In addition to pleasure and gratification, sex has a variety of benefits including improved mood, stronger immunity, and reduced pain.

Sexual issues are not uncommon in the new normal that exists for the rest of life after a diagnosis. Rather than not have sex or intimacy, the way you have sex or express intimacy may need to change for a while or permanently. 

Sexual issues can arise from:  

• The emotions that come with a diagnosis or living with a health condition.
• Physical changes resulting from the condition.
• A treatment such as surgery,chemotherapy, or radiation. 
• Medications to treat the disease or emotions. For example, anti-anxiety drugs. 

Keep in mind the following:

• Sex is only a part of sexuality and of intimacy. It is not the only way of having intimacy with another person. For some people, sex is only a small part. 
• Intercourse is not the only satisfying sexual activity. For example, cuddling and kissing with someone you care about and who cares about you can be very satisfying.
• Sexuality is about a lot of things including:
  • The way we think about ourselves as sexual beings. It involves both physical and non-physical parts and is different from person to person. 
  • The clothes we wear, the way we move, the way we have sex, with whom we have sex and even cultural and religious beliefs about sex.
• Sexuality is different from Intimacy.  As a general matter, intimacy is the sharing of our innermost thoughts and emotions. Intimacy can involve sex and/or touching, but it doesn’t have to.
• How we think about ourselves as sexual beings influences our behavior. If we have negative feelings about ourselves, we are likely to feel down and withdraw from other people – even from a partner and children.

If you have cancer and are in treatment, as a general matter, you can have sex during treatment. However, it is advisable to always check ahead of time with the doctor who is overseeing the treatment.  Sex during treatment is not recommended if:

• Your immune system is low (“immunosuppressed”)
• You have very low blood counts
• You are in the first weeks of recovery after surgery
• You have an ostomy

If sexual or intimacy issues are a concern:

• Involve your partner.
  • Communication about your needs and concerns is critical.
  • The best communication is to state a fact, then a belief, then a suggested action.
  • If your partner is not interested in sexual activities, perhaps there is an underlying fear or anxiety that can be reduced or eliminated with communication. If not, there are steps to take. For instance, consider cuddling plus self pleasure.
  • To learn how to involve your partner, click here.
• Be creative. Think about your needs. Keep in mind that skin is the largest sex organ and the brain is the most important sex organ which means that the possibilities are limitless. Communicate with your partner.
  
• Be patient.
• Keep a sense of humor. A sense of humor is a must. (To learn about keeping a sense of humor, click here.)
• For tips about minimizing sexual issues, click here.

If you don’t find the answer that works for you, speak with your doctor. Don’t wait for him or her to bring up the subject. While doctors consider quality of life subjects important, they tend to focus more on the physical aspects of your condition and/or treatment. Many physical issues can be treated. Your doctor may be able to help you pinpoint the cause of issues you are having. Perhaps a medication can be prescribed or a treatment can be changed. Your doctor may also have suggestions about working through emotional issues.

If sexual issues become unmanageable, consider couples counseling or consult a professional such as a licensed sex therapist who is experienced in dealing with people with your health condition or particular situation. You can find a sex therapist through the American Association of Sex Educators and Therapists, www.aasect.org .

For additional information, see:

• Myths About Cancer And Sex
• How Surgery Can Affect Sexuality
• How A Diagnosis Can Affect Sexuality And Sex Drive

NOTE:

• Men and women:
  • If a drug or treatment could render you unable to have children:
    • You can preserve the ability to have a child by banking eggs and sperm prior to starting a drug or treatment. To learn more, click here. 
    • Adoption is also an option. To learn more about adoption after a diagnosis, click here.
  • If you are considering undergoing resection surgery, there are exercises known as Kegel Exercises that you can start before surgery to help manage incontinence. The exercises can also be helpful with an erection for men.  To learn more, click here.
• Women:    
  • If you are considering undergoing radiation or surgery anywhere near the pelvic area, or if you are pre-menopausal and are considering chemotherapy, ask your doctor about starting dilative therapy early to keep your vagina from narrowing (“Stenonsis”). A preventive approach avoids trying to catch up with something that either has scar tissue or has shrunk.
  • If you experience stenosis, there are pelvic therapists who are trained in vaginal reconditioning. The odds are there are at least a few such experts in a gynecological practice in every metropolitan area.

The content of this article is based in large part on work by Sage Bolte, PhD, LCSW, OSW-C, Oncology Counselor, Fairfax, VA

Myth: Cancer can be spread through sex

Reality: Only cervical cancer can be spread through sex. 

Myth: Once a person has cancer, sex goes out the window.

Reality: Sexuality is a part of life. It doesn't disappear because of cancer or its treatment.  Particularly during or immediately after treatment, there may be a lack of interest for a while on your part, or on your partner's part. Lack of interest in sexuality is not permanent. 

 Myth: Older people are not interested in sex.

Reality: Sexuality is about how you define yourself as a man or woman, who you are attracted to, and whether you want a relationship. Sexuality doesn't go away. On the other hand, the type of sex in which you are interested may change over time. For example, you may become more interested in cuddling or foreplay than having intercourse.  

 Myth: Men enjoy sex more than women.

Reality: If sex is good, both men and women enjoy it.  

