Your sexual response

Sometimes unhelpful thoughts about body image, or fear of pain or rejection, can lead you to avoid intimacy and sex. While this may feel easier in the short term, it is not a helpful long-term strategy. Addressing and overcoming the issues could allow you to enjoy sex and intimacy again.

Often, the longer you’ve not been sexually active, the less intense your sexual response becomes. After cancer treatment, you may notice that your sexual desire or response has changed. To help revive your response, you can begin sexual activity even if your desire is low or you’re not aroused. You still may not reach orgasm, but you may feel pleasure and sexual satisfaction.

Most people experience four stages of sexual response. However, you can have a satisfying sexual experience without going through all four stages – many people enjoy the intimacy of sex with or without orgasm.

• Stage 1: arousal – You may become aroused by seeing someone you like; having a sexual thought or fantasy; having your genitals or other areas touched, kissed or stroked; or starting to masturbate.
• Stage 2: plateau – This is a stage of more intense excitement. The plateau stage often leads to an orgasm, but this doesn’t always happen.
• Stage 3: orgasm – The peak or climax of sexual response. The muscles in the genital area contract in rhythm, sending waves of pleasurable feelings through the body. In men, semen is pushed through the urethra and out of the penis (ejaculation). Female orgasms involve intense sensitivity of the clitoris and vaginal expansion. Some women also experience a small ejaculation.
• Stage 4: resolution – Body functions slowly return to normal. Some women can quickly return to the orgasm phase and have multiple orgasms, although many women feel satisfied after one orgasm. Men usually cannot be aroused again for a while.

Areas of the body that are highly sensitive to stimulation are known as erogenous zones. The clitoris in women and the penis, scrotum and anus in men are especially sensitive, but erogenous zones are located all over the body. Other pleasurable zones often include:

• the breasts and nipples in women
• the chest and nipples in men
• the mouth, ears, neck and inner thighs in both men and women.

If you need to change how you have sex, you may discover new pleasures by exploring all of the body’s erogenous zones.

Hormones are substances that affect how your body works. They act as messengers carrying information and instructions from one group of cells to another. Hormones control many of the body’s functions, including growth, development and reproduction.

Male sex hormones

The major male sex hormone is testosterone, which is produced mostly in the testicles and also in the adrenal glands (found on top of the kidneys). Testosterone causes a man’s reproductive organs to develop and is responsible for other sexual characteristics, such as a deep voice and facial hair. Cancer treatments that lower a man’s hormone levels, such as testosterone-blocking drugs for prostate cancer, can affect his ability to get or keep an erection and reduce his desire for sex.

Female sex hormones

The major female sex hormones are oestrogen and progesterone. Oestrogen keeps the vagina moist and supple, while progesterone controls reproduction. Both these hormones are produced mostly in the ovaries until menopause, when the ovaries cease releasing eggs and periods stop. A small amount is made in the adrenal glands (found on top of the kidneys) before and after menopause. Some cancer treatments can affect women’s hormone levels in the short and long term, sometimes causing early menopause or menopause-like symptoms.

In women, the ovaries and adrenal glands also make small amounts of the male sex hormones (androgens). Androgen levels seem to be linked with a woman’s sexual desire. They decrease during and after chemotherapy and can drop abruptly if the ovaries are removed.

A man’s external sex organs (genitals) are the penis and scrotum:

• penis – the main male sex organ. It has three parts: the root, where the penis joins the abdomen; the shaft, the length of the penis; and the glans, the cone-shaped end. The glans is covered by a loose layer of skin called the foreskin, unless the foreskin has been removed by circumcision. The ridge on the underside of the glans, called the frenulum, is usually the most sensitive part of the penis. At the tip of the glans is a slit opening to the urethra, through which semen and urine pass
• scrotum – a loose pouch of skin at the base of the penis that holds the testicles. It acts as a ‘climate-control system’ for the testicles, keeping them slightly cooler than the rest of the body to allow for normal sperm development.

There are several other parts in a man’s reproductive system:

• testicles (also called testes) – two egg-shaped glands held in the scrotum. They make and store sperm and produce the male sex hormone, testosterone.
• epididymes – coiled tubes on the outer surface of the testicles. The immature sperm travel from each testicle to the epididymes, where they mature
• prostate – a small gland about the size of a walnut that sits below the bladder, deep in the pelvis. It surrounds the urethra, which carries urine from the bladder. The prostate produces fluids that form part of the semen
• seminal vesicles – glands that lie very close to the prostate and produce secretions that form part of the semen
• vas deferens – the tubes joining the testicles and the penis.

A woman’s external sex organs (genitals) are collectively referred to as the vulva:

• clitoris – the main sexual pleasure organ for women. It is located where the labia minora join. The clitoris is made up of highly sensitive erectile tissue and becomes erect during arousal
• mons pubis – the area of fatty tissue covered with pubic hair
• labia majora – the outer lips of the vulva
• labia minora – the inner lips of the vulva
• Bartholin glands – two small glands near the opening of the vagina. They produce mucus to lubricate the vagina.

Beneath the clitoris is the urethra, for passing urine. Further back is the entrance to the vagina. Beyond that is an area of skin called the perineum, and beyond that is the anus.

Several parts of a woman’s reproductive system are inside her body:

• vagina (birth canal) – a muscular sheath or canal that extends from the neck of the uterus (cervix) to the vulva
• uterus (womb) – a hollow muscular organ where a fertilised egg (ovum) is nourished to form a baby
• cervix – the neck of the uterus
• fallopian tubes – two long, thin tubes that extend from the uterus and open near the ovaries. These tubes carry sperm to the eggs, and carry the eggs from the ovaries to the uterus
• ovaries – two small glands found on either side of the uterus, near the end of the fallopian tubes. The ovaries contain eggs and produce the female sex hormone, oestrogen and progesterone, as well as small amounts of male sex hormones (androgens).