Is it normal for couples to put less emphasis on their sexual relationship while undergoing surgery, chemotherapy, and/or radiation?
Research suggests that during treatment for breast cancer it is very common for couples to de-emphasize their sexual relationship and prioritise “making it through the fatigue, nausea, and surgical recuperation.” Women and their partners may have fearful thoughts of loss and even death during this time, and mental health challenges such as depression, anxiety, and difficulty coping can impact simple activities of daily living.
Weeks, months, and sometimes years after the acute phase of the cancer experience has passed (when “life is getting back to normal”), the subject of a return to sexual intimacy may arise. You may not feel sexual but may want to cuddle or be held. You may only want to kiss, but other forms of sexual activity are not in your mind. Discuss your concerns with your lover or partner.
What if I am having trouble reestablishing a sexual relationship with my partner after treatment is over?
After a prolonged period of supportive but relatively platonic interaction, either or both members of the couple may find it very awkward to talk about and/or initiate sexual activity. The longer the couple struggles with this awkwardness, the longer it can be before intimacy returns. Many couples find it difficult to restart sexual activity and thus consult with their healthcare provider or a sexual specialist for assistance. The boundaries of what will feel good and what may be uncomfortable can no longer be assumed.
A sexual specialist can help a woman living with breast cancer and her sexual partner identify and address aspects of their sexual life (many that they have never had to overtly address during their entire relationship) and make suggestions about having a sexual dialogue, as well as about which lubricants, moisturizers, prescription medications, foreplay techniques, and sexual positions are best. This is often a wonderful time that promotes a sexual growth experience.
What “self-help” techniques allow women get their desire back?
It is normal for many women to “never feel in the mood spontaneously.” Most women who are dealing with a health issue report that they need to “psyche themselves up” to be physically intimate. There are many ways of augmenting desire.
Some specific strategies include reading erotic stories, watching sexy films, using vibrators or stimulators to self-pleasure, and fantasising about erotically charged times in the past. When women use these techniques, they are helping to enhance something known as reactive desire, which is the type of motivation for sex that happens when a woman says “yes” to a sexual invitation from a partner (even if she initially feels no initial interest or motivation for physical contact). After the sexual activity begins, however, she may begin to feel increasingly aroused and invested in the intimate activity. She may seek sexual closeness for a variety of reasons, not only sexual hunger or innate desire but often because of the urge to be close with her partner.
Many women report that “it’s only after things get going for a while that I start to think sexual thoughts. I start thinking that physical closeness is a good idea . . . I begin to enjoy the sensations and want them to continue.”
Reactive desire is facilitated most when a woman stays focused in the moment during intimacy and doesn’t let her mind wander to household, childrearing, or work issues. The renowned sex therapist team of Dr Barry McCarthy and his wife, Emily McCarthy, has suggested the following guidelines for revitalising sexual desire:
The keys to sexual desire are positive
• Anticipation and feeling that you deserve sexual pleasure.
• Each person is responsible for his or her desire with the couple functioning as an intimate team to nurture and enhance desire. Revitalising sexual desire is a couple function; guilt and blame subvert the change process.
• Inhibited desire is the most common sexual dysfunction, affecting one in three couples. Desire problems drain intimacy and good feelings from the relationship.
• The initial romantic love/passionate sex pattern of desire lasts less than 2 years and often less than 6 months. Desire is facilitated by an intimate, interactive sexual relationship.
• The essence of sexuality is giving and receiving pleasure-oriented touching. The prescription to revitalise and maintain sexual desire is intimacy, pleasuring, and eroticism.
• Inside and outside the bedroom. Touching does not always have to lead to intercourse.
• Couples who maintain a healthy sexual relationship use touching in many ways. One is affectionate touch (holding hands, kissing, hugging). Another is nongenital, sensual touch, which can be clothed, semi-clothed, or nude (body massage, cuddling on the couch, showering together, touching going to sleep or on awakening). Another is playful touching, which intermixes genital and nongenital touching- this can be in bed, dancing, or on the couch clothed or unclothed. Another is erotic touching (manual, oral, or rubbing) to high arousal and orgasm for one or both partners. The last form integrates pleasurable and erotic touch, which flows into intercourse.
• Both partners should value affectionate, sensual, playful, erotic, and intercourse experiences.
• Both partners should be comfortable initiating touching and intercourse. Both should feel free to say no and suggest an alternative way connect and share pleasure.
How do I know when it’s time to consult a professional?
Sometimes couples feel ill-prepared to address an interpersonal problem with which they have had no past experience and feel that it is too big to tackle on their own. Redefining what constitutes satisfying sex after cancer can be one such task. If this is the case, you are not alone; many couples benefit from a short course of sex therapy. Sexual health and vitality is a right for anyone regardless of disease or status of the chronic medical condition. Seek a professional if you and your partner have tried resuming your previous ways of being sexual with one another (verbally and nonverbally) and something is not working or not as you had assumed it would. Perhaps your partner is fearful of hurting you and is looking for clues (rather than asking) about what feels good and what doesn’t. Perhaps you are both struggling with the change in the appearance of the body or sensitivity of your breasts or genitals. All of these are very common themes among couples who may need assistance from a sexual healthcare provider.
What is sex therapy?
A certified sex therapist sometimes referred to as a behavioural sexologist, is an individual with advanced training in the psychosexual and behavioural management of sexual concerns that may stem from a myriad of circumstances, including cancer treatment and survival. A sex therapist can provide sexuality education, individual and couples counselling and support, instruction, and direction in specific techniques for symptom management. A treatment course of sex therapy is usually brief and goal directed as well as highly effective. Certified sexual therapists often work in close collaboration with the medical healthcare team and will (with your consent) discuss your case with the other specialists. Sex therapists are particularly valuable if you have concerns related to body image and sexual self-esteem, couples communication, a lack of sexual desire, or sexual pain.
How do I communicate to my partner about what has changed in my body?
Begin by starting the dialogue with comments such as, “I am really looking forward to being intimate with you again, but I am a little nervous about the differences in my body.”
A woman can actually anticipate and address her partner’s questions and concerns. Being honest about sexual fears is the first step in conquering them. Research confirms that partners want to discuss sexuality and intimate concerns but may feel that they don’t know the right words or appropriate timing. People want to share their concerns but are not sure when to do so. They will likely have no problem modifying their styles to maximise pleasure and minimise discomfort, but they may not be able to anticipate the specific ways that will be helpful for their spouse. By making specific suggestions, you can communicate your individual needs and move toward sexual wellness. Examples of specific comments include “
For now, please avoid touching • My incision site because it is very sensitive.”
• “Don’t be afraid to touch my breasts. There is no pain, and I really enjoy that closeness.”
• “I need to take some time before we make love to put on some special lubricant because my hormones have changed and I don’t get as wet as I used to.”
• “I want you inside of me but I can only handle about 5 minutes of intercourse before I start to feel sore.
We might have to stop and finish another way. Is that okay?”
Honest communication about sexual changes decreases misunderstandings and helps you and your partner work together.
Term:
Reactive Desire – Desire that is triggered by external stimuli rather than occurring spontaneously.
After a prolonged period of supportive but relatively platonic interaction, either or both members of the couple may find it very awkward to talk about and/or initiate sexual activity.
