Written by Alexis Dobranowski, a Communications Advisor at Sunnybrook.
Cancer diagnosis and treatment can cause physical changes that affect sexual desire. Cancer treatments can put women into permanent menopause and bring on a host of emotions and challenges for women on the cancer journey.
"Low libido, vaginal dryness and painful intercourse are very common," said Yulya Kagan, registered nurse in Sunnybrook's Sexual Health and Recovery Clinic (SHARE). "These physical issues add up and many women find themselves not talking about sex or intimacy, avoiding sexual relations and having difficulty in their intimate relationship. This can lead to depression or anxiety."
Kim Barrow, gynecologic oncology social worker, says she hears from her patients that while they want to resume sexual activity, they don't know where to start.
"It's kind of like the stuffing has been kicked out of them and they are rebuilding thread by thread," she says. "When it comes to sexual activity, there's a fear of interfering with healing, and of pain."
But the health-care team wants women who are undergoing or who are finished cancer treatment to know that they can resume sexual activity if they want and when they are ready.
Here are some of their tips.
This is normal.
"Many patients are going through this," Yulya says. "During your cancer journey, your circle of relationships surrounds you for support. Your family and friends help you. Once you are through this journey, you are changed. Things don't snap back to 'normal' - you are a new person now after this experience." And so, she says, some things, like how you get sexual pleasure, might be a little different going forward. "Ask yourself, 'How will I enjoy sex again?"
Focus on intimacy, rather than intercourse.
Try dating and enjoying each other's company. Cook together, explore a new neighbourhood, see a movie. Try new activities and have fun together to feel connected.
If sexual intercourse has been painful, we sometimes start to anticipate pain long before intercourse begins, Yulya said.
So, she says, explore intimacy that isn't intercourse. Try this exercise called Sensate Focus.
- Set up time for a date at home or at a hotel. (no kids, no phones or interruptions)
- Set the mood - candles, romantic music.
- If you have scars or other concerns that make you self-conscious, try a lingerie or something that makes you feel good.
- Take turns touching each other, one at a time. Ask your partner lay down on his/her stomach. Take plenty of time to explore your partner's body. Experiment with different sensations and types of touch. You can kiss, pet, touch your partner's body, avoiding genitals and breasts. Do this for 20 minutes. Then switch and have your partner do the touching.
- Repeat two times. Then discuss gently what you liked the most.
"When painful intercourse isn't anticipated, you may be more open for intimacy and enjoying it," Yulya says.
Talk to your partner.
"It's hard to talk about vaginas," Kim says. "For many cultures, it's just not talked about at all."
Kim encourages patients to speak with their partners about their fears, desires or lack of desire.
Often, Kim adds, it's the sexual partner who is most fearful of resuming sexual activity.
"This partner may have seen you when you were ill and in pain, and desperately doesn't want to hurt you or harm your healing," Kim says. She encourages her patients to bring their partner to an appointment where she can help facilitate the discussion.
Use a dilator and other tools.
A dilator can help with the physical side of things by preparing the vagina for intercourse (a dilator set slowly stretches the sides of the vagina.) Water-based lubricants (without any hormones in it) can help keep you wet. Non-hormonal vaginal moisturizers can be applied regularly to help ease dryness. There are also other options for numbing your vagina if it is very painful. Speak to your health-care provider.
If you would like more information check out the SHARE clinic online or speak to your health-care team.
For tips for men, check out Sexual health, intimacy & cancer: a guide for men.
And for a personal journey, read Let's talk about sex -- a cancer patient's perspective
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It’s wonderful to feel truly comfortable with another person, but there can be a downside to this as well. "As our relationship progresses, we start feeling more comfortable with each other,” says sex therapist Vanessa Marin. "Comfort in and of itself is awesome, but often it's accompanied by bit of stagnation. We stop making as much effort with ourselves and each other."
How do you counter comfort? You throw in a bit of excitement! Schedule fun dates, surprise each other, make sure to get time alone together, and just put in that extra effort to avoid getting into a rut.
As people live together longer and intertwine their lives in more ways, it’s inevitable that they’ll fight more often. Those fights can affect your sex life. "Fights lead to resentment, which leads to a growing sense of disconnection inside the bedroom,” Marin says. Working to resolve those fights, and to hopefully prevent some of them from happening, can have romantic benefits as well.
Sexual stagnation at some point during a long-term relationship is a bummer, but it’s also totally normal, Marin says. "So many couples panic when the spark starts to fade, but then they don't actually do anything to bring some renewed energy into their sex lives,” she says. "You have to recognize that great sex is something that requires ongoing effort, and that's not a bad thing!"
If sex is feeling routine, throwing something new into the mix can spice things up. Try new positions, toys, or fantasies, Marin suggests. Novelty is a great way to get some excitement back! "One of my favorite suggestions is to keep a shared Google Docs spreadsheet or Pinterest board together,” Marin says. "Whenever you stumble across an article with a position that sounds interesting or an idea that you like, put it in the document. It will keep the lines of conversation going, and help you stay inspired."
Open conversation is important for figuring out why your sex life has gotten off track — and for getting it fired up again. "Talk about sex,” Marin says. "I know this can seem intimidating for a lot of people, but you simply have to be willing to communicate about your sex life."
Work, housework, kids, hobbies — it can be hard to get any time together as a couple. But making that time is very important, Marin says. "You're not going to be having sex — much less exciting sex — if you don't make time in your day for it!"
Marin admits her bias, being a sex therapist, but says some couples can benefit from counselling before they even feel like there’s an issue. "When couples wait until they're on the verge of breaking up, it's much harder to make progress,” she says. "We're never given the opportunity to learn how to have great sex anywhere else, so working with a sex therapist can be an invaluable experience."
When you’re worried about sex and your relationship, you can get stressed out. When you’re stressed out, it’s hard to get in the mood. And while it does take effort to maintain a healthy and happy sex life, that doesn’t mean it should feel like drudgery. "We take sex so seriously, but sex can actually be incredibly playful and joyful,” Marin says. "Try to be in the moment, and don't get too in your head about it."
All this said, there are benefits that come with a long-term relationship that can reap rewards for your sex life. "Often couples have better sex as they get to know each other's bodies better,” Marin says. "Others value the sense of trust and intimacy that deepens over time. But the bottom line is any couple can have a hot sex life by working on it."
Follow Sunnybrook Health Sciences Centre on Twitter: www.twitter.com/Sunnybrook