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What No One Tells You About Cancer & Sexual Relationships

by Dr. Beth Boatman, PhD

Cancer and its treatments can not only have some major impacts on your sexual health, but it can also have a big impact on the way your sexual relationships function. Your providers may have gone over how cancer and its treatment can have an impact on things like sexual desire, arousal, orgasms, fertility, and even some genital changes. They may have even discussed how menopausal symptoms can have an impact on your quality of life. But unfortunately, many providers do not have the time and skills necessary to take a deep dive into how your relationship can be affected. Here are a few things that no one tells you about cancer and sexual relationships.

The caregiver/patient dynamic

Your partner becoming your caregiver may have been a necessary part of recovery during treatment. Maybe they took you to appointments, made sure you stayed hydrated, or maybe they even cleaned up your puke or other bodily fluids. Having this type of support when you feel like your being poisoned is incredibly helpful, and may have given you a whole new perspective on your relationship. What nobody tells you about this dynamic is that it can be detrimental to sex and intimacy. The adjustment in moving from caregiver/patient back to equal able partners can be a bit rocky. A 2010 study discussed that partner caregivers reported putting their own intimate needs to the side when they were in the caregiver role, and were less likely to ask for and initiate physical intimacy. When someone depends upon you for basic needs it can be hard to think about being sexual. Think about it... If you are helping someone clean and empty their Jackson-Pratt drain after breast surgery it can be hard to want, initiate, and ask for physical affection. Even if you still have the desire for physical connection, you can feel guilty about starting the conversation because you don’t know what type of affection is on or off the table. Both you and your partner can find it challenging to navigate and keep up with the ever changing set of norms that emerge for what type of physical intimacy is “acceptable” or even possible at different stages of your journey.

Isolation and emotional distance

Having cancer can be isolating enough, and when intercourse stops other forms of affection can also go out the window. I had a client once say, “I don’t want to start something that I can’t stop.” She was explaining that she was afraid to initiate and accept any type of physical affection out of fear that it would lead to sexual intercourse. This fear is common for many people who have experienced pain or discomfort with intercourse. When sex and physical intimacy suffer, then the relationship can suffer which can lead to feelings of isolation and emotional distance for both partners. One way to begin to move forward is having open honest conversations with your spouse about your needs, wants, and boundaries. Couples who are able to openly renegotiate sex after cancer can find new ways to meet both partners needs without crossing personal boundaries or causing pain. Don’t get caught up in the common cultural stereotype that penis-in-the-vagina sex is the only way to erotically connect with your partner. There are so many other ways that you and your partner can connect. You may have to get creative and make a new mutual definition of what “sex” means for your relationship. Friendly reminder: You NEVER have to “take one for the team”, “push through the pain”, or “bear through it until he finishes.” Sex is for you too!! Not just for your partner. You should be able to stop and say “no” at any point during sex, and then communicate and renegotiate in the moment what works best for both of you.

Talking about sex can feel like hitting a wall

Haven’t you heard! “You should communicate! Healthy communication can help you get your needs met! Just start having the conversation! Talk about your sexual needs, wants, and boundaries!” All of this is good and well, but what if you don’t know what feels good anymore? What if you are scared of disappointing your partner or leading them on? What if talking about it also means facing the fact that you are grieving the loss of the way you used to be able to physically connect with your partner? I could go on and on. There is a lot of fears in talking about sex, and they are often carefully disguised as “what ifs.” Let me just first say, it’s ok to be scared. Seriously. Talking about sex and intimacy is a vulnerable thing for many people, not just cancer survivors. So breathe, try to let go of any self judgement about the fear, and tell yourself it’s okay to feel the way you are feeling. I once had a client say to me, “I should be able to do this! I just survived cancer for God’s sake! Why can’t I talk about sex with my own husband?” She was definitely not alone, and you are not alone. If you are getting stuck and having trouble communicating with you partner, I would suggest seeing a licensed sex and relationship therapist. They can be helpful in guiding you through these difficult conversations.

It can actually bring you closer as a couple

I don’t want it to seem like everything about the cancer journey is bad. Don’t get me wrong, a lot of it absolutely sucks. Both you and your partner are put through the ringer when you walk the cancer walk. However, sometimes major life crises can put things into perspective and help you focus on priorities like your relationship, family, or your health. Coming out on the other end of what seems like a dark medical health tunnel can bring a sense of appreciation and gratitude for people who showed up or just held emotional space for you when you needed it the most.

Beth Boatman is a licensed marriage and family therapist and AASECT certified sexuality educator. Beth graduated with her PhD in Family Therapy at Texas Woman's University and specializes in sexuality education and counseling/psychotherapy for individuals and couples facing issues related to sexual dysfunction, intimacy issues, chronic illness, and medical family therapy.