Opening the Door to Intimacy Carolynn Peterson, RN, MSN, AOCN
What is the largest sex organ in humans?
Ways That Cancer or Its Treatment Can Affect Your Sexuality: 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
Estimates of sexual dysfunction after cancer treatments range from 10% to 90% depending on the site. Debilitating physical symptoms such as fatigue, nausea, anorexia, and pain can greatly diminish sexual desire. Cancers that do not directly affect sexual organs may have no less an impact on sexual self-image.
Surgery Surgical treatment for cancer can affect sexual functioning by impairing the vascular supply or the innervation to pelvic organs, by amputation of pelvic organs, or by reducing the circulating hormone levels.
Chemotherapy Systemic effects of chemotherapy can affect body image, sexual functioning, and fertility. Side effects include fatigue and nausea and vomiting that diminish libido and cause alterations of body image, along with hair loss, weight changes, pallor, and dry skin. Mucositis can interfere with kissing and oral sex. Immunosuppression may require a temporary break from intercourse, particularly in women, to prevent infection.
Radiation Therapy During treatment with external beam radiation therapy in combination with lumpectomy for breast cancer, women have an estimated 75% disruption in sexual activity Up to 79% of women treated with external beam and intracavitary radiation therapy for cervical cancer have reported sexual impairments. Radiation therapy can decrease a man's ability to have voluntary erections, even though desire and sexual sensations are still present
Hormone Therapy Men with low levels of testosterone may experience lowered sexual desire, difficulty in achieving a functional erection, less pleasurable orgasm or difficulty in reaching orgasm, decreased semen production, and diminished spermatogenesis If estrogen is used, estrogen excess can cause gynecomastia, feminization, penile and testicular atrophy, and erectile dysfunction
Have Things Changed? Has being ill interfered with your being a husband, father, wife, mother? Has your illness changed the way you see yourself as a man/woman? Has your illness affected your sexual function?
The Impact of Body Image Body image changes probably occur in most patients with cancer and can greatly impact quality of life The outward effects of cancer and its treatment can impact significantly on body image, self esteem and sexual desire Both men and women may be profoundly affected by hair loss due to chemotherapy
The Impact of Body Image Both men and women often lose interest in sex during cancer treatment, at least for a time Loss of desire may result from anxiety, depression, nausea, pain or many other symptoms Cancer treatment that interferes with the normal hormone balance can also lessen desire
Potential Obstacles Low White Blood Cell Count Low Platelet Count Vaginal Dryness Impotence Pain Physical Limitations Loss of Libido
Overcoming Obstacles Low White Blood Cell Count = Increase risk for infection Use of Condom Good personal hygiene Low Platelet Count = Increase risk of bleeding Gentle intercourse Abstain from oral and anal intercourse
Overcoming Obstacles Vaginal Dryness = Increased risk of pain and infection Use water-based lubricants Prolonged foreplay Use pre-lubricated condoms
Overcoming Obstacles Impotence = Inability to achieve or maintain erection Medication, if appropriate Surgical implants External devices: Pumps, bands Injections Positioning
Overcoming Obstacles Pain Premedicate Consider anti-anxiety agents Positioning Touching Physical Limitations Positioning Touching Communication
Overcoming Obstacles Loss of Libido Manage troubling symptoms Fatigue, pain, depression, nausea Go for a makeover Look Good Feel Better Make a date Innovate Body Image Accepting the Nude You
Ask Your Doctor How will my cancer treatment affect my desire for sex? Am I likely to have pain during sex as a result of treatment? How will this treatment affect my ability to have an erection and ejaculate? Will this treatment cause me to go through menopause? Will the effects be short-term or permanent? Will my appearance change? Is there any reason why I should not have sex while undergoing treatment?
Talking, Telling and Supporting Each Other Discuss your fears with one another State your feelings positively Ask for what you need Sexual sharing
Common Myths about Sexuality "Sex is Only for the Young and Able-Bodied" "Sex Means Intercourse" "The Goal of Sexual Activity is Orgasm" "Sexual Performance Equals Love" Sexual Activity is Natural and Spontaneous" "Masturbation is Harmful"
Myths about Cancer & Sexuality MYTH: Cancer is contagious TRUTH: Cancer is not contagious (cannot be passed from one person to another). You don t have to worry about giving cancer to your spouse or partner.
Myths about Cancer & Sexuality MYTH: Sex is harmful to the person with cancer or his or her partner. TRUTH: Cancer treatment doesn t make sexual activity dangerous. Check with your doctor if: You have radioactive seeds. You re receiving chemotherapy and are wondering if you should use condoms during your treatment (some chemotherapy drugs can be present in small amounts in semen or vaginal fluids). You re considering a form of birth control, as chemotherapy drugs may cause birth defects.
Myths about Cancer & Sexuality MYTH: Sex can cause problems with cancer treatment. TRUTH: For most people with cancer, having sex is not harmful, but sometimes you may need to wait awhile before having sex. Situations that may pose a risk to your health: If bleeding occurs in genital area/urinary tract, avoid intercourse until the cause is identified and treated. Infection may be a threat if your white blood cell count is low. DO NOT have unprotected sex if you or your partner has other sex partners. This helps avoid the risk of infection and STDs.
Strategies Ask your doctor and nurse about the usual and expected effects of cancer treatment on your sex life Remember to keep an open mind about ways to feel sexual pleasure Consider sexual counseling with a sex therapist for problems caused by anxiety
Strategies Stay active to fight depression and reduce stress. Consult with your doctor on appropriate types of exercise Use touching, holding, caressing Talk about your fears
Summary Survival overshadows sexuality Expect the unexpected Give yourself time Communication is all-important Take the pressure off intercourse Don't let your diagnosis dictate what you can do sexually You are loved for your total worth, not just for the appearance of your body You don't have to do it all yourself
Further information and support These materials and many more are available at www.cancer.org or (800) 227-2345 or your local Society office: Sexuality and Cancer: For the Woman who has Cancer and Her Partner Sexuality and Cancer: For the Man who has Cancer and His Partner Understanding Chemotherapy: A Guide for Patients and Families Understanding Radiation: A Guide for Patients and Families