Your Sexual Health and Cancer: What to Know, What to Do

March 16, 2017
Sage Bolte, PhD, LCSW, OSW-C, CST

Sage Bolte, PhD, LCSW, OSW-C, CST, is the Executive Director of Life with Cancer, which is a program of the Inova Schar Cancer Institute, a licensed clinical social worker, and a certified sex therapist. A nationally known expert on sexual health, she educates health care providers on the importance of assessing and addressing the sexual health needs of cancer survivors. Follow her on Twitter: @boltes and @lifewithcancer.

Embarrassed to ask your doctor about ways to improve your sexual function? share on twitter Don’t be. Many patients experience some form of sexual problem at some point after a cancer diagnosis. In fact, studies show that “altered sexuality” is a top concern of cancer survivors. And with survivors living longer, relationship issues are becoming that much more important.

Changes in sexuality can negatively affect your quality of life and that of your intimate partner. It can also persist for years after treatment ends. Sexual problems can be caused by common cancer treatment side effects, such as fatigue, nausea, pain, and hormone changes, as well as by an altered self-image of the body and emotional distress, including depression and anxiety.

Common sexual challenges and changes include:

Men

  • Erectile disorder
  • Changes in desire/interest
  • Changes in orgasmic intensity
  • Body image changes

Women

  • Changes in desire/interest
  • Effects of early menopause, such as vulvovaginal dryness, hot flashes, and painful intercourse
  • Vulvovaginal health, including vulvovaginal dryness and pain
  • Changes in sexual sensitivity, such as nipple sensitivity
  • Changes in orgasmic intensity
  • Body image changes

Why you may need to talk about sex before your doctor does

The sexual health of a person diagnosed with cancer can be overshadowed by the cancer and its treatment. As a survivor, it is important to ask for information and support related to your sexual health if problems appear.

It’s also important to know that sexual health and the “sexual self” are often confused with only intercourse or other sexual practices. But the sexual self is so much more. It include one’s body image or how we think and feel about ourselves as sexual beings, along with intimacy and the way we connect to people.

In other words, your sexual health matters — a lot.

Remember, you have the right to the best possible quality of life, which includes your sexual function and health.

How to have “the talk” with your doctor

It’s common for survivors to be anxious about bringing up sexual health concerns with their medical team. You may be concerned about embarrassing your health care provider or think that he or she won’t have solutions. Whether you are single or partnered, it’s important that you talk about sexual changes that are concerning to you and your partner. 

This conversation may require a little planning, so consider writing out your concerns ahead of time. One option to do this is using the “Fact, Feeling, Belief, and Question” formula. Here’s an example:

“I noticed that I have increased discomfort with intercourse (fact), and I’m upset about it (feeling). I believe it’s because of the treatments I was on (belief). Are there any tests that can be done or professionals I can talk to about how to improve this? (action)?”

You can have a close friend or partner review your questions to make sure that you’ve clearly identified your concerns.

Still feeling uncomfortable? Write down your question and hand them to your health care provider or email or fax them to him or her before your next appointment. You can also bring someone with you to your appointment to help you address your concerns. If you’re not at ease talking with your doctor about this topic, ask to meet with another member of the health care team member—maybe the nurse or social worker— with whom you feel more comfortable. 

Your health care team cares about you and your quality of life. Even if its members aren’t trained in the area of sexual health and recovery, they can refer you to health professionals who are.

What you can do right now

  • Schedule an assessment. Ask a health care professional to explore potential causes and treatments for changes in your sexual health and function.

  • Plan ahead. Appropriate timing of sex or intimacy may increase enjoyment. Plan for the times when you have the least fatigue or feel at your best. This may take creative planning for times that you would not normally carve out for connecting to yourself or with your partner or partners.

  • Communicate your needs. Ask for what you want and need. Your partner and health care providers may not be aware of changes you’ve experienced and what your needs are now.

  • Surround yourself with supportive people. Spend time with individuals who bring positive energy into your life and who are encouraging and accepting. Reevaluate relationships that don’t do this and may be toxic. 

  • Keep trying. Relationships take work from all involved parties. Having patience and a sense of humor are required.

  • Take it easy. Rest during sex if you need to; it’s not a marathon.

  • Be creative. Remember, sex isn’t the only form of intimacy. Skin is the largest sex organ and the brain is the most important sex organ—the possibilities are limitless!