Body Changes and Intimacy
Some body changes are short-term, and others will last forever. Either way, your looks may be a big concern after treatment. For example, people with ostomies after colon or rectal surgery are sometimes afraid to go out. They may feel ashamed or afraid that others will reject them. They may worry about the idea of having an "accident" in social situations.
Others don't like people being able to see treatment effects such as scars, skin changes, loss of limbs, and changes in weight. Even if your treatment doesn't show, your body changes may trouble you. Feelings of anger and grief are natural. Feeling bad about your body can also lower your sex drive. This loss of or reduction in your sex life may make you feel even worse about yourself.
Changes in the way you look can also be hard for your loved ones, which can be hard on you. Parents and grandparents often worry about how they look to a child or grandchild. They fear that changes in their appearance may scare the child or get in the way of their staying close.
How do you cope with body changes?
- Mourn your losses. They are real, and you have a right to grieve.
- Try to focus on the ways that coping with cancer has made you stronger, wiser, and more realistic.
- If you find that your skin has changed from radiation, ask your doctor about ways you can care for it.
- Look for new ways to enhance your appearance. A new haircut, hair color, makeup, or clothing may give you a lift.
- If you choose to wear a breast form (prosthesis), make sure it fits you well. Your health insurance plan may pay for it.
- Try to recognize that you are more than your cancer. Know that you have worth - no matter how you look or what happens to you in life.
You may have changes in your sex life after cancer treatment - many people do. Depending on the cancer you had, these problems may be short-term or longterm. For example, about half of women who have had long-term treatment for breast and reproductive organ cancers and more than half of men treated for prostate cancer report long-term sexual problems. Many cancer survivors say they were not prepared for the changes in their sex lives.
Sexual problems after cancer treatment are often caused by changes to your body - from surgery, chemotherapy, or radiation, or by the effects of certain medicines. Sometimes emotional issues can be the cause of sexual problems. Some examples include anxiety, depression, feelings of guilt about how you got cancer, changes in body image after surgery, and stress between you and your partner. Your past sex life is not related to your current sexual problems.
What types of problems occur? People report these main concerns:
- Worrying about intimacy after treatment. Some may struggle with their body image after treatment. Even thinking about being seen without clothes may be stressful. People may worry that having sex will hurt or that they won't be able to perform or will feel less attractive. Pain, loss of interest, depression, or cancer medicines can also affect sex drive.
- Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that also change your sex life.
- Some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis, or cancer of the testes. Some treatments can also weaken a man's orgasm or make it dry.
- Some women find it harder, or even painful, to have sex after cancer treatment. Some cancer treatments can cause these problems; sometimes, there is no clear cause. Some women also have a loss of sensation in their genital area.
- Having menopause symptoms. When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or other problems that can affect their desire to have sex.
- Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for cancer survivors to have children. Depending on type of treatment, age, and length of time since treatment, you may still be able to have children. For more information about fertility, refer to the organization, Fertile Hope.
"I knew about the chance of impotence. What I didn't expect was my total loss of interest in sex, which really caused some problems between my wife and me."
Your doctor may be able to help you deal with these problems, but he or she may not bring up the subject. You may have to mention it yourself. If you think you might have trouble getting started, bring this booklet with you.
Often, sexual problems will not get better on their own. To get help with many of these problems, it's important to tell your doctor about any changes in your sex life. Sometimes there can be an underlying medical problem that causes changes, such as:
- Erection problems. Medicine, assistive devices, counseling, surgery, or other approaches may help.
- Vaginal dryness. Dryness or tightness in the vagina can be caused by menopause. Ask whether using a water-based lubricant during sex, using vaginal dilators before sex, and/or taking hormones or using a hormone cream are options for you.
- Muscle weakness. You can help strengthen muscles in your genital area by doing Kegel exercises. Practice by controlling your muscles to stop the flow of urine. You can do these exercises even when you are not urinating. Just tighten and relax the muscles as you sit, stand, or go about your day.
Other issues you may want to discuss include:
- Concerns about having children. Discuss family planning concerns with your doctor. If you're a woman, ask if you still need to use birth control, even if you are not getting your period.
- Talking with a counselor or a psychologist. You may feel that some of your sexual problems are due to your emotions, like stress or body image. Some people find that sexual problems related to cancer start to strain their relationship with their partner. If this is the case, ask a nurse or social worker if you can talk to a counselor. Talking to someone alone, or with your partner, may help.
- Seeing a sex therapist. He or she may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.
Even for a couple that has been together a long time, staying connected can be a major challenge at first. It may be comforting to learn that very few committed relationships end because of ostomies, scars, or other body changes. Divorce rates are about the same for people with and without a cancer history.
Tell your partner how you feel about your sex life and what you would like to change. You might want to talk 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 it openly avoids blame, stays positive, and gives your partner a better sense of how you are feeling. Here is an example of how you might start your discussion:
"I know it's tough to talk about, but I think we should discuss our sex life. We've only made love a few times lately. I miss being close to you. I worry that my scars might be a problem. Can you tell me how you feel?"
Try to be open minded as you listen to your partner's point of view:
- Focus on your partner's comments, not on what you plan to say in response.
- Repeat what he or she says in your own words.
- Ask questions to better understand your partner's concerns.
- Acknowledge that your partner's views matter to you. Say things like "I see why you might think that" or "I never thought of it that way before."
Feeling Intimate After Treatment
- Be proud of your body. It got you through treatment!
- Think of things that help you feel more attractive and confident.
- Focus on the positive. Try to be aware of your thoughts, since they can affect your sex life.
- Touch each other. Kiss, hug, and cuddle, even if you cannot have the kind of sex that you used to have.
- Be open to change. You may find new ways to enjoy intimacy.
If you're single, body changes and concerns about sex can affect how you feel about dating. As you struggle to accept the changes yourself, you may also worry about how someone else will react to physical things, such as scars or ostomies. Or you may find it awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.
You may wonder how and when to tell a new person in your life about your cancer and body changes. For some, the fear of being rejected keeps them from seeking the social life they would like to have. Others who choose not to date may face pressure from friends or family to be more sociable. Here are some ideas that can make it easier to get back into social situations:
- Focus on activities that you have time to enjoy, such as taking a class or joining a club.
- Try not to let cancer be an excuse for not dating or trying to meet people.
- Wait until you feel a sense of trust and friendship before telling a new date about your cancer. Practice what you will say to someone if you are worried about how you will handle it. Think about how he or she might react, and be ready with a response.
- Think about dating as a learning process with the goal of having a social life you enjoy. Not every date has to be perfect. If some people reject you (which can happen with or without cancer), you have not failed. Try to remember that not all dates worked out before you had cancer.