Five Things Every Cancer Patient Should Know About Sex

When you are diagnosed with cancer, your first thoughts might be about mortality, family or mapping out a plan to beat the disease. You're probably not thinking about sex. But experts say you should be.

It turns out that among the 12 million cancer survivors living in the U.S., a huge number of them suffer from some kind of sexual problem directly related to their cancer or treatment. (Estimates range from 40 to 100 percent, according to the National Cancer Institute, depending on the type of cancer and therapy.)

Earlier this week, in a post entitled, Sex After Cancer: How To Get Your Groove Back, several cancer patients spoke frankly about their shattered sex lives both during and after treatment, and how they coped. (Answers: with therapy, hormones, patience, vibrators and talking, talking, talking with their partners.)

Here, clinical psychologist Dr. Sharon Bober, founder and director of the Sexual Health Program at the Dana-Farber Cancer Institute in Boston, discusses the most important facts about sex and sexual health all cancer patients should know before, during and after treatment.

1. Sex Is Bigger Than Any Body Part

Sexuality is complex, Bober says, and the ways that cancer and treatment can undermine a person's sexuality are multifaceted. Of course, if you are facing prostate, ovarian or any cancer involving a sex organ, the impact of chemotherapy, radiation or surgery will be direct and physical. But people with head and neck cancer, for example, might also face huge obstacles when it comes to intimacy: disfigurement, the loss of saliva, fatigue and other symptoms might contribute to a sharp decline in libido. Treatment-induced menopause may make it harder (or impossible) to reach an orgasm. Infertility could be a problem. And therapies that involve multiple doctors and technicians prodding and manipulating your body might, understandably, trigger a sharp drop in your desire to be touched, even lovingly. "It's how you feel about your body," Bober says. "Not just what's happening to your body."

2. Even If You're Afraid To Ask — Ask

Your treatment team might bring up the issue of sex after cancer — or not. It's really your job to ask. And here's what you can say: "What is the potential impact of my treatment on sexual function?" Or, "I understand my treatment might affect my sexual function. What should I expect?" A nurse, social worker or psychologist might be the one to answer your questions and help you connect with the right resources. Your oncologist, surgeon or other doctors will likely be so focused on beating the cancer and keeping you alive that discussions about sex may not top their list.

3. Don't Wait, Act Now

Once you find out what might happen, ask if there's anything you can do to prevent it, or at least manage the side effects. For example, instead of waiting for sex to become painful or uncomfortable, know up front that it might be and try to prepare. Have lubricants and vaginal moisturizers handy (the Dana-Farber hospital boutique now sells several varieties of vibrators and personal products on a shelf near the wigs, scarves and sunscreen), inquire about pelvic floor therapy and massage. Strategize with your partner about getting back in the saddle slowly, and with plenty of foreplay if that works for you.

4. You Are Not Alone

If you have a partner, your cancer experience will no doubt effect that person too. Have the conversation about potential sex problems before treatment if possible. Troubleshoot together and have a sense of humor. Remember, a partner or spouse may long for physical intimacy during this fraught and fearful time, but might be afraid of being too pushy, or appearing selfish. "Partners don't want to bring up the subject first," Bober says. If it's hard to raise these issues on your own, send your partner for help online. The American Cancer Society, The Lance Armstrong Foundation and the Macmillan Cancer Center in the UK all have detailed online resources.

5. An Epic Journey, Maybe, But Don't Give Up
Patients might feel ravaged and broken, undesirable or permanently scarred by treatment. Bober says its important to grieve for what's been lost, whether it's a part of your body or the sexual ease you once had. But then it's time to move on. Change is real, she says, and people have to remember, with or without cancer, sex changes. "No one is the same at 18 and 40 and 60. You have to expand your definition of sexuality and know you can have pleasure throughout life, but it might not look the same." Still, time is not your friend. If your sexual function and libido decline after cancer and you think you can wait it out and expect things to get better spontaneously — think again. "It's like exercise," Bober says. "If you get out of shape, you can't just sit around and wait for it to come back — you've got to get up and work out, be pro-active. It's the same with sex."