A diagnosis of cancer can add a complex new dimension to the sexual side of human relationships. From the emotional impact of diagnosis to the side effects of treatment, cancer affects sex in a myriad ways. According to the National Cancer Institute (NCI), there are a number of sexuality issues that concern cancer patients:
- Infertility resulting from treatment
- Erectile dysfunction
- Pain during penetration
- Body image
- Early menopause
- Depression and anxiety
- Loss of interest in sex
“At least half of [cancer] patients have some kind of sexual problem,” she says. “They don't tend to go away unless people do something about it.”
Certain cancers, such as prostate, breast, bladder and colorectal, are more often accompanied by sexual problems, and many treatments present their own difficulties — radiation, for example, can damage tissue in sensitive parts of the body.
“With women, radiation in the pelvic region can destroy ovarian function and result in scar tissue,” says Schover. “In men, radiation can be destructive, especially for prostate cancer.”
Couples and Cancer
Married couples whose relationship is strong can usually weather the storms of cancer diagnosis and treatment, notes Schover, who is also the author of Sexuality and Fertility after Cancer. “There is no evidence that there's an increase in the divorce rate after cancer,” she says. “A lot of couples say that the cancer experience made them feel closer.”
Young, single cancer patients, however, face the challenge of finding a partner and planning a family while confronting the after-effects of illness, including battered body image, infertility and mood disorders. In fact, research has shown that anxiety and depression are more common among young adults and unmarried patients. "Anyone who has cancer at a younger age is much more distressed about it,” Schover says.
Gays and lesbians may face discrimination from health care providers. "It's important to remember that not everyone with cancer is heterosexual, and gay people with cancer may have to face rude and insensitive [professional] treatment,” Schover says. “They need to be strong and get support from friends and family.”
And sexual minorities aren’t alone; a 2007 study in Australia found that patients sought information on sexual intimacy but were often frustrated by health professionals’ focus on survival, with less regard for patients' personal relationships or quality of life.
Experts recommend cancer patients seek professional treatment for sexual issues, either with a psychologist or a sex therapist. “What's really needed is an approach offering both counseling and medical treatment,” says Schover, who adds that some patients may avoid getting the help they need due to the stigma that surrounds sexual counseling.
There are a number of medical advances available for patients whose sex lives may be suffering as a result of cancer. Medication, surgery and devices, such as penile implants, can help with erectile dysfunction; hormones, lubricants and vaginal dilators can ease painful intercourse. Many young cancer patients today are preserving their fertility by freezing sperm and, in a newer, still-experimental process, even their eggs.
Patients in a relationship are encouraged to talk with their partner about issues that arise, either with or without a therapist. The NCI recommends couples discuss their concerns and their feelings about the current state of their sex life, and work together to find ways to feel better about sexual activity.
Single cancer patients need to decide when, or if, to tell someone they’re dating about their cancer status. Most experts advise waiting; get to know the person before discussing sensitive issues, such as cancer and sexuality.
In addition to recommending dating sites, such as CancerMatch.com and Prescription4Love.com, Schover also offers the following counsel for those in the dating pool: “Remember that anyone who would reject you because you are a cancer survivor probably isn't someone you'd want to spend a lifetime with. It separates the sheep from the goats.”
Leslie R. Schover, M.D. Anderson Cancer Center. Telephone interview, 8 Aug 2008.
"Facing Forward: Life After Cancer Treatment." 01 Nov 2006. Cancer.gov. National Cancer Institute. 6 Aug 2008 <http://www.cancer.gov/cancertopics/life-after-treatment/page5>.
Hordern, Amanda J., and Annette F. Street "Communicating About Patient Sexuality and Intimacy After Cancer: Mismatched Expectations and Unmet Needs." Medical Journal of Australia. 186 (2007): 224-227.
Noyes R. Jr., R.G. Kathol, P. Debelius-Enemark, J. Williams, A. Mutgi, M.T. Suelzer, and G.H. Clamon. "Distress Associated with Cancer as Measured by the Illness Distress Scale." Psychosomatics. 31:3(1990): 321-30. <http://psy.psychiatryonline.org/cgi/reprint/31/3/321>.