Resuming sexual activity

It is important to feel that your sexuality is respected when discussing how treatment will affect you. Recognition and validation of your sexuality is a crucial part of receiving support. Your clinical team should openly discuss your sexual needs and support you throughout treatment.

Try to find a doctor, nurse or counsellor who helps you feel at ease discussing sexual issues and relationships. You could also visit QLife, a national counselling and referral service for people who are lesbian, gay, bisexual, trans and/or intersex (LGBTI).

If you have a partner, take them to your appointments. This will show your doctor who’s important to you and will enable your partner to be included in discussions and treatment plans.

During and after cancer, young people need opportunities to continue to develop and mature. This means living as normal a life as possible, which might include going on dates or having a girlfriend or boyfriend. It can feel challenging, however, if you are dealing with body-image changes or fertility issues, particularly if you haven’t had much experience of sex.

As well as talking to your treatment team and possibly seeing a sexual therapist, you could get in touch with CanTeen. Young people aged 12–24 who have been affected by cancer can contact CanTeen for counselling in person or by phone, email or instant messaging. They also run online forums and camps. 

There are a number of ways to prepare for sex during or after cancer treatment:

• Talk openly with your partner – Share any fears you have about resuming sexual activity.
• Let your partner know how you feel – Tell them when you’re ready to have sex, what level of intensity you prefer, if they should do anything differently and how they can help you to feel pleasure.
• Ask your partner how they are feeling – They may be worried about hurting you or appearing too eager.
• Take it slowly – It may be easier to start with cuddles or a sensual massage the first few times, rather than penetrative sex.
• Plan ahead – Sex may need to be less spontaneous after treatment. Choosing a particular time can help deal with pain and fatigue, and may also build arousal.
• Explore different sexual practices – Some of the sexual practices you used to enjoy may not be possible after cancer treatment. If intercourse is difficult, try oral sex, mutual masturbation, or using sex toys.
• Focus on other aspects of your relationship – Many relationships are not dependent on sex. Be mindful if this is a concern for your partner.
• Try exploring your sexuality on your own – Self-pleasuring can help you understand what’s changed and what feels good, and you can then talk about this with your partner.
• Seek assistance – Talking to your doctor or seeing a sexual therapist can help you find solutions.
• Be patient – Things often improve with time and practice.

Communication is the most important tool for adjusting to sexual changes after cancer. If you have a partner, you may need to work together to adapt your sexual activities during and after your cancer experience. If you had a good relationship before the diagnosis and found it easy to communicate your needs, the process will probably be easier. However, problems can arise due to misunderstandings, differing expectations and different ways
of adapting to changes.

Talk with your partner about your feelings, concerns and needs. Common barriers to talking about sex during and after cancer treatment include:

• embarrassment
• lack of time or privacy
• fear of rejection
• fear of contracting cancer or confusion about treatment precautions
• waiting for the other person to mention it.

It may feel awkward, but try not to let embarrassment get in the way. Make the discussion a priority. Avoiding the topic can lead to frustration and confusion, as neither of you will have your needs met. See Let’s talk about sex for some ways to start talking to your partner.

It could help to acknowledge that your relationship is changing and that it may take time to readjust. Reconnect over a meal, go for walks together or have a date night, and then try non-sexual touch like hugging, skin-to-skin contact or massage.

When you are both coping with the demands of cancer and treatment, it can be difficult to act on relationship concerns. Don’t be afraid to seek support through counselling – call Cancer Council 13 11 20 or talk to your doctor to find a counsellor in your area. Rekindle is an online resource about sexuality after cancer. It includes a guide to improving communication in stressful situations.

Many people face cancer and treatment without the support of a partner. But in time, you may wish to meet new people and possibly start a relationship. Some cancer survivors say that a new relationship helped to restore their sexual confidence. On the other hand, you may decide that you don’t want to be in a relationship, either temporarily or for the long term, because of what you’ve been through. This is also a natural reaction and it is your choice.

