Issues for both sexes

Friday 29 October, 2010

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Reviewed by: Dr Amanda Hordern, PhD

On this page: Fatigue | Loss of libido | Different levels of desire | Fear | Difficulty reaching orgasm or satisfaction | Painful intercourse | Changed appearance | Depression | Adapting to life with a stoma | Incontinence | Pelvic floor exercises


Many of the problems discussed in this section 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 who have a particular cancer or need to have a particular type of treatment.

Fatigue

During and after cancer treatment, many people say they feel washed out and have no energy. They can feel like this for a long time. This extreme tiredness – which is often not relieved by rest – can lead to temporary loss of interest in intimacy.

Tips

  • Plan your day so that you have time to rest.
  • Take short naps or breaks, rather than one long rest period.
  • Eat as well as you can and drink plenty of fluids.
  • Try different times of the day to be intimate.
  • Take short walks or do light exercise if possible.
  • Try easier or shorter versions of activities you enjoy.
  • Try activities that are less strenuous, like listening to music or reading.
  • Save your energy for the most important things.
  • Become comfortable having others do some things that you usually do.
  • See what helps you feel less tired and make those activities a priority for you.

We have information sheet on fatigue. Telephone 13 11 20 for a free copy.

Loss of libido (loss of interest in sex)

This is common during cancer treatment, but may not be a problem for some people.

Cancer treatments may leave you tired and weak or you may be too worried about the cancer to think about sex. It can also occur when cancer treatments disturb the normal hormone balance. Libido usually returns some time after treatment is over. Keep in mind that libido changes with age.

Tips

  • Make it a priority to spend time with your partner. Arrange a ‘date'.
  • If you have lost your libido, talk about it with your partner. They need to know so they can think of ways to help get you in the mood.
  • Touching, holding, hugging and massaging are other ways of showing affection.
  • Set the scene with soft lights and your favourite music. Get dressed-up. All of these will assist with fantasy and help your mood.
  • Stimulate and help your partner reach satisfaction.
  • Suggest a quick, gentle lovemaking session rather than a long session.
  • Change the venue. If your home has been where you and your partner have been coping with side effects of treatment and your partner has been helping you with personal care, book a night away. Try using other rooms in the house not associated with cancer. Change the bedroom around or think about redecorating
    if your treatment is over.

If you have tried all of the above, it could be worthwhile to have a hormonal assessment done to check your androgen profile. There are also treatments available that may help. Talk to your doctor if you are interested.

Different levels of desire

In many relationships one partner is more interested in sex than the other. Cancer can exaggerate this. While you may have managed your different levels of desire before, cancer can complicate things. It may be upsetting for you both.

Tips

  • Talk it over with your partner. Agree on ways you can satisfy your partner without having sexual intercourse.
  • Discuss the range of videos and sex toys, for example, dildos and vibrators, that are available so your partner can satisfy themselves either alone or with you present.

Fear

Fear is a normal reaction to cancer and its treatment. You might fear the treatment you will undergo and how you might cope with it. You may be fearful about the uncertain future you face. People whose partners have cancer often worry they may lose someone they love. It is difficult to be interested in intimacy when you are fearful.

Tips

  • It is possible to learn how to cope with tension and anxiety. Different methods work for different people. Experiment to find the ways that work best for you.
  • Get counselling. Contact Cancer Council on 13 11 20, or an oncology social worker or psychologist, who are usually available at your hospital or oncology centre. The cancer nurse can send you the fact sheet Learning to relax, which discusses strategies for reducing anxiety.
  • Think about how you have managed fearful situations in the past. Discuss these strategies with your partner.
  • Learn to relax or meditate. Often relaxing your body and your mind can help you to feel good and in control.
  • Find out more about your illness - your treatment team will be happy to answer questions about your illness and what you can expect.
  • Talk it over with someone - a friend or colleague.
  • Make a list of things that you enjoy doing. Make time to do one enjoyable thing every day so you feel like you are achieving something that may help to ease your anxiety.
  • Talk with your doctor to see if anti-anxiety medication will be helpful. Keep in mind that some medications may lower your libido.

Difficulty reaching orgasm or satisfaction

This may be caused by pain during intercourse, or by distracting emotions or worrying thoughts - not uncommon among cancer patients.

