Sexuality, intimacy and cancer

Sexuality involves much more than just the act of sexual intercourse. It is about who you are, how you see yourself, how you express yourself sexually, and your sexual feelings for others. It can be expressed in many ways, such as by the clothes you wear, how you groom yourself, the way you move, the way you have sex and who you have sex with.

The role that sexuality plays in your life is influenced by your age, environment, health, relationships, culture and beliefs, opportunities and interests, and level of self-esteem.

Sex is often a way to experience intimacy, but intimacy is not necessarily about sex. Being intimate means being physically and emotionally close to someone else. Intimacy is about:

• loving and being loved
• demonstrating mutual care and concern
• showing you value another person and feeling valued in return.

Intimacy is also expressed in different ways:

• by talking and listening on a personal level
• by sharing a special place or a meaningful experience
• through physical affection.

Most people need some kind of physical connection to others. Even for people who are not sexually active, touch is still important.

Whether or not we have a partner, we are all sexual beings – having cancer doesn’t change that. Cancer can, however, affect your sexuality and your ability to be intimate in both physical and emotional ways. Addressing any changes and challenges early on may help you and your partner (if you have one) to have a fulfilling sex life after cancer.

Creating intimacy

A sense of closeness or togetherness takes time to develop or restore. These tips may help to encourage intimacy during and after treatment.

• Fact finding – Even if you’re in a long-term partnership, don’t assume you know what your partner is thinking and feeling.
• Time and space – Check if your partner feels ready to talk. They may need time to process the changes first.
• Communication – Spend time talking and actively listening to help maintain a sense of emotional intimacy. Pick a good time to talk, when you can give your full attention and are unlikely to be interrupted.
• Power of touch – Offer non-sexual comfort and reassurance through holding hands, hugging or massage.

Cancer and its treatment can have a range of effects on sexuality. The most obvious impacts are physical. Some types of cancer require treatment that can directly affect the physical ability to have sex or to enjoy it. More generally, many cancer treatments have side effects that may interfere with sexual pleasure.

Any type of cancer experience can also influence your body image, emotions and relationships, all of which can change how you feel about sex. Cancer diagnosis and treatment often magnify existing stresses. If there have been issues in your sexual relationship (or in your relationship more generally) prior to diagnosis, these may be intensified and it becomes all the more important to address them.

Most people who have had cancer treatment say they have faced issues with sexuality and intimacy. Some find that any change in their sexuality is temporary. Others have to adapt to long-term changes, and these may be the most difficult aspect of life after cancer. It is possible, however, for the experience to strengthen a relationship, improve communication and lead to new ways to express sexuality and intimacy.

Research shows that sexuality is a key concern for people who have cancer, even when cancer is advanced.

During the initial shock of diagnosis, sex might be the furthest thing from your mind. Sometimes treatment begins straightaway and there isn’t much opportunity for reflection.

Over time, however, you may start to have questions about the likely impact of treatments, when you can resume sexual activity, and how you can have a fulfilling sexual and intimate life after cancer.

– Pat

Discussing sexual concerns with your treatment team might be difficult for you. You may feel uncomfortable with the subject, or sense that your health professional may be uncomfortable too. Or you might think there is no point because you don’t realise that there are treatment options available. Sometimes your doctor may not be able to offer you the time needed for a sensitive and thorough discussion.

If your health professional doesn’t ask about your sexuality, it’s perfectly okay for you to bring up the subject. If you do not feel satisfied with the response, ask for a referral to someone who can more freely discuss sexual matters with you. You can also ask for a referral if you are same-sex attracted or transgender and feel that your health professional is uncomfortable talking about your sexual practices.

You can start by talking to your GP or cancer specialist about your concerns, but you may also want to see someone who has particular expertise in sexuality or more time available to explore the issues. You might choose to see a clinical psychologist or a sexual therapist.

• Psychologists – Most large public hospitals have a clinic staffed by psychologists with experience providing support and advice about sexuality and intimacy in the context of cancer. This may be called a psycho-oncology clinic. Speak to your cancer specialist about accessing these services. Additionally, you and/or your partner can discuss concerns with a private psychologist with relevant experience.
• Sexual therapists – Also known as sex therapists, sexual counsellors or sexologists, sexual therapists are usually qualified counsellors who specialise in human sexuality. Some may also be psychologists. They have been trained to help people manage sexual concerns. Ask your treatment team for advice on finding a sexual therapist. Sex therapy is not yet regulated by the government, so untrained people can call themselves sexual therapists.

  You can see a sexual therapist with a partner or on your own. You will not be asked to undress or do anything sexual in the therapist’s room. The therapist will provide practical advice and reassurance, and help you develop strategies and goals to work through any sexual issues that concern you.

If you don’t have a partner, you may feel that you can’t raise sexual issues with your treatment team. However, your sexuality is as important as anyone else’s, and your treatment team should openly discuss any concerns you have.

You may be worried about finding a new partner after cancer treatment and how you will tell a potential partner about the effects of the cancer. See Let’s talk about sex for ways to talk to current or potential partners. You can also ask for a referral to a sexual therapist if you want to build up your sexual confidence for a future relationship.

This will vary depending on the treatment you have had and how quickly you are healing – both physically and emotionally. Your doctor will tell you how long you need to wait before engaging in particular sexual practices, such as intercourse. This waiting period is for medical reasons, such as preventing injury or infection after surgery. It can be considered the minimum period – for some people, it will be much longer before they feel ready to have sex again.

Your partner cannot ‘catch’ cancer from you. After some types of treatment, such as chemotherapy and radiation therapy, your doctor may advise you to protect your partner by using barrier contraception, such as condoms, for a short time.

Sexual activity will not make the cancer worse. If you feel like having sex, the emotional benefits of an intimate physical relationship may help you cope with the demands of treatment and recovery.

Roles within relationships often change during cancer treatment. Sometimes it happens gradually almost without noticing, and sometimes it is more sudden and obvious.

It is important to recognise the changes and discuss them openly with your partner. You can develop strategies to manage sexuality and intimacy that take the changes into account. For example, regular ‘date nights’ can be scheduled, during which you revert to the role of partners and make a special effort to treat each other like people on a date.

Most people can have a fulfilling sex life after cancer, but it often takes time, and you may need to develop a new approach to sex. If you have to learn different ways to give and receive sexual pleasure, you might not get it right first go. As with any new skills, practice, patience and perseverance are the keys. Some people say that because they have to try new things, their sex lives actually end up being much better after cancer.

Click on the icon below to download a PDF booklet on Sexuality, Intimacy and Cancer.