If you’ve had major body changes after treatment, finding a new partner can seem daunting. You may worry that you are no longer attractive. Attraction in a new relationship is always a combination of emotional and physical attraction, so the physical changes may be less important than you imagine. Even so, it is difficult to tell a new person in your life that you’ve had a breast removed, had a breast reconstruction or have a stoma. It’s natural to be worried about their reaction to seeing your body for the first time. Likewise, you may feel concerned about explaining any fertility issues, especially if you had cancer when you were young.

Take your time and have the discussion when you feel ready. It may be easier if you practise what you want to say – Let’s talk about sex offers tips for beginning conversations with current and potential partners. You might want to show the other person how your body has changed before any sexual activity so that you can both get used to how that makes you feel.

You know you have to talk about it, but it’s hard to find the right words. Even if these suggestions don’t fit your situation, they might give you a starting point. 

Talking to your partner

• “I feel like I never have any energy for sex, but I’m worried about how you’re feeling about that. Maybe we can work out a plan together.”
• “I am going to show you the way I like to be touched and the places that are sore and out of bounds.”
• “I feel ready for sex again, but I’d like to take things slowly.”
• “There are some things I would like to try to do together that will help us feel close and connected, without ‘going all the way’.”
• “I really miss our sex life. When should we talk about being physically close again?”
• “That’s the right spot, but a lighter touch would feel good.”

Talking to a new or potential partner

• “The cancer treatment changed my body in different ways. It’s hard to talk about the changes, but I want you to know about them. The treatment left me with [a stoma/erection problems/etc.].”
• “Before we get really serious, I want to let you know how cancer treatment affected my fertility. I can’t physically have/father children, but I’m willing to explore other ways of becoming a parent down the track.”
• “I really like where our relationship is going. I need you to know that I had cancer some years ago, but I’m afraid you might prefer to be with someone who hasn’t had cancer. What are your thoughts about it?”
• “I am still interested in sex, but we might have to be a little inventive.”
• “I haven’t had sex since my cancer treatment and I’m worried about how things will go. How do you feel about taking things slowly?”

If you feel unsure about yourself because of the cancer, you may also lack confidence sexually. It can be especially difficult if you are feeling unwell and tired while still coming to terms with having cancer. Things that lift your overall wellbeing, like good food, exercise and relaxation, will help to boost your sexual confidence. Call Cancer Council 13 11 20 to find out about programs to improve self-esteem and wellbeing after cancer treatment.

Sex appeal is sometimes judged by physical characteristics, but for most people, sexual attraction is based on a combination of looks and other personal attributes, such as personality and sense of humour. It may help to express how you feel with your partner, a trusted friend or family member, or a doctor or counsellor.

It is easy to become distracted during sex, particularly if you are feeling anxious about the sex or preoccupied with other worries. If this happens to you, try talking to your partner about why you’re distracted. Without this communication, your partner might misinterpret your distraction as a lack of interest in them and feel that the sex lacks intimacy.

Mindfulness and relaxation techniques can help you stay in the moment with your partner. Your treatment centre may run a program where you can learn such techniques, or may be able to direct you to organisations that run these programs. You can also call Cancer Council 13 11 20 to ask about mindful meditation and relaxation resources that may help.

Self-pleasuring (masturbation) can be a positive and satisfying way to enjoy sexual activity when you don’t have a partner or if you’re not ready for intimacy with a partner. It can help you find out what your body is capable of sexually. Many couples enjoy mutual masturbation as an alternative to penetrative sex. You can masturbate with your hand or with a vibrator.

If you have had treatment in your breast or genital region, it may help to spend time alone touching these areas to find out if there is soreness or numbness, what feels different and what you enjoy. This preparation may make it easier to tell your partner what feels good and what doesn’t when you are ready to be intimate.

When cancer means you have to adapt to sexual changes, it can be helpful to embrace a new definition of ‘real’ sex. For many people, arousal does not happen as easily as it once did. Your favourite sexual positions may now be uncomfortable or unsatisfying, or penetrative sex may no longer be possible.

Managing sexual changes provides suggestions for particular situations, but some general sexual strategies that might help include:

• exploring different erogenous zones, such as the breasts, ears or thighs
• mutual masturbation
• oral sex
• personal lubricant
• vibrators and other sex toys
• erotic images and stories
• sexual fantasies.

With a playful approach and open communication, many people find new ways to have a fulfilling sex life after cancer.