A person's capacity to reach orgasm usually remains intact unless cancer treatment damages the spinal cord and the genital area is numb. Cancer surgery can also remove sensitive parts such as the clitoris, lower vagina or vulva in women, or the penis or scrotum in men. However, recent research has found that some women and men are still able to have an orgasm after extensive surgery to their genital areas. Nerves may also be damaged during prostate or bowel surgery.

Tips

  • Choose a time when you won't be disturbed and set the mood or atmosphere with soft lighting or candles and music.
  • Help each other by placing your partner's hands and fingers on the areas that arouse and excite you - or do it yourself, if you feel comfortable.
  • Use generous amounts of water-based lubrication, available from the supermarket or chemist.
  • Change your normal positions to more comfortable ones that heighten stimulation. Use pillows to support parts of your body to make you more comfortable.
  • Accept that you may not reach an orgasm each time, and to take the pressure off, focus on other things that give you pleasure.
  • Don't be too disappointed if you do not reach orgasm.

Painful intercourse

This can sometimes be experienced after cancer treatment.

In men, irritation of the prostate gland or urethra from surgery or radiotherapy can cause painful orgasms. Some men may develop scar tissue in their penis after some cancer treatments such as cystoscopy or transurethral prostatectomy, which may cause pain or bleeding. This usually settles down in time.

In women, pain is often related to changes in the size of the vagina or extreme dryness. These changes can occur after pelvic surgery, radiotherapy or treatment that affects a woman's hormones. Your capacity to orgasm usually remains intact unless the cancer surgery removes sensitive areas such as the clitoris or vulva. Sometimes pain during intercourse can distract you from reaching orgasm.

Tips

  • Plan sexual activity for the time of day when your pain is lowest. If you are using pain medication, take it shortly before sex so it will have maximum effect.
  • Find a position for touching or intercourse that puts minimal pressure on the painful areas of your body (see diagrams).
  • Try to focus on your feelings of pleasure and excitement.
  • Use plenty of water-based lubricant.
  • Avoid sexual activity when you are tired or stressed.

Changed appearance

You may look different, or feel less attractive, because of effects from your cancer and treatment. Some commonly experienced changes include weight loss or weight gain, hair loss, loss of a body part and surgery scars.

Some cancers of the head and neck may result in significant change to your appearance. This can be upsetting, not only because the change is visible, but also because speech and eating may be affected. It may take some time before you are used to, and more confident about, your new appearance.

Here are some ideas that might help:

Tips

  • Lower the lights when you have sex until you feel more confident about your bo dy.
  • Show your partner any body changes before sexual activity. This may help you both express how you feel.
  • Choose clothes that hide the part of your body you feel uncomfortable about. There are crotchless knickers, special underwear for men, etc. which can be left on during sexual play.
  • Wear a wig or scarf if your hair has fallen out from chemotherapy.
  • Choose sexual positions that make the changed area less visible if you are self-conscious.
  • If you have a significant change in your facial appearance from surgery or radiotherapy, talk to your doctor about the possibility of plastic surgery or a facial prosthesis. This may help you regain a more natural appearance and help with altered speech.

Depression

Depression is very common in cancer patients and can and should be treated. Discuss with your doctor whether medication, counselling or both will be helpful.

Tips

  • Ask your doctor if your mood change could be related to medications, hormone changes or other medical illness. Depression is a common feature of low testosterone in men and of low sex hormones in women.
  • Be as active as possible. Plan activities for each day such as exercise or meeting people.
  • Find someone who will allow you to talk about your feelings. Try the nurses at Cancer Council on 13 11 20 as a starting point.

‘I lacked confidence in my appearance. I was thin, pale and bald and had a tube sticking out of my chest. During sex I kept a T-shirt on to hide the tube. I kept the lights down low.' - Leanne, 40

Adapting to life with a stoma

Surgery for cancer that results in the formation of a stoma - allowing waste (urine or faeces) to flow through an opening in the abdomen and to be collected in a pouch - means a sudden change in the way you see yourself and the way your partner sees you. You may feel different or unattractive or feel that your pouch smells.

Whatever sexual positions you choose should not affect the pouch or cover, as long as you have put on your pouch securely.

Intercourse via the stoma can be dangerous and sexually transmitted diseases can be transmitted through the stoma. The closing of the anus may be a problem for you and your partner and may require adjustment. Understanding, communication and warmth between you and your partner are vital. If necessary, a stomal therapy nurse can refer you to an appropriate counsellor.

