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Sex and Intimacy After Cancer

BY LACEY MEYER
PUBLISHED SUNDAY, JUNE 6, 2010
In 2005, chemotherapy for stage 2B breast cancer threw Cathy Nilon into menopause at 43. Nilon’s menstrual cycle stopped during chemo, and because her cancer was estrogen receptor-positive, she chose to have a complete hysterectomy in which her uterus, cervix, and ovaries were removed.

Nilon, a children’s book illustrator in Seattle, still struggles with the resulting sexual dysfunction, including low libido and severe vaginal dryness. She didn’t ask for help until a year after treatment ended. “I wanted to take it slow, and my husband was very patient with me,” she says. “I kind of was just leveling out to try to see how life was going to be without hormones, without estrogen, without my ovaries.”

Sexual dysfunction following cancer treatment can be both physical and psychological. Hormonal therapy, chemotherapy, and surgery or radiation in the pelvic area can be a physical cause of erectile dysfunction for men and vaginal dryness and pain for women. Negative body image, performance anxiety, and depression can also lead to or worsen sexual dysfunction.

“Lots of times it’s a combination where there’s some real physical element to what’s happening, but then very quickly it’s exacerbated by a performance anxiety, shame, embarrassment,” says Sharon Bober, PhD, director of the Sexual Health Program at Dana-Farber Cancer Institute in Boston.

Studies suggest anywhere from 40 percent to 100 percent of cancer survivors—most of the research has been done in women with breast or gynecologic cancers and men with prostate cancer—experience sexual dysfunction, but it is seldom brought up by health care professionals. 

Low libido, or loss of desire for sex, may be a direct side effect of cancer treatment or supportive care drugs, such as opioids for pain or antidepressants. But loss of libido may also result from anxiety and frustration.

“I like to think of libido as a recipe with many ingredients,” Bober says. She emphasizes figuring out the “ingredients” and then working from there. She says that pain or fatigue is often the first thing that leads to not feeling “in the mood.” Feelings of guilt and worries about a partner’s needs and satisfaction become the elephant in the room, she says. “Nobody wants to talk about it. It becomes a self-propelling problem, in that, the longer time goes by, people then also become kind of less connected with that part of themselves,” Bober says.

Bober suggests survivors take baby steps to get used to being touched again such as solo touching, massage, or taking a bath with their partner. This can lead to partners exploring each others’ bodies together to determine what feels good as they indulge in fantasy or other mutually stimulating activities.

Barbara Rabinowitz, PhD, LCSW, RN, a certified sex therapist practicing in Southport, North Carolina, and founder of the National Consortium of Breast Centers, suggests survivors and their partners read together about sexual recovery. “It may help them feel more comfortable talking with each other. It may also give them some ideas about some things they want to try out together.”

Rabbi Ed Weinsberg suffered low libido and erectile dysfunction for nine months after hormonal therapy with Lupron (leuprolide) followed by a radical prostatectomy for prostate cancer in 2007. But after two years of a low PSA score, his doctor decided it was safe to prescribe a synthetic testosterone replacement that Weinsberg says did “wonders” for him.

‘‘Nobody wants to talk about it. It becomes a self-propelling problem, in that, the longer time goes by, people then also become kind of less connected with that part of themselves.’’

“I’ve been on it for close to a year and it’s made a difference not only in raising libido but in eliminating body flab and loss of energy, which happens when your testosterone drops,” he says. But hormone levels are unique to each person and may only be part of the issue, which is why a psychological assessment is recommended before hormone treatment.

Weinsberg also advocates “faith and fitness” to improve sexual function, suggesting that survivors not only need faith that the side effects may not be permanent but also personal resilience and ability to adapt. He adds that exercise promotes blood circulation, including in the genitals, and produces endorphins, which may help with mood and depression.

In addition to low libido, women may also experience vaginal dryness and pain. Eliminating estrogen leads to decreased vaginal lubrication and vaginal atrophy, resulting in dryness, pain, and possible vaginal tearing during sex. Vaginal moisturizers applied two to three times a week plus the use of non-medicated lubricants during sex may help. Rabinowitz recommends a woman’s partner apply the lubricant and that they incorporate it as a part of their love-making.

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