Sexuality & cancer treatment

Friday 31 May, 2013

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On this page: How cancer and treatment may affect sexuality | Planning for changes after treatment | A note to partners


When you're first diagnosed with cancer it's natural to focus on getting well. You may not think about the impact on your self-esteem, body image, relationships and sex life until treatment's over. Even if you're aware of the potential impact, it's very hard to predict how cancer and its treatment will affect you. Some changes are temporary; others may be longer lasting or permanent.

Cancer and its treatments can affect your:

  • feelings (including fear, anxiety, sadness, anger and joy)
  • body's production of the hormones needed for sexual response
  • physical ability to give and receive sexual pleasure
  • body image (how you see yourself) and self-esteem
  • roles and relationships.

Emotions and sexuality

It's normal to feel a range of emotions when dealing with cancer and its treatment. Some of the emotions you may feel include:

Anger: You may feel angry about having cancer and about the ways it's affected your life, including your sexuality or your ability to have children (fertility).

Anxiety: The thought of having sex again after treatment can cause anxiety. You may be unsure how you'll perform, dread being touched, or feel self-conscious about being seen naked. If you're single, you may feel anxious about getting involved in a new relationship. Worrying that you're not satisfying your partner sexually can also cause distress. 

Fear: You may worry that others will avoid or reject you when they see how your body's changed. You may not be able to imagine yourself in a sexual situation again.

Guilt: Many people think they should just be grateful to have the cancer treated and feel guilty for thinking about sex or their sexual needs. Some people wonder if past sexual activity has contributed to their cancer. Cancer isn't sexually transmitted, but some cancers may be linked to a sexually transmitted infection.

Self-consciousness: If your body has changed physically after treatment, you may feel self-conscious. Often people discover that their partner isn't as concerned about these changes as they are.

Shame: You may feel ashamed by changes that affect your sexuality, your appearance or the way your body functions.

Depression: Symptoms of depression can include feeling sad, irritable or anxious, having trouble sleeping, losing interest in activities you previously enjoyed, poor appetite and a decreased interest in sex (low libido).

Grief: You may grieve for your former body and sex life if things have changed significantly. These feelings can affect your self-esteem, sexuality and attitude towards intimacy. It can help to talk about how you're feeling with someone you trust and feel comfortable with, such as your partner, another person who's had cancer, or your doctor, cancer nurse coordinator or counsellor.

Call 13 11 20 for a free copy of the Emotions and Cancer booklet. 

Common sexual problems associated with cancer treatment

General problems

  • losing interest in sex
  • tiredness and lethargy (fatigue)
  • losing a body part, such as a reproductive organ or breast
  • changed body image, e.g. due to scarring, loss of a body part or changes in weight
  • fertility problems (temporary or permanent)
  • painful intercourse
  • depression and anxiety
  • strain on, or changes to, your relationship(s). 

Male problems

Specific problems for men may include:

  • erectile dysfunction
  • ejaculation difficulties. 

Female problems

Specific problems for women may include:

  • trouble reaching an orgasm
  • vaginal dryness
  • reduced vaginal size
  • loss of sensation
  • pelvic pain
  • menopausal symptoms.

 

Treatment and sexuality

The most common cancer treatments are surgery, radiotherapy and chemotherapy. These treatments can have temporary or permanent effects on your sexuality.

"Max felt he wasn't the same man after treatment. He'd avoid talking and touching. Counselling gave us ways to help express what was really going on." — Amy 

Surgery

Surgery aims to remove the cancer from your body. It can potentially affect your sex organs and body image.

Bowel or rectal surgery

In most cases, when part or all of the bowel or rectum containing the cancer is removed, the bowel is joined back together. In a small number of cases, because of the position or size of the cancer, the bowel is brought to an opening on the outside of the abdomen. This procedure is called a colostomy and the opening is called a stoma. Waste (faeces) is then collected in a disposable plastic bag attached to the stoma (colostomy bag).

Sometimes a stoma is only needed for a short time, but in other cases it's permanent. If you have had a stoma, you may feel self-conscious about the
change in your body's appearance and this may affect your desire to have sex. 

In men, the surgeon may not be able to preserve the nerve function in the abdomen. This may make it difficult to have and/or sustain an erection (erectile dysfunction). Erection performance may improve over time but sometimes it's permanently affected.

Pelvic surgery

This surgery (pelvic exenteration) involves removing the major organs of the pelvis, including the uterus, cervix, vagina, bladder, and rectum. It can be done to treat advanced or recurrent cancer in the pelvic area, such as cervical, uterus, vulva or vaginal cancer. People who have this surgery will require a stoma to remove faeces from the body and a surgically created opening in the skin to remove urine from the body (vesicostomy).