Sexual activity needs a little more planning but can still be satisfying and fulfilling.

Tips

  • Change the pouch before intercourse. You may like to wear a cover over your pouch to prevent the plastic clinging to your skin. Covers can be made in many materials such as cotton or satin.
  • When making love, some women like to wear a sexy mini-slip or short nightgown, or crotchless knickers. Men may like to wear a cummerbund, nightshirt, specially designed underwear or boxer shorts.
  • If you have a colostomy, then consider using either a plug or stoma cap or learning irrigation of the bowel to regain some control. Talk to your stomal therapy nurse, who will explain the procedure.
  • Rest for at least two or three hours after a heavy meal before having sex.
  • Have sex in the bath or shower.
  • Use perfumes, aftershave lotions or odour control products to help with odour control. You can obtain a list of these products from the stomal therapist or ostomy association.
  • If your partner wants to see the stoma or touch it, let this happen.
  • Contact your local continence or ostomy association for support.

Incontinence

Incontinence means poor bladder or bowel control, but may also involve increased frequency or urgency without actually leaking. Just as the physical ability of the pelvic floor muscles affect bladder and bowel control, this can also affect sexual function and interest.

Incontinence can be temporary or permanent. It is one potential side effect of treatment for cancer of the prostate, bladder, bowel, and penis or of the female reproductive organs.

Men experiencing urinary incontinence may find they dribble after urinating. Women may dribble after an orgasm.

Men and women may leak when coughing, sneezing or laughing. This is known as stress incontinence.

For many people, incontinence and the impact this has on sexuality is an embarrassing problem, for which they find it difficult to seek help.

For advice on managing bowel or bladder problems, visit the Continence Foundation of Australia or call their helpline on 1800 330 066, 8am to 8pm Monday to Friday.

Specialist continence adviser nurses from the Royal District Nursing Service are able to visit you to assess your continence and provide advice and support. Contact 1300 33 44 55 to be put in touch with your closest centre.

Tips

  • If you have an indwelling or supra-pubic catheter, tape the catheter to your skin, remove the bag and insert a flow valve or stopper.
  • It is important that you find someone you feel comfortable talking to. You may wish to call the nurses at Cancer Council on 13 11 20.
  • Have a continence assessment done with a specialised physiotherapist, continence nurse or through the Royal District Nursing Service, so incontinence can be better managed or perhaps cured.
  • Exercising the pelvic floor muscles (see next page) can help with incontinence problems and with erection or ejaculation problems.
  • Oestrogen, inserted into the vagina as a cream or tablet, may improve pelvic floor muscles.
  • Plan for sex - wait at least two to three hours after a meal and empty the bowel or bladder beforehand.
  • If you have faecal oozing, use plugs designed for rectal use.
‘My gym instructor turned out to be really helpful here, giving me a set of exercises that not only strengthened my pelvic floor but helped with a back problem as well and only needed to be done each morning.' — (Ian, 58)

Pelvic floor exercises for men and women

These exercises are used to improve bladder control.

To correctly identify the pelvic floor muscles:

  • Sit on a chair, leaning forward with your knees slightly apart.
  • Now imagine that you are trying to stop yourself from passing wind. You should be aware of the skin around your back passage tightening and being pulled up and away from the chair. Your buttocks and legs should not move at all.
  • Now imagine that you are sitting on a toilet passing urine. Try to stop your stream of urine. This will help you to identify the right muscle. Again, you should feel a lifting and tightening.

Practising your exercises:

  • Sit, stand or lie with your knees slightly apart. Slowly tighten and draw up around the back passage and urethra (and vagina for women) all at once, lifting them up inside. Try and hold strongly for a count of five, then release and relax. You should feel a definite ‘letting go' sensation.
  • Repeat and squeeze and lift and relax, making sure you rest for 10 seconds between contractions. If you find holding for five seconds easy, aim for longer - up to 10 seconds.
  • Repeat this as many times as possible - up to 8-10 squeezes.
  • Now do 5-10 short, fast but strong contractions.
  • Do this whole exercise routine at least four to five times each day.

(Adapted from the Continence Foundation of Australia's publications: The continence guide: bladder and bowel control explained and Sexuality and incontinence).

Updated: 29 Oct, 2010