Sexuality and Intimacy
You may be concerned about how blood cancer and treatment will affect your current or future relationships and your sexuality. Sexuality refers to physical, psychological, social, emotional and spiritual factors. It includes self-image, body image, reproductive ability, emotional intimacy, sensual feelings and sexual functioning.
Cancer and Sexuality
Sexuality-related concerns may arise from the physical aspects of your disease or treatment, as well as from emotional aspects. Anger, guilt or worry - about illness and survival, treatment or finances - may affect sexuality. Some physical or emotional effects resolve over time or when treatment ends. Other effects may be long lasting.
Cancer or cancer treatment may affect your sexuality in several ways:
- You may have a different sense of self-worth and self-confidence than you did before being diagnosed with cancer.
- You may feel depressed or anxious or have little or no interest in sex.
- You may feel embarrassed or worry that others see you differently because of physical changes, such as weight gain, weight loss, hair loss, swelling, scars or the presence of a central line or port.
- You may have few chances to be alone or intimate with your partner because of hospitalization or treatment schedules.
- Survivors of childhood cancer may be self-conscious about underdevelopment or delayed development.
- Treatment side effects, such as peripheral neuropathy or graft versus host disease, may make your skin sensitive or uncomfortable.
- Fatigue, pain, nausea or vomiting, problems with erection or premature ejaculation, vaginal dryness or discomfort during intercourse may interfere with your ability to be interested in or enjoy sex.
- Your oncology team may advise you to abstain from intercourse for a period if your total white cell or platelet counts are low or for other medical reasons.
Questions to Ask Your Doctor
Be open with your doctor about sexuality and intimacy so he or she can help you. If you're not sure of how to bring up the topic, here are some questions you can ask your doctor:
- Will my treatment affect my ability to have sex? If it will, how long will this effect last?
- Is it safe for me to have sex while I'm in treatment?
- Will my illness or treatment affect my ability to become pregnant (or father a child)?
- Where can I get information about fertility and family-planning options?
- Where can I get information about nutrition, exercise and skin care?
- Who else can I speak with about this topic? Are there counselors, sex therapists, support groups or other support services in my area?
- (For hospitalized patients) Can you help me arrange for some private time with my partner, as long as it doesn't interfere with my medical care?
- What do I need to know about birth control and protection from sexually transmitted infections (STIs)?
It's important to use barrier protection (condoms or dental dams) during intercourse or oral sex to protect you and your partner from STIs or from possible exposure to residues of chemotherapies that may be present in semen or the vagina. If you're of childbearing age, birth control is important because some cancer treatments can harm an unborn child. For some therapies, your doctor may advise you to use birth control for up to one year after treatment ends. Ask your healthcare team for more information.
To help you talk with your healthcare providers, you may want to:
- Bring your partner to your next visit with your physician or counselor. Give your partner a chance to ask any questions he or she may have.
- Ask your physician or counselor to use models or drawings to help convey information.
- Ask if you can record the questions and answers. By recording what your physician or counselor says, you'll be able to replay the information as many times as you need later on.
- Keep a journal or notebook of questions to ask your physician or counselor at your next visit. Leave space for answers so that you can refer to them afterward.
- Ask your physician or counselor if he or she communicates with patients by email or has a website with information for patients.
Members of your oncology team can give you referrals to other healthcare professionals. A consultation with a gynecologist, urologist or family physician, an oncology social worker or a certified sex therapist may be helpful, depending on your situation. You may want to get information from support organizations, including information about maintaining intimacy in your relationships and ways you can feel more attractive. You may find value in talking with cancer survivors to learn how they're dealing with self-image issues and other aspects of their sexuality. You may also find it helpful to talk with a good friend, a family member or a spiritual adviser about how you feel.
Communicating with Your Partner
An intimate relationship doesn't have to include sexual intercourse. You and your partner may want to set aside more time to spend together, to communicate openly and to enjoy other ways to experience physical closeness - touching, kissing, cuddling, holding hands, giving each other a massage or taking a walk together.
Discussing experiences, feelings and concerns with your partner - giving each other the chance to talk and listen - may be an important part of maintaining or improving your quality of life. Your partner may have his or her own concerns, such as being afraid of hurting you during sex, feeling guilty or selfish for wanting to be intimate with you or not knowing how to talk about his or her feelings. You may want to talk about seeking help from a professional, such as a couples counselor.
If sexual intercourse is important to you, but one or both partners are having difficulties with sexual desire or performance, consult with your doctor to rule out any physiological problems. A sex therapist can assist in solving certain difficulties. The American Association of Sexuality Educators, Counselors and Therapists can help you find a therapist or you can ask your doctor for a referral.
Suggestions for Coping with Cancer and Intimacy
- Write love notes or simple messages in an email to remind your partner how much you love and appreciate him or her.
- If needed, take medication for pain or nausea 30 to 60 minutes before intimacy. Some drugs for nausea and pain may interfere with sexual performance. Ask your oncology team about side effects, and, if needed, possible alternatives or dosing options.
- Talk with your oncology team about using lubricants or other aids to make intercourse more comfortable. Some treatments may cause vaginal dryness.
- Take a warm shower or bath to help relax your body.
- Take a nap before intercourse to help you feel less tired.
- Set the mood: Light candles and play music.
- Take your time - appreciate and enjoy each other and the gift of being able to be fully open and intimate with one another.
- Talk with your partner about what each of you wants and how each of you feels to help you understand each other better. You may not be interested in sex but still feel obligated. You may want to speak with an oncology social worker or counselor, either by yourself or as a couple.
If you're in a new relationship or planning to start dating, you may wonder how to tell someone that you have cancer. Before you begin dating, consider any physical changes, or changes in the way you perceive yourself, both positive and negative, since your cancer diagnosis. If you're uncomfortable with any changes, spend time reconnecting to your body and finding things about yourself that you appreciate.
One way to feel comfortable telling your story is to role-play with a friend. Act as though you were on a date and wanted to disclose your cancer story. It may also help to:
- Share your story at your own pace - there's no right or wrong time to tell. However, you should probably discuss your diagnosis before there's a close emotional attachment. If the other person is uncomfortable about you being a survivor, there will be less heartache or conflict.
- Take advantage of survivorship conferences and camps to connect with other survivors and hear their stories.
- Be positive and find laughter in your life.
- Tell s friend about your worries or fears so you have someone to encourage you.
- Talk to a social worker or counselor about your concerns.