Cancer and sexuality: are these two compatible?
By Marie-Eve Letellier, Sandra Rotholc and Anna Towers
The 21st century is seeing worldwide openness in recognition of sexual needs, sexual orientation and gender identity. However, even if society is striving to become more open and more inclusive, sexuality remains a taboo subject – culture-wise and even more – oncology-wise.1,2
Whena disease such as cancer develops, there is the urgency to treat it as soon as possible and to address potential sequelae afterwards, if these are even acknowledged.1 To note, in oncology settings, many sexual dysfunctions and disturbances are not the result of the cancer itself but rather are caused by medical interventions.1,2
The World Health Organization (WHO) has defined sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality and not merely the absence of disease, dysfunction or infirmity” and regards sexuality as one of the major components that
contribute to a sense of a fulfilled life.5 That being said, it is known that a minimum of 40% of all cancers directly impact the sexual organs and frequently lead to sexual, body image concerns and/or relationship issues, which can affect both men and women, patient and/or the spouse.1,2 Matters may be worse if the person has cancer-related lymphedema.3,4, 6
Sexuality is not a question of age or gender and does remain important for most.7 In addition, the absence of a partner does not imply the absence of sexual activity.1,2 As it remains taboo, patients do not feel comfortable discussing sexuality, and they
Marie-Ève Letellier, PhD CDT Kinesiology has been working in close collaboration with Dr. Anna Towers for almost 20 years, and is currently combining research and clinical work at the MUHC Lymphedema Clinic (Montreal).
Sandra Rotholc, RSW RP RMFT ACST has been practicing for 30 years as an Individual, Couples, Family and Sex Therapist and currently has a private practice in Toronto.
Anna Towers, MD is Director, Lymphedema Program, Supportive and Palliative Care Services, MUHC, and Associate Professor in the Department of Oncology and Family Medicine, McGill University, Montréal.
Cancer-related sexual problems may impact one or several aspects of a person’s life and should be addressed within an integrative biopsycho-social model.
hope that healthcare professionals (HPs) will initiate the conversation.1,2,6,7 On the other hand, HPs rarely dare to ask about it as they feel they are not trained in that regard and would not know how to address concerns skillfully.7
Cancer-related sexual problems may impact one or several aspects of a person’s life and should be addressed within an integrative bio-psycho-social model, as described by Bober and Varela2, including the following components: biologic (e.g. pain, loss of body part), interpersonal (e.g. fear of intimacy, lack of communication), social/cultural (e.g. religious beliefs, social norms), and psychological (e.g. emotions, body image). Thankfully, sex therapists are HPs that can and should be consulted, no matter how “big” or “small” the problem seems. Again, sex matters for individuals and couples. After a diagnosis of cancer, it is important not to be embarrassed to think about and discuss changes in your sex life or your body. A sex therapist allows the opportunity for a cancer
patient to communicate their emotions around sex and sexuality. With the help of the sex therapist, the patient can start to develop a comfortable sexual style for themselves.
The patient can start to ask themselves questions that can help them be creative about their sexual relationship with themselves and/ or partner. The sex therapist can help the patient rethink what feels good and how they might want to have different sexual experiences. One might ask: “How do I get started on my sex education?” At this point, it is key to recognize one’s goals and
the impact of cancer/treatment on your connection to your mind and body.
Dealing with vaginal dryness
It can be overwhelming navigating and managing cancer treatment with the many changes to the person’s overall lifestyle, and this applies for both genders. Some common changes that influence sexual health and intimacy are vaginal dryness, pain with intercourse, low arousal, erectile dysfunction, changing roles and body image concerns.
There are three different types of lubricants:
1 Water-based lubricants are the most used. It is important to read the ingredients and avoid additives such as glycerine, parabens, scent, flavouring, and tingle agents. Water-based lubricants can become sticky and dry quickly, so don’t be shy about reapplying for moisture! The idea is to have moisture for easy movement and, hopefully, more relaxation.
2 Silicone-based lubricants are becoming more popular and accessible at shops and online. Some people enjoy silicone lubricants more than water-based lubricants, as they can remain slippery longer.
3 Oil-based lubricants are typically used for full-body massage and intimacy.
For example, a woman may experience vaginal dryness, which can lead to uncomfortable intercourse. Let’s briefly discuss lubricants and moisturizers; there are differences between product types, and often, women (and men!) are unaware of this. This is important, and it’s critical to talk with your doctor for more education. In a nutshell, moisturizers help restore moisture inside the vagina over time with repeated use. There are several prescriptions and over-thecounter products available. Moisturizers used regularly can be comforting for women, giving them day-to-day relief. Lubricants, often called lubes, are used to make the vagina moist just before intercourse or other forms of pleasure.
