Sexuality & intimacy

Friday 31 May, 2013

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On this page: Creating physical and emotional intimacy | The role of hormones | How your body responds sexually | Erogenous zonesFemale sex organs | Male sex organs | Reviewers

Sexuality encompasses much more than just the act of sexual intercourse. It's about who you are, how you see yourself, how you express yourself sexually, and your sexual feelings for others. It can be expressed in many ways, such as the clothes you wear, how you groom yourself, the way you move, the way you have sex and who you have sex with.

The role it plays is influenced by your age, environment, health, relationships, culture and beliefs, opportunities and interests, and your level of self-esteem.

Sexuality is often an expression of intimacy, but intimacy isn't necessarily about sex. Being intimate means being physically and emotionally close to someone else. Intimacy is about:

  • loving and being loved
  • expressing mutual care and concern
  • showing you value another person and feeling valued in return.

Intimacy is also expressed in different ways: by talking and listening on a personal level, by sharing a special place or a meaningful experience, and through physical affection. Most people need some kind of physical connection to others. Even for people who aren't sexually active, touch is still important.

Whether or not we have a partner, we're all sexual beings – having cancer doesn't change that. Cancer can, however, affect your sexuality and your ability to be intimate in both physical and emotional ways. Addressing any changes and challenges early on may help you and your partner (if you have one) to adjust more easily.

For personalised information and support, call Cancer Council on 13 11 20 to speak with an experienced cancer nurse, or arrange a counselling session with a medical expert in this area. Both services are free and confidential. 

Creating physical and emotional intimacy

  • Offer comfort and reassurance through holding hands, hugging or massage.
  • Spend time talking and actively listening to help maintain emotional intimacy.
  • Ask permission to talk about your partner's feelings.
  • Pick a good time to talk, e.g. when you can give your full attention.
  • Even if you're in a long-term partnership, don't assume you know what your partner's thinking and feeling 

The role of hormones

Hormones are substances that affect how your body works. They act as messengers carrying information and instructions from one group of cells to another. Hormones control many of the body's functions, including growth, development and reproduction.

Male sex hormones

The major male sex hormone is testosterone, which is produced mostly in the testicles. Testosterone causes the reproductive organs to develop and is responsible for other sexual characteristics, such as a deep voice and facial hair. The adrenal glands, which sit on top of the kidneys, also produce small amounts of testosterone in men and women.

Men's hormone levels vary widely but a man with a low level of testosterone could have trouble getting or keeping an erection and may lose his desire for sex 

Female sex hormones

The major female sex hormones are oestrogen and progesterone. Both are produced mostly in the ovaries. A small amount is also made in the adrenal glands (found on top of the kidneys).

Oestrogen: keeps the vagina moist and supple so it can expand during sexual intercourse.

Progesterone: controls reproduction and helps prepare a woman's body for pregnancy.

In women's bodies, the ovaries and adrenal glands make small amounts of the male sex hormones (androgens). Androgens are linked with sexual desire, arousal and ability to orgasm. The adrenal glands make enough androgens to maintain sexual desire after oestrogen production slows down, but androgen levels decrease during and after chemotherapy.

Cancer and its treatments can affect women's hormone levels in the short and long term, sometimes causing early menopause (when the ovaries have ceased releasing eggs and the menstrual cycle has stopped) or menopause-like symptoms. This can affect fertility, quality of life, self image and sexuality.

How your body responds sexually

The mind and sex

Sexuality starts in the mind. The brain is responsible for making you feel interested in sex through fantasies, memories, imagination and feelings. These thoughts are created by what you see, smell, touch, taste, hear and remember.

Our levels of sexual desire (also called libido) are affected by many factors, including stress and illness, so if you're depressed, anxious or worried about cancer and its treatment, you'll probably be less interested in sex.

The mind also affects how you feel about your body and how you think it looks (your body image). After changes to your body from cancer, you may feel ‘less of a man' or ‘less of a woman', or think you're less attractive.

Stages of sexual response

Libido: is the interest you have in sex. The willingness to engage in sex is complex and is influenced by emotional, social and biological factors, including: overall wellbeing; relationship satisfaction; body image; and the desire to express love, receive pleasure, please your partner and create a sense of intimacy and connection.

Excitement or arousal: is when you begin to feel ready for sex. You may become aroused by seeing someone you like; having a sexual thought or fantasy; having your genitals or some other sensitive areas touched, kissed or stroked; starting to masturbate or having oral sex. Your body responds to this excitement in various ways. As you become aroused, your blood pressure and heart rate increase and blood is sent to the genital areas.

In both men and women, the nipples may harden. In men, the penis becomes erect and sensitive. In women, the clitoris becomes erect and more sensitive, and the vagina moistens and increases in depth and width. Sexual arousal may lead to an orgasm but this doesn't always happen.

