FOR MORE INFORMATION ABOUT THE FOLLOWING, SEE THE OTHER SECTIONS OF THIS DOCUMENT

Sexual issues are not uncommon in the new normal that exists for life after a diagnosis. Still, neither sex nor intimacy need to end. You may need to change the way you have sex or express intimacy, not “whether” you engage in either of them.

Sex has a variety of benefits including improved mood, stronger immunity, and reduced pain.

Keep in mind that sex is only a part of sexuality and of intimacy. It is not the only way of having intimacy with another person. For some people, sex is only a small part. Also keep in mind that Intercourse is not the only satisfying sexual activity. For example, cuddling and kissing with someone you care about and who cares about you can be very satisfying.

Sexuality is the way we think about ourselves as sexual beings. It involves both physical and non-physical parts and is different from person to person. Sexuality involves the clothes we wear, the way we move, the way we have sex, with whom we have sex and even cultural and religious beliefs about sex.

Sexuality is different from Intimacy.  As a general matter, intimacy is the sharing of our innermost thoughts and emotions. Intimacy can involve sex and/or touching, but it doesn’t have to.

How we think about ourselves as sexual beings influences our behavior. If we have negative feelings about ourselves, we are likely to feel down and withdraw from other people – even from a partner and children.

As a general matter, you can have sex during treatment. However, it is advisable to always check ahead of time with the doctor who is overseeing the treatment.  Sex during treatment is not recommended if:

• Your immune system is low (“immunosuppressed”)
• You have very low blood counts
• You are in the first weeks of recovery after surgery
• You have an ostomy

Different treatments have different side effects which are described in an attached section. As you look at the list of potential side effects, keep in mind that different people have different side effects and experience them differently. Other sections of this document discuss the impact of these side effects on sexuality, and tips for dealing with them. If you are looking for information about dealing with the other aspects of a particular side effect, see the documents in “To Learn More.”

Be creative. Think about your needs. Keep in mind that skin is the largest sex organ and the brain is the most important sex organ which means that the possibilities are limitless. Communicate with your partner.

If sexual or intimacy issues are a concern, see the sections which are part of this document for suggestions that help with sex or sexuality.

If you don’t find the answer that works for you, speak with your doctor. Don’t wait for him or her to bring up the subject. While doctors consider quality of life subjects important, they tend to focus more on the physical aspects of your condition and/or treatment. Many physical issues can be treated. Your doctor may be able to help you pinpoint the cause of issues you are having. Perhaps a medication can be prescribed or a treatment can be changed. Your doctor may also have suggestions about working through emotional issues.

Involve your partner.

• Communication about your needs and concerns is critical.
• The best communication is to state a fact, then a belief, then a suggested action.
• If your partner is not interested in sexual activities, perhaps there is an underlying fear or anxiety that can be reduced or eliminated with communication. If not, there are steps to take. For instance, consider cuddling plus self pleasure.

Be patient.

Keep a sense of humor. A sense of humor is a must. (See the document in “To Learn More” if you have difficulty finding humor in the situation and/or in life).

If sexual issues become unmanageable, consider couples counseling or consult a professional such as a licensed sex therapist who is experienced in dealing with people with your health condition or particular situation. You can find a sex therapist through the American Association of Sex Educators and Therapists, www.aasect.org .

NOTE:

• Men and women:
  • If you are considering undergoing resection surgery, there are exercises known as Kegel Exercises that you can start before surgery to help manage incontinence. The exercises can also be helpful with an erection for men.  To learn more, click here.
  • If a drug or treatment could render you unable to have children, you can preserve the ability to have a child by banking eggs and sperm prior to starting a drug or treatment. To learn more, click here. Adoption is also an option. To learn more about adoption after a diagnosis, click here.
• Women    
  • If you are considering undergoing radiation or surgery anywhere near the pelvic area, or if you are pre-menopausal and are considering chemotherapy, ask your doctor about starting dilative therapy early to keep your vagina from narrowing (“Stenonsis”). A preventive approach avoids trying to catch up with something that either has scar tissue or has shrunk.
  • If you experience stenosis, there are pelvic therapists who are trained in vaginal reconditioning. The odds are there are at least a few such experts in a gynecological practice in every metropolitan area.

The content of this document is based in large part on work by Sage Bolte, PhD, LCSW, OSW-C, Oncology Counselor, Fairfax, VA

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