In men, the prostate is removed, which will affect the ability to get and maintain an erection.

In women, this surgery involves the partial or complete removal of the vagina, cervix, uterus, Fallopian tubes, ovaries and levator muscle (a broad, thin muscle situated to the side of the pelvis). It may also include removal of the vulva. 

The emotional impact of having cancer and surgery is significant. It can affect your sexual identity and sexual confidence.
Call 13 11 20 to talk with a counsellor or to find a sexual therapist. 

Surgery for men

Prostate surgery

For men with early prostate cancer, surgery to remove the prostate is a common option. This is called a prostatectomy. After this type of surgery, most men will experience some degree of erectile dysfunction, which may be temporary or longer lasting. It may be possible to preserve the nerves that control erections. This is called nerve-sparing surgery (see below).

Other common effects of prostatectomy include:

  • feeling the same sensations of build-up before orgasm, not ejaculating semen during climax (dry orgasm)
  • the semen going backwards toward the bladder instead of forwards (retrograde ejaculation)
  • urinary incontinence during orgasm (climacturia)
  • pain during orgasm.

Nerve-sparing surgery

Preserving the nerves that control erections can help reduce the risk of erectile dysfunction. The possibility of nerve-sparing surgery depends on the location of the cancer and whether or not it's spread along the nerves.

Nerve-sparing surgery works best for younger men who had good quality erections before the surgery. Problems with erections are common for
1-3 years after nerve-sparing surgery, but aids such as penile injection therapy can improve the situation.

Removal of the testicles

Removal of the testicles is called an orchidectomy (or orchiectomy). If you have one testicle removed, there are no lasting effects on your ability to have sex. The operation won't affect your fertility or your ability to get or maintain an erection. Your remaining testicle should make enough testosterone and sperm for you to be able to father children.

Having both testicles removed (bilateral orchidectomy) will cause some permanent side effects. The lower testosterone levels may affect your sex drive, but this can be improved with hormone replacement therapy. The appearance of your scrotum can be maintained with an artificial testis (prosthesis).

Since you'll become infertile after having both testicles removed, you may be able to have sperm stored before treatment starts, for use at a later date. Speak to your doctor about this option before starting treatment.

Removal of the lymph glands

If cancer has spread to the lymph glands in your abdomen you may need surgery (a lymphadenectomy) to remove them. After a lymphadenectomy you can still get an erection and have an orgasm.

Removal of the bladder

The operation to remove your bladder (cystectomy) may damage the nerves in the pelvic area. making it difficult to get an erection. 

Removal of the penis

This operation is only done for cancer of the penis, which is very rare. Depending on the location of the tumour, part or all of the penis may be removed. The part of the penis that remains may still get erect with arousal and may be long enough for penetration. It's sometimes possible to have a penis reconstructed after removal but this reconstructive surgery is still experimental. This would require another operation. A penile implant is another option to help get and maintain an erection.

Surgery for women

Breast surgery

Most breast cancers are treated with surgery. Women may have: part of the breast removed (breast conserving surgery or lumpectomy); the whole breast removed (mastectomy); or both breasts removed (bilateral mastectomy). Mastectomy can also damage the nerves in the nipple. This can affect sexual activity, particularly if you're aroused by touch to the breast and nipple. Breast and nipple feeling usually remains the same after breast conservation surgery. See our pages on Understanding Breast Prostheses and Reconstruction.

Lymph nodes are sometimes removed to prevent the spread of breast cancer. This may cause the arm to swell (lymphoedema), making movement and daily activities such as dressing difficult. The swelling may also make you feel embarrassed or self-conscious. Breast surgery may make you feel like you have lost part of your female identity. You may feel less attractive or worry that your partner or a prospective partner will reject you because of the appearance of your breast(s).

Removal of the uterus

The removal of the uterus (womb) is called a hysterectomy. A hysterectomy may be used to treat gynaecological cancers, such as cancer of the cervix, ovary, uterus and endometrium (lining of the uterus). After a hysterectomy you'll be unable to fall pregnant.

After the uterus is removed, the top part of the vagina is shortened. This shouldn't affect your ability to feel sexual pleasure, though some women notice if the cervix has been removed as well. The clitoris and the lining of the vagina will remain sensitive.

Removal of the ovaries

The removal of an ovary is called an oophorectomy. If only one ovary has been removed, the other should continue to release eggs. If both ovaries are removed, and if you haven't already been through menopause, you'll no longer have your monthly periods or be able to become pregnant.

