When people are diagnosed with cancer or living with cancer, they have many questions regarding sex and sexuality. They often find it difficult to discuss these questions with other people, even their own partners. They become worried, stressed and concerned with many questions, such as the following:
• Can I have sex when I am diagnosed with cancer?
• When is it safe to have sex?
• Will I still be able to have sex?
• Will my partner catch cancer from me?
• Will my partner still love me?
• Will I be able to date again?
• Will I ever be sexually aroused again?
• Will my partner leave me because I have cancer?
• How will I have sex when I have a colostomy or urinary bag?
• Is there anybody with whom I can discuss my sex concerns?
Most of these concerns are either related to being diagnosed with cancer or a result of cancer treatment. Most sexuality issues and problems during cancer treatment are psychological, physical, physiological, or a combination of these. Many of these problems are a direct result of chemotherapy, surgeries, or radiation therapy. Some estimates show that almost all people have some form of sexual dysfunction or sexuality-related problems after cancer treatment. Research suggests that almost 50 per cent of women who have had breast cancer or gynaecologic cancer experience long-term sexual dysfunction. For men with prostate cancer, erectile dysfunction and impotence are the main sexual problems. Research also shows that almost 25 per cent of people who have had Hodgkin’s lymphoma or testicular cancer develop long-term sexual problems.
The most common sexual problem for both men and women with cancer is loss of desire for sex, or low libido. ED (impotence) among men and pain during sex among women are as common as the loss of desire for sex. Other problems, such as anxiety, depression, pain, and fatigue, also reduce the patient’s desire for sex. Unfortunately, unlike many other side effects of cancer treatment, sexual problems do not improve early and may even worsen.
Cancer treatment can also affect fertility, which means that women cannot get pregnant and men cannot make women pregnant after cancer treatment. Many sexual and fertility problems are the direct result of radiation therapy to the pelvic area. For women, this includes radiation to the vagina, uterus, or ovaries, and for men this includes radiation to the testicles or prostate. Surgeries such as breast removal, penis amputation, limb amputation, and permanent colostomy bags cause a negative body image and low self-esteem, which directly affect sexuality and sexual activities.
Management of problems among women
The common problems among women include pain or discomfort during sex, menopausal symptoms, and inability to fall pregnant. In general, women should be able to have sex six weeks after the operation. It is okay to have sex while receiving radiation or chemotherapy treatments, unless the doctor has advised otherwise.
If there is pain during sexual intercourse, using water-based lubricants, such as K-Y Jelly, can help. For a dry vagina, a vaginal moisturiser, such as Replens, can be used once a day. If the vagina is dry and the woman has menopausal symptoms, it is important for her to discuss with her doctor whether she can use hormonal creams or pills.
If the vagina is narrowed and causing pain during sex, an instrument called a vaginal dilator can be used to stretch the vaginal walls. Patients should discuss using a dilator with their doctor. If the vagina is shortened during surgery, the penis hits the back of the vagina during sex and causes pain. This can be reduced by the woman sitting or lying above her partner while having sex. It is also worth reading books and pamphlets to understand different positions for sexual intercourse. Having a warm bath just before having sex can loosen tight muscles and help the muscles relax during sex.
If a woman wishes to fall pregnant following cancer treatment, she should discuss this with her doctor before beginning any treatment. The doctor may suggest ways of preserving the woman’s fertility. If the woman is receiving radiation therapy, she must ensure she does not fall pregnant, because radiation therapy can damage the foetus. In such cases, women should discuss their contraceptive options with their doctor.
Management of problems among men
Men experience a few sexual problems after cancer treatment, mainly after prostate and testicular cancer treatment. These problems may include inability to have an erection (impotence), low sex drive (low libido), and ejaculation problems and inability to make a woman pregnant.
In general, like women, men should be able to have sex six weeks after their operation. It is okay to have sex while receiving radiation or chemotherapy, unless the doctor has advised otherwise.
Impotence may be psychological, physiological, or a combination of both. Radiotherapy, surgery, and hormone treatment can all lead to difficulty in getting an erection. Depending on the type of treatment the patient has received, this may be temporary or permanent. The patient should discuss treatment options with his doctor. Depending on the cause of impotence, the doctor may refer the patient to a sex therapist or advise pills (Viagra, Cialis), injections (caverject), or devices like vacuum pumps and penile implants that can help the patient get an erection. There are also doctors who specialise in men’s health (or sexual health) who can help the patient deal with impotence.
If the patient experiences low sexual desire, he should discuss with his doctor to determine whether the cause of low sexual drive is the cancer treatment or psychological issues. The doctor may refer the patient to a sex therapist or counsellor, or may suggest hormone therapy, if appropriate.
If the cancer treatment will make the patient infertile-such as with removal of the testicles-and the patient wishes to father children in the future, the patient’s sperm must be collected before treatment. The patient should discuss this with his doctor. The doctor may suggest collecting sperm before beginning any treatment.
In summary, it is very important for patients to openly discuss their problems with their doctor, because most of these problems can be solved. Patients may be offered various treatment options or referral to other health professionals including sexual therapists, psychologists, or counsellors as required.