As with any product, learn about the pros and cons for yourself. For example, a con for a silicone lubricant is that it should not be used with sexual toys or dilators that are made of silicone. If you are using latex condoms, do not use those with an oil-based lubricant.
Finding adaptive solutions
Another example could be a man experiencing penile retraction, erectile dysfunction and/ or penile lymphedema after his treatments for cancer. When erection cannot be sustained, a dildo attached to a belt could be used for intercourse.
Ultimately, it is a personal choice and good to try out the products to see what you
like. Understanding more about listening to your mind and body can help you overcome the tendency to want to shut down emotionally. Having the right tools to help with changes that do occur with the mind and body during cancer treatment can help one feel more sexually empowered.
Newly diagnosed lymphedema patients soon realize they need to spend time on lymphedema self-management routines, which may impact their flexibility for romance.6 Understanding these nuances can be an opener to asking for help with skincare or light touch and massage. The idea is to see potential and to make a date with yourself and/or your partner. If a patient is using a night garment (arm or leg), learning to communicate and knowing it is all right to initiate timed intimate and scheduled sexual experiences are key.
Communication is vital Communication is essential regardless of which HPs you are and/or will be consulting. In addition, at some point, it is recommended that the partner be invited to the consultation. This has two aims: it will likely increase concordance with treatment if the partner also understands the whys and wherefores of the various elements involved in the treatment, their side effects, the impact of decongestive therapy, and if lifestyle changes are required. If the partner is present during the consultation, it is more likely that intimacy issues will be discussed.
For the attention of HPs, the first thing to do when receiving such a clientele is to do no harm! Be aware that lymphedema treatments themselves have an impact on lifestyle, including intimacy. How does the patient or their partner feel about wearing bulky night-time garments? How could they integrate lymphedema
management into their intimate life? Is the patient foregoing social events or activities with their partner because of fear of making their lymphedema worse?
For example, a patient stopped spending weekends with the spouse at the couple’s lakeside cabin because of fear of insect bites on the lymphedematous leg! Therefore, on a follow-up appointment, a discussion was opened about what approach should be considered to continue enjoying great moments together in the country.
So, are cancer and sexuality compatible? Absolutely! For patients reading this article, we hope that it could be the starting point for a discussion with your partner and/or HP. For HPs reading this, please don’t taboo the subject; open the discussion to your level of competence and refer for proper help. Everyone must keep in mind that a solution can and should be found most of the time when the problem is well addressed. LP
References
1. Reisman Y, Gianotten WL, eds. Cancer, Intimacy and Sexuality: A Practical Approach. Cham, Switzerland: Springer; 2017.
2. Bober, S. L., & Varela, V. S. (2012). Sexuality in adult cancer survivors: challenges and intervention. Journal of Clinical Oncology, 30(30), 3712-3719.
3. Eaton, L. H., Narkthong, N., & Hulett, J. M. (2020). Psychosocial issues associated with breast cancer-related lymphedema: a literature review. Current Breast Cancer Reports, 1-9.
4. Winch, C. J., Sherman, K. A., Smith, K. M., Koelmeyer, L. A., Mackie, H., & Boyages, J. (2016). “You’re naked, you’re vulnerable”: Sexual well-being and body image of women with lower limb lymphedema. Body Image, 18, 123-134.
5. WHO (2006). Defining sexual health: report of a technical consultation on sexual health, 28–31 January 2002. Geneva, World Health Organizationdoi:10.1007/978-3-319-43193-2
Ultimately, it is a personal choice and good to try out the products to see what you like. Understanding more about listening to your mind and body can help you overcome the tendency to want to shut down emotionally.
6. Radina ME, Fu MR, Horstman L, Kang Y. Breast cancer-related lymphedema and sexual experiences: a mixed-method comparison study. Psychooncology. 2015;24(12):1655-1662. doi:10.1002/pon.3778
7. Chen, Y. H., Jones, C., & Bannatyne, A. (2020). Assessment of health-care professionals’ knowledge and attitudes on sexuality and aging: an integrative review. Educational Gerontology, 46(7), 393-417.
Some Resources
Canadian Cancer Society. Sex, Intimacy and Cancer (Sex Intimacy and Cancer | Canadian Cancer Society) Cancer Care Ontario. Intimacy and sex; for people with cancer and their partners (Intimacy and sex: For people with cancer and their partners (cancercareontario.ca))
American Cancer Society. How Cancer and Cancer Treatment Can Affect Sexuality (How Cancer and Cancer Treatment Can Affect Sexuality | American Cancer Society)
