Ask CancerCare

August 2007 This Month's Topic: Cancer, Intimacy and Relationship Concerns Featured Expert: Les Gallo-Silver

Q. I'm trying to prepare myself mentally about having a mastectomy. I don't think I would ever want to look at my body again, much less expect my significant other to ever find me attractive with such a scar. I can't imagine anyone ever wanting to know my body again. What can I do?

A. A surgery that removes part of you is a loss. This loss must be honored with mourning and grief. A loss changes you but also can make you more aware of what you still have. Most people need time to get used to the scars on their body. With patience, and caring, couples do enjoy being intimate again. For now, it would help most for you to appreciate yourself more as a total person. Here are some tips that may help you.

• Keep a journal in which you can freely express your thoughts and write down all of your feelings, both good and bad.
• Be open and willing to tell the people who care about you what kind of physical affection and comforting you need now.
• Give yourself "credit." Practice praising yourself out loud about any of the things you like about yourself, such as your intelligence, your faith, your laugh, your kindness and other positive qualities.
• Be generous to yourself. Give yourself little gifts that give you pleasure such as a new book of poems, a massage, a luxury spa product, or other items that demonstrate how thoughtful and sensitive you can be to your own needs.
• Make bathing a special experience. Use a scented liquid soap, a soft wash cloth or sponge, and big fluffy towels. Music, candles, or flowers can enhance the experience.
• Wear something comfortably feminine and pleasing to you when you go to bed.
• Adorn the new you. Get new make-up that complements your best features. Choose clothing colors that match your current skin tone. Seek out programs such as Look Good, Feel Better to learn helpful tips.
• Join a support group of women who have similar concerns. CancerCare offers online and telephone groups. A CancerCare social worker can also help you locate face-to-face groups in your area.
• Share information with your partner. One useful guide is, "When the Woman You Love Has Breast Cancer," available from the Y-Me National Breast Cancer Organization.

Q. I have been treated for breast cancer and I just don’t feel like being intimate. Is this due to my treatments or did I just change as a person? My partner is concerned and wants to know if we will ever be intimate again.

A. For many women, treatment for breast cancer has a side effect of diminishing their desire for physical intimacy. This occurs when your treatment has affected the amount of estrogen your body produces. There are ways for you to address your partner’s wish for physical intimacy. But one of the issues between the two of you may have something to do with communication. Openly discussing sex may not be typical even for couples who have been together for a long time. Reminiscing about the funny and tender things you have shared together, and your history of how you met and decided to be a couple, can be a comfortable way to begin. Your sexual relationship is a part of being a couple, but there are many other elements to your relationship such as emotional closeness, feeling your partner is there to comfort and support you, affection and companionship to name a few. Once you have addressed these aspects of being a couple, being physically intimate becomes a natural part of sharing your love with each other. People do change due to their cancer experience. Cancer often makes people evaluate their lives and sometimes this changes their priorities. If you have been satisfied with your relationship prior to cancer, then you would be satisfied after treatment even if your relationship needs some fine tuning. Joining a support group or seeking counseling, whether individually or as a couple, can be ways to further help you and your partner.

To find a counselor who specializes in intimacy issues, contact the American Association of Sexuality Educators, Counselors and Therapists.

Also, the American Psychosocial Oncology Society offers a toll-free Helpline to help people with cancer and their caregivers find counseling services in their own communities.

Q. I have just had a surgery for my prostate cancer. When will I be able to be sexually active? Is there anything I should do? And, how do I explain things to my partner?

A. The first step is to talk to your urologist about your concerns. The most common problem following surgery for prostate cancer is erectile dysfunction (ED), or the inability to achieve an erection. (This condition does not affect your ability to reach orgasm, which is a separate but related process.) You should begin to be intimate with your partner when your urologist feels you are appropriately healed. You and your partner’s ability to find other ways to be intimate that do not require an erection can help you on your road to recovery. In the meantime, you can ask to be referred to an urologist who specializes in ED. Some physicians have their patients use an ED medication to help in the recovery process. Many partners need reassurance that the person with cancer still has an interest in being intimate, and vice versa. Interest is not only about physical attraction but in how you both feel and think about your relationship together. Your partner may be concerned that voicing a wish to be intimate again will be a source of stress and upset for both of you. Being open about these concerns is the best way to examine and explore these feelings together. Talking to other men who have similar concerns may also be helpful. Below are some organizations that can help you find a support group.

• CancerCare offers support groups for men facing cancer (face-to-face, online and telephone).
• The American Cancer Society offers a supportive program, “Man-to-Man” for men who have prostate cancer.
• Us TOO International Prostate Cancer Education & Support Network has chapters and support groups throughout the US.
• As mentioned in a previous response, you can find a counselor who specializes in intimacy issues, by contacting the American Association of Sexuality Educators, Counselors and Therapists.

Q. I'm starting chemotherapy soon. Should I avoid having sex with my partner?

A. There are ways to continue to be sexually active while in treatment. Often cancer related fatigue, changes in your blood chemistry, and/or changes in your hormones can be obstacles. Please be patient with yourself if these treatment side effects prevent you from continuing your sex life while under active treatment. Here are some helpful hints for both men and women in treatment who want to retain physical intimacy in their relationships.

• Ask your doctor or nurse when it is safe for you to be sexually active. This requires that your blood chemistry be at values that insure you have enough red, white, and platelet blood cells.
• Always use a barrier when having sex. This most often is a condom but can also be a dental dam that covers the vaginal wall. Barriers also protect both genders from any source of infection and women from pregnancy.
• Talk with your partner about your desire to continue having sex, and ask for their help to find ways to remain physically intimate.
• Consider couple's counseling to help you both learn to cope together.
• Consider different types of sexual expression other than those that requires penetration. Sensual massage that focuses on the whole body as well as the genitals is a safe alternative.
• If you are a women having trouble lubricating ask your oncologist or gynecologist to suggest different lubricants and moisturizes that do not contain any of the forms of estrogen.
• If you are a man having trouble with erections, ask your oncologist or urologist to prescribe an appropriate erectile dysfunction medication.
• Remain appropriately physically active, being physically intimate requires energy. In addition activity can help you manage fatigue. Ask you doctor what kinds of exercise is best for you.

Remember that you can speak with a CancerCare social worker to find information and availability of couples, individual, or face-to-face/online/telephone group counseling.

Les Gallo-Silver, LCSW-R, is the Director of Clinical Programs at CancerCare. Prior to this he worked at Memorial Sloan Kettering Cancer Center and the NYU Medical Center. He is a nationally recognized expert in the field of the sexual recovery of the person with cancer.

The questions and answers listed above are from the August 2007 Ask CancerCare feature.  New Ask CancerCare topics are introduced every month. 

If you have additional questions about cancer, intimacy and relationship concerns, please contact CancerCare directly for information and guidance. CancerCare provides free professional support services, including counseling, education, financial assistance and practical help. These services are provided by professional oncology social workers. If you have a specific concern or question and would like to speak with an oncology social worker, please contact us at info@cancercare.org or 1-800-813-HOPE (4673).

For questions about medical issues, please visit Cancer.net, the patient information website of the American Society of Clinical Oncology (ASCO).

Ask CancerCare Archive (questions and answers from previous months)