Sex after cancer therapy: expert tips and tricks to regain intimacy
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Sex after cancer therapyΒ is republished with the kind permission of theΒ Fred Hutchinson Cancer Research Center
Sex after cancer therapy: expert tips and tricks to regain intimacy
Sex after cancer therapy can be complicated. Toxic treatment saves your skin in some ways, but totally messes with it in others. Your confidence and sex drive may disappear so fast youβll half expect to see pictures of them on a milk carton. Your body may become terra incognita almost overnight β completely numb in some areas, hypersensitive in others. Surgery, chemo, radiation and anti-hormone therapy keep you alive, yes, but often thereβs a cost: your energy, your erections, your tiny tingles, and your big O.
Unfortunately, cancer treatmentβs sexual toxicity has become the elephant in the bedroom β and the doctorβs office. Patients, partners, and practitioners donβt always want, or even know how to discuss it with each other.
βWe donβt even talk about sex when itβs going well so how can we talk about it when itβs not?β said Leslie Heron, a nurse practitioner with the Survivorship Clinic at Seattle Cancer Care Alliance, the treatment arm of theΒ Fred Hutchinson Cancer Research Center.
We know itβs tough to talk about sex after cancer therapy. But we also know there are ways to counteract the collateral damage and replenish and replace that which Mother Nature gave you and treatment took away.
Read on for a few tips and tools βΒ some PG-13Β β to help you hack your sex life after cancer treatment. Herewith, your cancer sex Rx.
Speak up about sex after cancer β¦ to someone
Doctors are no better at talking about sex and sexuality than we are, said Heron. Theyβre also usually completely focused on saving your life. So if you have concerns about the sexual impact of surgery and treatment and your doctor doesnβt address them, bite the bullet and bring them up yourself β with someone. If not your oncologist or surgeon or primary care physician, then a nurse or nurse practitioner or physicianβs assistant.
βLet them know itβs something thatβs important to you,β said Heron. βAnd you can do that before treatment or early on in treatment. Ask, βWill this affect my sexuality? Will this affect my ability to function sexually? Will this affect my sensation that I feel with intercourse?β You will get a straight answer.β
The same goes for after treatment. If youβre unable to get an erection or have an orgasm or even think about getting naked with somebody again, mention it.
βDonβt wait for your doctor to start the conversation,β advised patient advocateΒ Michele Longabaugh. βThey may never bring it up. Find someone youβre comfortable with and talk to them. If you donβt tell them, they wonβt know itβs a problem. The more people speak out about it, the more itβs going to be part of regular care.β
Map your body for sex after cancer therapy
Survivors often have to figure out what they can and canβt do after treatment, mobility-wise, fertility-wise, and yes, intimacy-wise. Surgery and treatment can leave skin deadened in some spots and super-sensitive in others. You might not be able to twist or turn a certain way anymore; you might not want to take your shirt off because of scarred or missing breasts.
Until you know yourself what works or doesnβt work, you canβt communicate that to your partner. And communication is key to sex after cancer therapy (although talking about these sexual health challenges can be complicated).
Heron encourages both men and women to spend time figuring out what feels good and what doesnβt. Stroke your forearm lightly, she suggested, then a little more firmly, then deeply. Be able to describe what a light, medium or deep touch feels like to you and what parts like what.
βTouch yourself on your arm, your rib, your belly, your inner thigh, your breast, your penis and so on using a light, medium and deep touch,β she said. βThen youβll be able to tell your partner, βThe deep touch feels really good here, but only light touch feels good here.ββ
If a certain section of your sexual territory is gone or changed, perhaps another can pinch-hit. Breast cancer patients may not want a partner to touch their reconstructed (or unreconstructed) breasts, but a nuzzle on the neck might serve nicely in its stead.
Sex after cancer: finding a common language
Once youβve figured out what still packs a sexual punch for you (or not), communicate that to your partner. That doesnβt mean you have to suddenly start talking like a phone sex operator, Heron said, but it does mean you have to understand each other.
βDecide what lingo youβre comfortable using,β she said. βIf you want to use βhoo-haβ instead of βvagina,β then go for it. Just as long as everybody understands the language. So if you say, βI want a light touch on my hoo-ha,β theyβre not going to rub your feet.β
Heron said sometimes when sex doesnβt work the way it once did β thereβs pain or tenderness or lack of response β it becomes awkward and a βdead endβ for couples. If thatβs the case for you and your partner, temporarily focus on intimacy rather than sex.
βSometimes Iβll tell patients to just leave the genitals out of [it] and start with hand-holding,β she said. βThere are other activities that might feel good β even just holding each other, rubbing each other, being physically sexual without having intercourse.β
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Read more:Β The sexual aftermath of cancer treatment
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Director of Fred Hutchβs Survivorship Program Dr. Karen Syrjala also stressed the importance of non-sexual intimacy.
βEven if intercourse isnβt the same as it used to be, the idea of sexual closeness is still an extremely important human need,β she said.
What if you donβt currently have a partner?
βThis is just as important when someone is going out into the dating world and meeting a new person,β said Heron. βIf theyβve mapped their own body sensations and know what feels good and safe and energizing and sexy, then they can start off using that common language and requesting what they want. Then no one is going to be disappointed.β
Learn and explore sex after cancer
Most patients research their disease and its treatment. Doing your homework regarding cancerβs sexual aftermath pays off, too.
Heron recommends taking a field trip to an adult toy store to check out the various products they carry, which include everything from lubes to vibrators to erection rings.
