Specific intimacy issues
On this page: Adapting to changes | Staying sexually confident | Masturbation | Communicating with your partner | What if I don't have a partner? | Reviewers
Many of the problems discussed below are common among women and men who have cancer. They may be temporary or ongoing. Some changes, such as incontinence and having a stoma, affect people with a particular cancer who've had a particular type of treatment.
During and after cancer treatment, many people feel tired and have no energy. Fatigue (extreme tiredness that's often not relieved by rest) can lead to a temporary loss of interest in sex and intimacy. Any form of fatigue should be discussed with you doctor. How long this lasts varies from person to person.
- Plan your day so you have time to rest. Take short naps, rather than a long one.
- Eat as well as you can and drink plenty of fluids.
- See what helps you feel less tired and make those activities a priority.
- Take short walks or do light exercise if possible. Try easier or shorter versions of the activities you enjoy.
- Try to allow others to help.
- Although you're tired, exercise and fresh air may make you feel more energised.
- Try less strenuous activities like listening to music or reading.
- Save your energy for the most important things. Allow others to do some things that you usually do.
- Try to be intimate at different times of the day.
- Ask for flexibility if you work, e.g. variable starting times.
Sadness and depression
Depression is very common in cancer patients, but it can be treated. It's natural to feel down after cancer treatment. Changes to your body can be upsetting and it takes time to get used to them. You may find that you have difficulty sleeping, lose interest in activities you normally enjoyed, don't feel like eating or lack energy. Your energy and desire for sex may also be low.
If you suspect that you, or someone you care for, may be depressed, you can find a simple depression checklist and helpful
information at the Beyond Blue website.
Spend time with people who have a positive attitude. This may help to focus on what can be done.
- Do things that make you feel good such as watching funny movies, going for a walk or having a massage.
- Get up at the same time every morning, regardless of how tired you feel.
- Avoid long naps during the day and just before bedtime.
- Try to regain parts of your life from before you had cancer.
- Be as active as possible. Plan activities for each day such as exercise, spending time with other people, or reading.
- Ask your doctor if your mood change could be related to medications, hormone changes or another illness. Depression is a common
result of low testosterone in men and of low sex hormones in women.
- If feelings of depression are ongoing, tell your doctor about it, as counselling or medication may help.
Changes in appearance
Common physical changes caused by treatment include weight loss or weight gain; hair loss; loss of a body part and use of a prosthesis; lymphoedema; having a colostomy; and scars.
You may feel the visible changes to your body make you less attractive and worry that others will reject you when they see the changes.
Some cancers of the head and neck result in significant changes to your appearance. This can be upsetting because the change is visible and because kissing, speech and eating may be affected.
It's natural to focus on the part of your body that's changed. This may affect how you feel about yourself and your body image, which may, in turn, affect your sexual confidence. Body image doesn't depend on how you look, but on how you think you look.
Look Good...Feel Better program
Cancer treatments, such as chemotherapy and radiotherapy, can sometimes cause side effects such as hair loss and skin irritation. These changes can make you feel self-conscious.
Look Good...Feel Better is a free two-hour program for both men and women to teach them techniques using skin care, hats and wigs to help restore appearance and self-esteem during and after treatment. See information about upcoming Look Good...Feel Better workshops.
- Be gentle with yourself at all times and acknowledge how you're feeling.
- Give yourself time to get used to any physical changes.
- Focus on yourself as a whole person and not just the part of you that's changed.
- Talk about your concerns with your partner, a close friend or counsellor.
- Draw attention to your good features with clothing, makeup or accessories.
- Choose well-fitting clothes. Wearing something too tight or too baggy will draw attention to your weight loss or gain.
- Wear a hat, wig or scarf if your hair has fallen out.
- Show your partner any body changes before sexual activity. This may allow both of you get used to how it makes you feel.
- Wear clothes that hide the part of your body you feel uncomfortable about. For example, crotchless knickers for women and special underwear for men are designed to be worn during sex.
- Talk to your doctor about the possibility of plastic surgery or a facial prosthesis if you've had a significant change in your facial appearance from surgery or radiotherapy. This may help you regain a more natural appearance and help with altered speech.
