by Anne Katz PhD, RN
Sexuality is about much more than sex – it’s about who you are attracted to and who you choose to be sexual with (or not), what your sexual desires and fantasies are, how you react to touch, and yes, also to what you do sexually. Trying to figure this out is an important task of adolescence and young adulthood – and it’s not always easy! Having cancer makes things a lot more complicated because the treatments all have sexual side effects. The chapter on body image highlights some issues that affect sexuality – but there are others that directly impact on how your body works and these can cause problems.
Eighty percent of cancer survivors experience some sort of sexual problem after treatment but they have rarely been asked about this by health care providers. It’s even worse for lesbian, gay, bisexual or transgender survivors. Health care providers are people too and they have the same hang ups about talking openly and honestly about sexuality as the rest of the population. They may think that you are too young to be sexually active, or too sick, or they may just not think about it at all! YOU may have to bring up the topic – and most will answer your questions or try to find you someone to talk to. If your doctor or nurse seems shocked, try again with someone else! There will be someone who can answer your questions but meanwhile, here is the low down in short form of what sexual changes can happen.
For GUYS – radiation or surgery to the pelvis may affect erections or orgasm and/or ejaculation. Men produce sperm continually and so after treatment you may not be sterile (more about that later) but your sperm count may be lower than it was before treatment. For GIRLS, radiation to the pelvis may affect your ovaries and you may see changes in your natural lubrication. Some kinds of chemotherapy can do that as well – or make you go through menopause earlier. Surgical removal of the ovaries will stop your periods and can affect sexual desire as well as causing instant menopause.
What can be done about this? If a guy is having difficulty getting or keeping an erection pills such as Viagra, Cialis or Levitra can help. If those don’t work, there are other more invasive aids such as penile pumps or injections (this sounds worse than it is!). For girls, the most common complaint is vaginal (inside) and/or vulval (outside) dryness. Moisturizers like Replens or Vitamin E oil can help for daily dryness and lubricants should be used for sexual activity (water- or silicone-based lubricants are great and are available at most drugstores). Don’t use anything that is warming or cooling or exploding/intensifying as these will burn sensitive tissues. And don’t use any kind of cooking oil (olive, peanut, coconut or Crisco or butter as they can go rancid from your body heat). Lack of desire is another common problem but fixing this is much more complicated; a couple of sessions with a sexuality counselor or therapist can really help with this.
Everyone needs to use good contraception – even if you think you are sterile, surprises can happen and the timing may not be right for you or your partner to be pregnant. Pregnancy is possible for women who have not had a period for ages– this may be the month that you ovulate again. And for guys, it takes just one sperm to get someone pregnant! And you still need to protect yourself against sexually transmitted infections so condoms are essential, especially if you are playing the field and you aren’t in a monogamous relationship.
The most important sex organ is the brain and you have to use it to make sure that you are in a sexually healthy relationship. You have to TALK to your partner(s) about what you want and what makes you feel good. You have to ASK your health care provider for help if you need information or help with a problem. You also have to figure out what makes YOU feel good – so explore your body and find out what feels good or great and let your partner know where to touch you. It can be really scary to start a sexual relationship with someone new – or resume a sexual relationship – after treatment. Take your time and TALK about what you want and what you like and what feels good. Your partner is probably just as scared as you are – he or she doesn’t want to hurt you – and remember to keep a sense of humour about the things that go wrong (like an elbow to the head) and be happy about the things that go right (it really is like riding a bike!)