Orgasm: is the peak of sexual response. The nervous system creates intense pleasure that you experience in the genital area. This causes the muscles in the genital area to contract in rhythm, sending waves of pleasurable feelings through the body. Breathing becomes faster and shallower, heart rate and blood pressure increase, and you may sweat.

In men, ejaculation occurs when the muscles around the base of the penis begin to squeeze in rhythm, pushing the semen through the urethra and out of the penis (ejaculation). In women, an orgasm involves intense sensitivity of the clitoris, vaginal expansion and muscle contractions. Some women also experience a small ejaculation. Female orgasms can vary in length and intensity and can be reached in different ways.

Some women have orgasms through vaginal penetration (intercourse) alone, but many women need added stimulation. This can include stimulation from applying lubrication or touching the vulva. It can also include clitoral stimulation through masturbation and oral sex, or having the breasts or inner thighs stroked. Some health professionals call this ‘outercourse'.

Many women generally feel relaxed and satisfied after one orgasm but some women are able to have multiple orgasms.

Resolution: is the phase where your breathing, heart rate and blood pressure return to normal. Men usually can't be sexually aroused again for a while. The length of time between erections usually increases with age. The strength of erections may also decrease with age.

Ageing and illness can affect your sexual response. Often, the longer you've not been sexually active, the less intense your sexual response may become. After cancer treatment, you may notice that your sexual response has changed. To help re-establish your response you can start sexual activity without having much libido or without being aroused. You still may not experience orgasm, but you may feel sexually satisfied. 

Erogenous zones

Areas of the body that are highly sensitive to stimulation are known as erogenous zones. For women, the clitoris is the main sexual pleasure organ, but other areas include the breasts and nipples. For men, the penis, scrotum and anus are highly sensitive and respond to stimulation, but other pleasurable zones exist, such as the chest and nipples.

Female sex organs

A female's sex organs (genitals) are mostly inside her body.

  • Vagina (birth canal): a muscular sheath or canal that extends from the entrance of the uterus to the vulva (see below).
  • Uterus (womb): a hollow muscular organ where a fertilised egg (ovum) is nourished to form a baby.
  • Cervix: the entrance to the uterus.
  • Fallopian tubes: two long thin tubes that extend from the uterus and open near the ovaries. These tubes carry sperm to the eggs and the eggs from the ovaries to the uterus.
  • Ovaries: two small almond-shaped glands that contain eggs. The ovaries are found on either side of the uterus, close to the end of the Fallopian tubes. The female sex hormones, oestrogen and progesterone, are made by the ovaries.  

A woman's outer sex organs (genitals) are collectively referred to as the vulva:

  • Clitoris: the main sexual pleasure organ for women. It's located where the labia minora join. It's made up of erectile tissue with rich sensory nerve endings and becomes erect during arousal.
  • Mons pubis: the area of fatty tissue covered with pubic hair.
  • Labia majora: the outer lips of skin.
  • Labia minora: the inner lips of skin.

Beneath the clitoris is the urethra, for passing urine. Further back is the entrance to the vagina. Beyond that is an area of skin called the perineum and beyond that is the anus.

An illustration of female sex organs

Male sex organs

Penis: is covered by the foreskin, if it hasn't been removed by circumcision. The ridge on the underside of the head of the penis, called the frenulum, is usually a man's most sensitive part. At the very end of the penis is a slit opening to the urethra, through which semen and urine pass.

  • Scrotum: a pouch of skin at the base of the penis. It contains the testicles.
  • Testicles (also called testes): make and store sperm and produce the male sex hormone, testosterone. It's normal for the testicles to vary in position and size.
  • Epididymes: coiled tubes on the outer surface of the testicles. The immature sperm travel from each testicle to the epididymes, where they mature. The other parts of a man's reproductive system are inside his body.
  • Prostate: a small gland about the size of a walnut that sits below the bladder, deep in the pelvis. It surrounds the urethra, which carries urine from the bladder. The prostate produces fluids that form part of the semen.
  • Seminal vesicles: glands that lie very close to the prostate and produce secretions that form part of the semen.
  • Vas deferens: the tubes joining the testicles and the penis.

An illustration of male sex organs

Reviewers: Dr Lesley Yee, Sexual Health Physician and Psychotherapist, Australian Centre for Sexual Health, NSW; Sandy Hutchison, Executive Manager, Cancer Counselling, Cancer Council Queensland; Helena Green, Clinical Nurse Specialist and Breast Nurse, Sexologist, RELATE Sexuality, WA; Sam Gibson, Cancer Nurse Coordinator, St John of God Subiaco Hospital, WA; Carole Arbuckle, Cancer Support Nurse, Cancer Council Victoria; Deb Roffe, Gynaecological Research Nurse, Queensland Institute of Medical Research, QLD; and Garth Wootton, Consumer.
Updated: 31 May, 2013