A cancer diagnosis has the potential to throw your entire life into disarray, impacting both your physical and mental wellbeing. At SurvivorNet, we believe treating the whole person is imperative, so we've teamed up with Dr. Marianna Strongin to leverage her expertise as a licensed clinical psychologist. Dr. Strongin will answer SurvivorNet reader questions on topics ranging from navigating a partner’s mourning to learning ways to improve sleep and everything in between. (You can submit your questions here.)
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It’s important to differentiate between issues with desire versus functionality. In your case, the desire is still very much there but as far as performance, it will be most important to redefine your meaning of sex and become flexible and open to new sexual experiences. Sex doesn’t have to be the same way you have defined sex. Kissing, touching, oral sex and manual sex are other forms of pleasure. Rather than focusing on what you no longer can do, it will be important to develop a flexible mindset and focus on all the ways to experience and provide pleasure. Again, open communication will be essential as you both communicate your desires while also holding space for frustrations.
In one of the larger pilot intervention studies using 84 men with prostate cancer with erectile dysfunction, they found that education on communication strategies as well as sensate focus practice can enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma (Canada AL, et al.) Sensate focus is a practice technique, developed by Dr. William H. Masters and Virginia E. Johnson, which consists of a series of touching exercises that a couple completes in a sequence. This can be particularly effective in your case because this exercise aims for partners to let go of their expectations and judgments of mutual touching, and instead focus solely on the sensory aspects of touch like temperature, texture, and pressure. Sensate focus allows couples to relax and be mindful of the sensual touching experience, without being weighed down by preconceived ideas of what "should" happen. This mindful touching can become an integral component of your new sexual experience and turn this challenge into a gateway of even stronger intimacy.
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I am 31 years old, and I have stage 3 breast cancer. I am about to finish my last round of treatment. My friends keep saying that I must be so excited to go back to my "normal life…" but I'm not returning to my pre-cancer life. That's impossible. The biggest shift I've seen is that I no longer am intimate with my partner and that makes me feel not whole. I'm on new medication where my sex drive is next to nonexistent, and I fear it will hurt our relationship in the long run.
Dr. Strongin: Cancer and its impact on sexuality is such an important topic, and I applaud you for having the courage to look at this part of your well-being with motivation to evolve and begin to restore. Being diagnosed with and treated for cancer affects sexuality and intimacy physically, emotionally, and even interpersonally.
From the physical perspective, we have to acknowledge that the treatment and subsequent medication can diminish and impact your libido (sexual desire) in more ways than one. Lower estrogen, progesterone, or testosterone levels brought on by your breast cancer treatment can diminish libido and also make sexual intercourse less pleasurable and often painful. It sounds like your libido has withstood a major change which essentially turns your mind away from sexual thoughts and feelings. Therefore it will be important to create arousal more purposely in order to stimulate your mind with more sexual thoughts, ideas, and fantasies. I encourage doing this both alone and with your partner. In addition, I recommend speaking with your oncologist about medications and lubricants that may increase libido and also reduce pain during intercourse.
Emotionally, a cancer diagnosis can affect sexuality through related stress, anxiety, or depression, and body image changes. You are absolutely right, there is no going back to “normal life,” which is often what causes the grief for our old self. In order to begin accepting our reality, it is important that you spend time and space with your feelings. Rather than pressuring yourself to restore sexuality in your relationship, it is essential that you take time for yourself, allowing your mind and body to begin communicating again and trusting one another. When someone is diagnosed with cancer there is an inherent mind/body breakdown. In your case, your relationship with parts of your body may feel disconnected and therefore contribute to a lack of libido. In order to become vulnerable and intimate with your partner, your body must feel safe and accepted again and for this reason, the emotional side of healing is essential.
Interpersonally, cancer has a way of radically shifting roles in relationships from ones that tend to be more equal to a patient/caregiver role, which at times can threaten the established sexual roles that were previously developed. The Intimacy Enhancing Couples Therapy Model teaches us that we must shift the focus from coping as an individual to coping as a couple. This removes blame and responsibility from the sexual relationship and instead uses the “us” frame to address sexual difficulties. As a result, couples can begin communicating and working together to address their feelings, dissatisfactions, and even fears. Eventually, the couple can together decide on the timing of their sexual encounters and take the first steps together.
As you begin to slowly heal and reconnect with your body, sexuality will also begin to revive itself. Most important is to give yourself space and kindness so that the layers (physical, emotional, and interpersonal) of our sexual health have time to heal.
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