Here is a telling statistic…100% of breast cancer survivors experience some form of sexual dysfunction. My guess is that it is the same for prostate cancer survivors. Maybe it has to do with the fact that these cancers involve sexual organs, but then again, maybe not. It wouldn’t surprise me if most survivors notice changes in their sex lives. Far be it from me to pretend to be the Masters and Johnson of survivors. But, as a survivor, I have some firsthand experiences and, as a gynecologist, I have quite a bit of secondhand information to guide me.
Let’s start with the obvious…the physical manifestations of cancer and their impact on a survivor’s sex life. My comments may focus on breast cancer, but really can be applied to other cancers as well. When surgery, radiation, and/or chemotherapy are a part of the treatment, there remain physical scars as a daily reminder. Lumpectomy or mastectomy both result in the loss of what was once a source of pleasure for most women. With each sexual touch thereafter, there is a constant reminder of cancer. After treatments, few patients report that they have sexual pleasure from foreplay involving their breasts, even if they have one intact breast. At worst, there is pain. Most commonly, there is numbness. Even I, a physician, never realized that my chest would no longer feel pleasure sensations after my mastectomies. What I am able feel is pressure, and if the pressure is too hard, then there is shooting pain…and there is not much erotic about the sensation.
Many spouses of breast cancer survivors think they are being sensitive when they announce that their lovers’ reconstructed breasts are still a source of sexual pleasure. But they don’t realize that this comment is a double-edged sword. The patient wants to please her mate or feels a pressure to resume normal sexual function to prove the cancer is over. She doesn’t want to say “please, don’t touch my breasts even if they turn you on because each touch is a reminder of my cancer and I can’t feel anything anyway”. Instead, they permit touching. This can result in resentment toward a partner that really had good intentions. While he feels that telling her that her breasts are still sexy to him, he can’t intuit her discomfort and is not able to understand the delicacy of the whole issue. But they say that the road to hell is paved with good intentions and this is an example.
Many couples start to bypass the breasts altogether. For some, this works out just fine. I counsel that wearing lingerie or some type of cover-up helps. The negligee can allow looking without touching, creating a visual erogenous zone. If the couple can be creative, they find other sources of arousal, concentrating the other four senses (taste, smell, sight, vision). If they don’t adapt, sex changes radically. Little foreplay and not enough time for the woman to become excited enough to climax. Many patients tell me that sex becomes a chore. They are happy to have it be over quickly because they no longer enjoy it.
If this is the case for breast cancer,what about other kinds of cancer? While I have personal experience with the physical challenges posed by breast cancer, I have learned about other sexual problems from patients with other kinds of cancer. Some gynecologic cancer surgery renders women incapable of intercourse altogether. Few of these women recover sexually. Their embarrassment, pain, and frustration often make even an attempt at having sex not worthwhile. Many patients get depressed. The medications we give them to treat depression often worsen the problem by decreasing their libido and making orgasm virtually impossible.
A lot of women go through menopause as a result of their treatments. The lack of hormones diminishes their libido and vaginal dryness can make sex excruciating. Luckily, if they have a sensitive gynecologist, the dryness can be reversed. The libido is another story. Libido is 90% between the ears. It fluctuates throughout life. Few postmenopausal women have a high libido. No matter what Suzanne Sommers says! I try to teach my patients that the less they have sex, the less they want it and the less they want it, the less they have it. Kind of like going to gym…once there, most are happy they went! And the converse is true…the more they do, the more they want to do, etc, etc. Just getting started is the hard part. If I can help eliminate the physical pain of intercourse, then they are far more likely to try.
I can only imagine what it is like for men, but my instincts tell me they have similar sexual obstacles as a result of cancer. Many prostate procedures render patients impotent or subject to erectile dysfunction or ejaculation difficulties. Some wives have confided in me that their husband’s cancer was the end of their love life. Without the ability to have intercourse, some men just stop trying to have any type of intimacy.
If sex after cancer becomes difficult or nonexistent, what impact does that have on the relationship? The answer is that it all depends on the relationship. Some weather storms well and others do not. Some couples get very close and have the affection and caring of best friends. Others end with infidelity or divorce. Statistically it is about 50-50 that the marriage will survive. The 50% that do make all share two important traits…patience and communication. Without them, you might as well move into another bedroom!
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