- Lower the lights when you have sex until you feel more confident about your body.
Different levels of desire
Often in relationships, one partner is more interested in sex than the other. Cancer can exaggerate this. While it may not be a problem for some people, a loss of interest in sex (low libido) is common during cancer treatment.
Cancer treatments may leave you tired and weak, or you may be too worried about the cancer to think about sex. Low libido can also occur when cancer treatments disturb your normal hormone balance. Libido usually returns when treatment is over, but keep in mind that libido changes with age.
If you don't want to have sex, talk this over with your partner so you understand each other's expectations and also so they don't feel rejected. Agree on other ways you can satisfy each other.
Explore and discuss the range of videos and adult enhancement products that are available (for example, personal lubricant and sex toys like dildos and vibrators), so your partner can satisfy themselves, either alone or with you present. It may take time, but you can learn how to feel good about yourself sexually despite cancer and the side effects of treatment.
If you feel you need further support or ideas on how to help your relationship get through this stressful time, consider talking to a
counsellor or a specialist in sex and relationships. Call 13 11 20 for contacts in your local area.
- If you've lost your desire for sexual intimacy, talk about it with your partner.
- Make it a priority to spend time with your partner. Arrange a ‘date'.
- Reconnect by initially trying skin-to-skin touch, such as massaging each other.
- Suggest a quick, gentle lovemaking session rather than a long session.
- Set the scene with soft lights, your favourite music and dressing in something that makes you feel good, sensual and sexy. All of these may help to get in the mood for sexual activity.
- Stimulate yourself so you become aware of how you like to be touched.
- Explore different ways to help you and your partner reach satisfaction.
- Try different sexual positions if your usual ones have become uncomfortable.
- Use cushions or pillows to support your weight.
- Change the venue. If your home has been where you and your partner have been coping with the side effects of treatment, book a night away or try using other rooms in the house not associated with cancer.
- Change the bedroom around or think about redecorating if your treatment is over.
- Have a hormonal assessment to check your hormone levels.
Fear is a normal reaction to cancer and its treatment. You might dread the treatment and how you'll cope with it. You may be concerned about an uncertain future. People whose partners have cancer often worry that they may lose someone they love. It's difficult to be interested in intimacy when you're feeling afraid.
- Think about how you've managed fearful situations in the past. Discuss these strategies with your partner.
- Find out more about your illness – ask your treatment team about what to expect.
- Talk it over with a friend or colleague.
- Make a list of things you enjoy doing and make time to do one enjoyable thing every day, so you feel like you're achieving something.
- Ask your doctor if anti-anxiety medication will help. Keep in mind that some medications may lower your libido.
- Learn how to cope with fear, tension and anxiety by experimenting with different methods. Find out what works best for you.
- Learn ‘mindfulness-based techniques', including deep relaxation and meditation. Often, relaxing your body and mind help you to feel better and more in control. Cancer Council has resources that may help.
- Seek counselling. Call Cancer Council Helpline 13 11 20, or ask to see an oncology social worker or psychologist.
Difficulty reaching orgasm
A person's ability to reach orgasm usually remains unless cancer treatment damages the spinal cord and causes the genital area to
become numb. Nerves may be damaged during prostate or bowel surgery, and surgery can also remove sensitive parts such as the
clitoris, lower vagina or vulva in women, or the penis or scrotum in men.
However, some women and men are still able to have an orgasm after extensive surgery to their genital areas. Difficulty in reaching
orgasm may also be caused by painful intercourse, distracting emotions or worrying thoughts.
- Choose a time when you won't be disturbed and set the mood with soft lighting, candles and music.
- Place your partner's hands and fingers on the areas that arouse and excite you – or do it yourself, if you feel comfortable.
- Change your normal positions to more comfortable ones that heighten stimulation.
- Use pillows to support parts of your body.
- Use generous amounts of water-based lubrication, available from the supermarket or chemist, e.g. PjurTM, SylkTM or AstroglideTM.
- Accept that you may not reach an orgasm every time and, to take the pressure off, focus on other things that give you pleasure.
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.