Myth: All physical contact must lead to intercourse

Cuddling and other physical activities can be satisfying. As noted in the summary, you can have intimacy without sex, much less intercourse.

Myth: Sex is a failure if both people do not reach orgasm.

Reality:  Men and women can have wonderful sexual relationships without orgasm or penetration. The key is how you define sex and what you get out of it.

General advice is to wait for several weeks from the date of surgery before having sex. If you have a question about when sex is okay, speak with your surgeon or his or her nurse.

Possible side effects of surgery which can affect sexuality include:

• Physical changes including scarring, and possibly an ostomy. If an ostomy is in place, your image of your physical self may be lowered.
• Changes in sensations.
• Urinary or bowel dysfunction (“Incontinence”) which can make a person anxious about engaging in sex because there may be a leak or smell. There may be concern about what your partner thinks.  Incontinence can lead to not wanting to start sex. It can also lead to a lack of desire, or a desire to respond, particularly if nerves are damaged.  (For tips about dealing with incontinence, click here.)
• Pain – which can affect interest in being sexually active in addition to the function of sexual organs. For tips about dealing with pain, click here. 
• Men:
  • Erection difficulties  (For information about dealing with erection difficulties, click here.)
  • If you have an abdominal perineal resection, you can have “dry” orgasms if there is damage to the nerves that control ejaculation. In some cases, the surgery causes semen to go backwards into your bladder (“retrograde ejaculation”). If you want to have a child and experience retrograde ejaculation, sperm cells which can be used to impregnate a woman can be recovered from your urine. If sperm cells cannot be recovered from your semen or urine, it may be retrieved directly from your testicle by minor surgery. 
  • Orgasm pleasure may become less intense.
• Women: May experience diminished orgasm.

NOTE: Safer sex techniques will prevent pregnancy and transmission of sexually transmitted diseases. (For information about safer sex techniques, click here. 

A diagnosis and treatment of a serious health condition can affect sexuality and sex drive as follows: 

• Loss of sex drive (“Libido”) due to depression or anxiety.  Both men and women who are diagnosed with cancer are 15 or 20 percent more likely to have depression or anxiety. Depression and anxiety can affect mood, your connection with your self, your connection with your partner and children, and with your co-workers. (For information about how to cope, click on the appropriate link: Depression, Anxiety.)
• Self consciousness: Both patients and their partners are likely to feel more self-conscious and less secure which can affect  a person's self-esteem and sex drive or prowess.
• Fear of recurrence: Even though it is not logical, fear of recurrence can also impact sexual relationships because of a fear that sex could harm a surgical site if there was surgery.
• Negative feeling about self: Because of physical changes such as hair loss, scars or loss of weight, patients can have a lowered feeling about themselves which can lower sex drive.
• Role changes: If a bread winner is diagnosed and has to stay home or needs physical help, the partner has more to do, and may even have to return to work. The partner is also likely to change from being an equal to being a caregiver. These changes can cause conflict and can lower self esteem – which in turn lowers sex drive.
• Reproductive concerns: Chemotherapy and other treatments can affect fertility. In turn, this can have an emotional impact as well as the physical result of no longer being able to have children.
• Side effects: Side effects such as weight gain or loss, change in sense of smell and taste, dry mouth can have an effect on interest in sex and being sexual.

NOTE: Use of alcohol and smoking can cause erection difficulties and lack of interest in sex.

Sex is only a part of sexuality and intimacy.

If you are not able to have sex in the manner you're used to, you can still be a good lover. Oral and manual stimulation can lead to orgasm. Touching and caressing are also important.

Men

If a man has difficulty getting or maintaining an erection:

• Medications such as those sold under the brand name Viagra or Cialis may help. Speak with your doctor or other health care professional.
• Penile prostheses are also available. A urologist who specializes in penile prostheses can explain the available types and the implantation procedure.
• Consider the possible cause. It could be due to depression or fatigue - or even to dealing with a life changing condition. For discussions about depression and fatigue, see the documents in "To Learn More."

Women:

• Dryness and soreness in the vagina may lead to painful intercourse. It can be treated with vaginal lubricants during sex and/or hormones.
• If you undergo radiation or surgery,  the vagina may narrow making sex painful. Vaginal dilators before sex may help prevent narrowing of the vagina.
• Consider whether difficulties are caused by depression or fatigue - or even to dealing with a life changing condition. For discussions about depression and fatigue, see the documents in "To Learn More."

Advice about physical and emotional issues around sex and intimacy is available through a referral to a sex or couples counselor. The two are likely intertwined.

Discuss your sexual  concerns and issues with your partner or person with whom you want to have sex. If  you keep the matter to yourself while changing your behavior, it  will send mixed signals which can easily be misinterpreted as a lack of interest in sex or in the other person.

Talk about how you feel about your sex life, and what you would like to change. Consider talking about your concerns, your beliefs about why your sex life is the way it is, your feelings, and what would make you feel better.

Approaching the subject openly avoids blame, stays positive, and gives your partner a better sense of how you are feeling.

Likewise, ask your partner or other person to discuss his or her concerns and issues.

• It is not unusual for other people to be confused about how to behave.
• Try to be open minded as you listen to your partner's point of view.

Consider asking your partner to accompany you to your visits with your specialist. He or she can be part of the discussion about sex and intimacy issues, as well as about possible solutions.