A lot has been said about cancer and as we commemorate Breast Cancer Awareness Month, be prepared to hear and learn more. However, in all these discussions, the topic on sexuality and cancer will be conspicuously missing, yet cancer treatment might change the ability of one having or enjoying sex. So, let’s talk about sex and cancer…

Cancer treatment such as chemotherapy, surgery and radiotherapy often leave cancer patients and survivors with side effects like nausea, fatigue, depression, irritability, pain and bowel problems among others. However, what many people do not know is that the treatment can also have a debilitating effect on a patient’s sexuality. It doesn’t help that this is often ignored and hence patients end up languishing in silence and sometimes broken relationships. Research shows that nearly 50 per cent of women who have undergone treatment for gynecologic and breast cancers, and 70 per cent of men who have been treated for prostate cancer experience long-term sexual dysfunction.

It is noteworthy that the effects of cancer treatment with regard to sexuality will vary from individual to individual. Some people may completely lose interest in sex, while others might want to make love more than before. It is also common for individuals suffering from cancer to struggle with their body image and this may interfere with their libido. In addition, some cancer patients have reported feeling ‘unclean’ after treatment, making them shy away from any sexual activity. Other treatments require the surgical removal of the part of the body affected such as the breast and may thus take sometime for the patient to come to terms with the changes to their body.

That aside, the sexual effects of cancer on men and women are more or less the same. For men, they may experience inability to attain or maintain an erection, decrease or loss of libido, change in orgasm (intensity, duration and even dry ejaculation) or inability to reach orgasm, or pain during intercourse. Women suffering from cancer may experience pain during sex, loss of sexual desire, inability to reach orgasm and vaginal dryness, which may lead to pain during penetration.

Also note that most of these problems are not caused by cancer but the treatment itself. For instance, in women, chemotherapy may damage the ovaries leading to hormonal changes and at times temporary or permanent menopause while radiation in the pelvic area can damage the ovaries. Vaginal radiation is likely to irritate vaginal lining leading to decrease in lubrication, making sex painful.

Parts of a woman’s sexual organs such as part or all of the vagina and vulva may be removed during surgery for pelvic cancer. Needless to say, removal of the breast during breast cancer surgery will deny a woman pleasure from breast caressing as well as dent her self-esteem. Other medicines meant to alleviate pain; nausea or depression can negatively affect a woman’s libido or ability to reach orgasm.

Pelvic surgery for men can affect the blood vessels and nerves responsible for erection hence interfering with ability to achieve and maintain an erection. It may take up to two years for some men to regain erectile function. Ejaculation can be affected when the nerves responsible for it are removed or damaged. In addition, a man can experience dry ejaculation after surgery for prostate cancer as the seminal vesicles and the prostate, which are responsible for secreting semen, are no longer there.

Radiation can also lead to damage of nerves responsible for erection as well as cause dry ejaculation when the nerves responsible are damaged. Note that a man can still reach orgasm without ejaculation. Chemotherapy in men can result in fluctuations in libido, while hormone therapy treatment for prostate cancer decreases testosterone levels (testosterone hormone is responsible for sex drive).

While it is possible to have sex during cancer treatment, this is dictated by a few factors such as interest, comfort and energy levels. Those who have undergone surgery in the pelvic area (treatment for gynecologic cancers, anal cancers, colorectal cancers, prostrate cancer or penile cancers) are advised to let the wound heal before engaging in sexual activity involving penetration. Also, if one has low platelet or white blood cell count, it is recommended they steer clear of penetrative sex as it increases the risk of infection and even bleeding. Men who have received brachytherapy for prostrate cancer are advised to limit physical contact with their partner so as to prevent exposing her to radiation.

Patients with an infusion catheter may worry that sex may harm it hence it is advisable to take care not to rub against the dressing. Often times during chemotherapy or radiotherapy treatments, a person’s immune system may not be functioning optimally, putting the patient at risk of infection. Ask your doctor for advice before engaging in any sexual activity.

Physiological effects of cancer treatment aside, there are psychological factors, some of which have been mentioned earlier in this article that can affect your sexuality. For instance, there are patients who believe that perhaps their previous sexual activities might have contributed or led to cancer. Others believe that cancer can be sexually transmitted hence they avoid physical contact with their partners. A cancer diagnosis is likely to make one depressed, which can lead to loss of libido as well as decrease in sexual enjoyment.

Also, patients might become anxious or fearful about their first sexual experience after treatment begins and this may cause them to avoid intimacy altogether. On the other hand, the partner might be at crossroads on how to approach the issue or even engaging in intercourse for fear of hurting their loved one. It is therefore advisable for couples to openly communicate and discuss their concerns, feelings and preferences. Talking to a sex therapist or even a counsellor can help you to find ways of navigating your worries. You can also start or join a support group where you will be able to openly discuss and share your experiences.

Practicing safe sexual activity

Certainly, it doesn’t hurt to take precaution when it comes to sex. Couples are advised to use a reliable form of contraceptive so as to prevent pregnancy. This is because some form of cancer treatment such as chemotherapy can cause harm to the foetus hence precautions need to be taken to prevent pregnancy. Chemotherapy can be excreted in semen and vaginal secretions two to three days after treatment. Use a condom during this period to avoid exposing your partner to the chemotherapy. It is prudent to schedule the sexual activity when the side effects of chemotherapy are minimal so that both of you can enjoy the experience. If possible, the patient can take painkillers two to three hours before intercourse to lessen pain.

Experiment with different positions and work with what you are comfortable with. Remember; sexual activity does not just involve penetration. You can kiss, caress, gently hug and touch to satisfy each other. Prior to the sexual activity, find ways of relaxation such as massage or taking a shower together so as to lessen the discomfort.  You can also use pillows to support areas that ache. Moreover, the healthy partner should play an active role during intercourse so as to lessen the patient’s movements.

In addition, maintain a healthy weight, eat right and exercise so as to boost your mood and self-esteem. For women suffering from vaginal dryness, it is advisable to use a lubricant such as K-Y jelly. The lubricant should be applied on your vaginal area and also on your partner’s penis.  Never use oils, lotion or petroleum jelly as a lubricant as they weaken latex condoms.

When the cancer is at an advanced stage, resort to other methods of sexual enjoyment mentioned above especially if sex is too much for the patient.  Note that sexual feelings exist in everyone even when a person is very ill.

For the healthy partner:

  Create a conducive environment where your partner can communicate feelings

  Be supportive; try not to be judgmental

Maintain a healthy attitude, your partner needs it

  Go for dates, watch erotic movies together or play erotic music to get both of you in the mood

  Learn the art of therapeutic touch and include it as part of your intimacy regimen

  Initiate intimacy when your partner is well rested

Published in October 2016