The removal of both ovaries (bilateral oophorectomy) will also cause permanent menopause. This means that your periods will stop, for women who are still having periods, and it will no longer be possible to become pregnant. 

Removal of the vulva

The removal of some or all the vulva (outer sex organs) is called a vulvectomy. This surgery will change the appearance of your genital area and affect sexual activity. You may also feel you've lost a part of your female identity or be worried about how your partner will react. These are all natural reactions.

Even if the clitoris is removed, an orgasm may still be possible. Stimulation of other sensitive areas of your body, such as your breasts or inner thigh, can lead to a climax. It may take time for you and your partner to adjust to this.

Vaginal surgery

Vaginal cancer may be removed by surgery that takes out a small section of the vagina. Usually the remaining vaginal tissue can be stretched so you're still able to have intercourse. Some women need a larger operation that removes the whole vagina (a vaginectomy).

A vaginal reconstruction may be an option, but the scar tissue from surgery can make intercourse painful and difficult. 

Most women feel shocked and upset about having cancer in one of the most intimate and private areas of their body.
Call Cancer Council Helpline 13 11 20 for support. 

 

 

 

 

 

 

 

 

 

 

 

 

How cancer and treatment may affect sexuality

It is very difficult to predict how cancer and its treatment will affect you. For many people there are changes that mean they need to develop new ways of giving and receiving pleasure. This may involve having an orgasm or simply being touched or caressed. Some of the changes are temporary; others may be longer lasting.

Cancer and its treatments can affect your:

  • production of the hormones that are important for sexual responses
  • physical ability to give and receive sexual pleasure
  • thoughts and body image (how you see yourself)
  • feelings such as fear, sadness, anger and joy
  • roles and relationships.

These are linked. For example, if you lose your hair you may not feel as attractive. This means you may feel less confident or desirable when you are with your partner.

Remember, you should be able to develop or renew your sexuality, despite cancer and side effects from treatment.

Planning for changes after treatment

Discussing your feelings, concerns and what you want with your partner can help your sex life. Not talking can lead to frustration and confusion.

Your relationship is undergoing change. It can take time for both of you to readjust.

There are many ways you can prepare for sex after or during cancer treatment:

  • Talk openly with your partner about any fears you have about resuming sexual activity.
  • Let your partner know how you feel - when you're ready to have sex, what level of intensity you prefer, if they should do anything different and how they can help you to feel pleasure.
  • Be concerned about how your partner feels, as they may be worried about hurting you or appearing too eager.
  • Take it slowly. It may be easier to start with cuddles or a sensual massage the first few times rather than penetrative sex.
  • Plan ahead. While this may lessen spontaneity, choosing the right time can help deal with fatigue and pain.
  • Be patient. Things will improve with time and practice.

Below are some suggested ways to start talking to your partner:

‘I am going to show you the way I like to be touched and the places that are sore and out of bounds ...'

‘There are some things I would like to try and do together that will help us feel close and connected, without "going all the way". 

‘I want to put "going all the way" aside for a while until I get my confidence back. We can try some new things out to make us feel close.'

A note to partners ...

This can be a very difficult time for both of you. It can be upsetting watching someone you love go through cancer, its treatments and side effects. You may have concerns but feel unable to express them for fear of worrying your partner.

It can be helpful to talk to close family or friends, or someone you trust, about your fears and concerns for your partner. Call Cancer Council on 13 11 20 to speak with a cancer nurse and to be linked with a carer from Family Cancer Connect. They can connect you to someone who has been in a similar situation to you.

Try to make time to spend with your partner doing things you enjoy doing together, such as seeing a movie or walking in the park, so that you are not focusing on the cancer all the time.

During cancer and its treatment, roles within the relationship may need to change. Try to talk openly about these changes and how you can readjust your life around them.

Honest and open discussions are important so that you aren't trying to guess what your partner may be thinking.

Despite physical and emotional changes, your partner needs to know that you still love them and find them attractive. They may be concerned about losing you or being unable to satisfy you sexually. If they have changed physically, remind yourself of their other qualities, such as their sense of humour, intelligence or personality. These will help you see past the physical changes.

Be prepared to go at their pace. Give your partner time and space to recover.

Ask your partner to tell you or show you what feels good or what areas are sensitive to touch, as well as areas that are sore or painful.

You may be concerned that you could get cancer from your partner. It is not possible for cancer to be passed from person to person through kissing, intercourse or oral sex. Also, sex will not make the cancer grow or spread.

Take time to adjust.

Updated: 31 May, 2013