βIf people have access to an adult toy store, I do recommend they go to someplace like Shine [operated by Seattle Cancer Care Alliance] or Babeland in Seattle or Shebop in Portland,β she said. βThere are places all over.β
Shopping online works, too, she said, and can often help to desensitize those who may not be all that familiar with the world of adult products. The downside? When you buy online, you wonβt know how things feel or smell or operate and if you buy an item that doesnβt click with you, you canβt exactly return it. Going to a store in person allows you to feel the texture of a certain lubricant, see how strong a vibration might be against your skin.
βIf you take a vibrator and put it on the end of your nose, youβll be able to tell if itβs too strong,β she said. βYou canβt tell that from an online picture.β
Sex after cancer: get some medical mojo
Sure, treatments like chemo, radiation and hormone therapy kicked your cancer to the curb, but they kicked a lot of other normal healthy functions along with it. Luckily, modern science has some tricks up its sleeve when it comes to getting you aroused, erect and ready to rock and roll.
Cancer patient Jon Dibblee, who had both of his testicles removed in two separate bouts with cancer, swears by testosterone replacement therapy, which he calls the βmiracle drugβ that allowed him and his wife of 34 years to maintain their sexual relationship. Viagra, Cialis, and other erectile dysfunction drugs can also help, said Heron, but only if men are able to get a partial erection on their own.
βIf someone can get even a glimmer of an erection, thereβs a chance those meds are going to be helpful,β she said. βThen we know those blood vessels and nerves are working.β
If you have no sensation and are having trouble getting even partially erect, βa gallon of Cialis β¦ wonβt work,β said Heron. But there are workarounds. Erection rings come in handy for those whose can get, but not stay, erect. Heron recommends a ring that works a bit like a bolo tie (especially for beginners). Men who arenβt able to gain any kind of erection can also talk to their doctor about a surgical implant, she said.
βYou can have an implant in the penis with a pump bulb in the scrotum,β she said. βYou or a partner can inflate the penis and then de-inflate it. It requires minor surgery, but itβs very discreet. Looking at it from the outside, youβd never know.β
When it comes to increasing sexual arousal in women, Heron said Viagra and other ED drugs arenβt recommended but she said there is a βlittle pink pillβ called Addyi on the market that has given some women good results.
Estrogen replacement products such as estrings are another viable option, but itβs crucial to talk to your oncologist or gyn-onc before you go this route. Some are fine for cancer patients; others could be harmful.
βWe donβt want women with an ER-positive cancer having systemic estrogen in, say, a tablet or a patch,β said Heron. βBut frequently, estrings or vaginal suppositories or creams are acceptable. The vaginal area is like an estrogen sponge. If you use a topical estrogen product like an estring or an estrogen cream, itβs incredibly unlikely youβll find that estrogen anywhere else in the body.β
Replenishing whatβs been lost
Most cancer treatment reduces blood flow to the genitalia, which in turn can cause atrophy, pain, loss of lubrication and lack of sensation.
What helps? Lubrication and stimulation.
βUse it or lose it,β said Syrjala, whoβs done clinical research on the sexual side effects of treatment. βI suggest vibrators, more than just dilators, for women. I think thereβs increased sexual response and perceived benefit with vibrators. People are more familiar with them.β
Dilators are useful for women who may have radiation or other damage to their vagina. They often come in a variety pack of sizes (think Russian nesting dolls) and, according to Heron, using them consistently βmakes all the difference.β
Lubes and moisturizers are for everybody and arenβt just for sex (although they definitely help). Just as you moisturized your burns with special creams and ointments when you were getting blasted by daily radiation, you moisturize the delicate tissues of your genitalia in order to replenish the natural moisture that chemo, radiation and anti-hormone treatment may have leeched away. This is especially important for women, many of whom have to deal with menopause symptoms decades before they normally would have. (Fred Hutchβs MsFLASH researchers are looking at ways to help alleviate these symptoms for all women.)
Heron said there are several types of vaginal moisturizers and three basic categories of lubes. Water-based products are easy to wash off and best for those with sensitive skin. Oil-based lubes will stain your bedsheets and certain ones contain ingredients that can trigger nut allergies. Silicone-based products are more slippery, wash off only with soap and water and canβt be used with other silicone-based sex toys (theyβll bond together and become tacky because β¦ science).
Water-based lubricants are best for newbies, said Heron (over-the-counter products like K-Y Jelly and Slippery Stuff are available at most pharmacies). Greater selection and better quality products β including organic lubes β can be found at the specialty stores mentioned earlier.
You are not alone when it comes to sex after cancer therapy
There are other tools in the toolkit, of course: antidepressants, counseling, numbing creams and good old lingerie and candlelight. Even commiserating with other cancer patients can help defuse some of the sting of a treatment-driven sexual dysfunction.Β As can humor.
If cancer has wreaked havoc with your sex life, know that you are not alone when it comes to sex after cancer therapy. Help is only as far away as your laptop or phone. Seattle Cancer Care Alliance has information online about common sexuality concerns, sexuality and self-care during treatment and an excellent resource list. The American Cancer Society and other sites offer a slew of information on sexuality and cancer for both men and women.
Cancerβs sexual aftermath can be devastating for some; nominal for others. But thereβs no reason to suffer in silence. Talk to your doctor about sex after cancer therapy; check out a workshop. Get the help you need. Otherwise, you may just continue to stumble around in the dark. And not in a good way.
Sex after cancer therapy: expert tips and tricks to regain intimacyΒ is republished with the kind permission of theΒ Fred Hutchinson Cancer Research Center

Diane Mapes
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications.
Caption:
Unfortunately, cancer treatmentβs sexual toxicity has become the elephant in the bedroom β and the doctorβs office - affecting intimacy and sex after cancer.