available through the psychosocial departments at Edmonton’s Cross Cancer Institute and the Glenrose Sexual Health Service or Calgary’s Tom Baker Cancer Centre and the Prostate Cancer Centre. Physicians can advise what’s available in your area.

*name changed by request