Sexuality – a ‘new me’ and a ‘new we’

Satisfying sexual activity doesn’t rely on full physical perfection, and often after a diagnosis of cancer, a couple can connect and find levels of intimacy greater than what they had previously. Dr Anthony Smith explains.

The diagnosis and management of cancer causes a radical disruption to normal life and can be devastating to the sexual lives of men. Over the last decade advancing therapies have allowed more people to survive cancer, resulting in longer periods of time over which disturbances in sexual function can occur. How cancer affects a man’s sexual health can broadly be divided into three areas: 

• Sexual function

This includes the capacity to feel desire, the development of an erection, and the experience of an orgasm. These can be disturbed by many factors. 

Chemotherapy, radiotherapy, surgery and various other medications can cause damage to the endocrine system, blood vessels and nerves of the pelvis, and make it difficult or impossible for normal sexual activity. 

• Sexual identity

The diagnosis of cancer and its treatment can affect how a person sees themselves as a sexual being. A man’s sexual identity is closely related to his feeling of ‘potency’. If treatments have caused him to be infertile, or if they have radically changed his external appearance, he may suffer a blow to his sexual confidence. 

This is particularly true of cancers that affect the genital area, including prostate, penile and testicular cancer. These men experience a loss of ‘male characteristics’, with diminished desire, assertiveness and erection, worsened by developing ‘female characteristics’, including breast enlargement, female pattern weight gain, hair loss and hot flushes – the result of testosterone deprivation. 

• Sexual relationships

Cancer treatments inevitably affect sexual relationships. Avoidance of initiating sexual intimacy can often result in a total shutdown of lovemaking. Both partners can experience feelings of guilt, anger and frustration. 

This can be especially hard on the partner of the cancer sufferer, whose role may become that of primary carer, often exhausted and now seeing their spouse as a patient rather than an erotic partner. While a diagnosis of cancer can bring a couple together, it can also undermine the stability of the partnership. 

Period of fear

Cancer sufferers typically go through a long period of fear. Fear of death and fear of reoccurrence, such that every new physical symptom becomes a sign of a catastrophe and every new medical examination an ordeal. 

It’s not surprising that those with cancer can often become depressed and anxious. Mood problems and the antidepressants used to treat them can negatively impact sexual function too. 

Not all doom and gloom

Reviewing what’s been written so far, it will seem that everything is doom and gloom. But it is not! Couples are often able to surpass the limitations of the cancer, to maintain active and satisfactory sex lives. 

The key to success is in adapting to changing circumstances. The range of sexual reactions to a diagnosis and treatment of cancer is very wide. 

Often the initial diagnosis and treatment has a serious impact on sexual intimacy. Some people quit all together, others refrain only from genital contact, and others persevere no matter what. Much depends on the quality of the relationship and the part sexuality plays in it. 

Once the initial treatments have passed, couples will look to redefine their sex lives, and those who are most successful will gradually develop a ‘new me’ and a ‘new we.’ A new normal. They will accept their physical limitations and expand their capacity to communicate sexually. 

Tips to successfully maintain a good sex life after cancer

• Be mindful of how a sexual disturbance can affect your partner. Sexuality is about more than sex, so spend time cultivating romance, relaxation and connection together. 
• Often couples establish fixed sexual patterns over many years. Be prepared to try alternative and creative solutions to satisfy each other.
• Keep communicating what feels good, and what doesn’t feel good so that a new erotic roadmap can be established.
• To maintain a healthy body image, maintain a healthy weight, keep exercising, eat well, and actively combat fatigue, mood and low self-esteem. 
• Talk with your healthcare team about changes in body relating to sexuality. 
• It may be that certain medications can be stopped, or added; aids can be suggested; and referrals to members of a multi-disciplinary team who specialise in sexual dysfunction could help. 

MEET OUR EXPERT – Dr Anthony Smith

Dr Anthony Smith is a general practitioner in private practice, with an interest in sexual medicine. He is a Fellow of the European Committee of Sexual Medicine (FECSM).