Cancer treatment discussions typically revolve around the scientific, procedural, and physical aspects, often side-lining other pivotal components of a patient’s well-being, such as intimacy and sexual health. However, as an oncologist, I’ve come to appreciate the profound impact these aspects have on our overall quality of life and the richness they bring to our human experience. There’s no denying the hardships cancer treatments present on the path of maintaining intimacy. Still, I firmly believe that with empathy, open communication, and steadfast support, we can traverse this path together. Let’s delve into the intricate dance of managing sexuality and intimacy amid treatment. We’ll touch upon the obstacles and propose strategies to foster a fulfilling intimate life for patients and their loved ones.
Let’s start with the story of Michael, a wonderfully resilient patient who graciously let me into his world. As he fought his cancer battle, Michael navigated an array of physical and emotional changes. From fatigue and hair loss to hormonal imbalances and altered body image, he grappled with an evolving sense of self that shook his confidence and affected his relationship with his own sexuality. Most male patients are comfortable discussing these issues with me, and most often the spouses of my female patients will bring this up as well. I assume this is probably the opposite issue for female medical oncologist. Over time, he expressed how these shifts impacted his intimate connection with his partner. Together, we navigated these choppy waters, exploring various tools and resources that could help them preserve their bond and address their changing needs. Through their courage to communicate and their willingness to seek help, Michael discovered ways to sustain a fulfilling intimate life.
As a medical oncologist, discussing sexuality and intimacy with cancer patients can be a sensitive yet vital part of the comprehensive care provided. Here are 10 issues that can be addressed in meaningful ways:
Physical Side Effects of Treatment:
These can include fatigue, pain, changes in weight and appearance, such as hair loss or surgical scars, that can impact a person’s self-image and sexual desire. For instance, a patient may find it difficult to feel attractive due to hair loss from chemotherapy or radiation therapy.
Sexual Dysfunction:
Some treatments can lead to issues like erectile dysfunction in men or vaginal dryness in women, making sexual intercourse challenging. A prostate cancer patient may experience erectile dysfunction following surgery or radiation. Hormonal therapy is the mainstay of many treatments given for breast and prostrate cancer patients with one significant adverse effects of decreased sexual interest.
Hormonal Changes:
Treatments, particularly for breast or prostate cancers, can induce menopause or cause low testosterone levels, affecting libido and sexual function. A woman undergoing treatment for breast cancer may experience early menopause, impacting her desire for sexual intimacy.
Infertility Concerns:
Some treatments can affect fertility, which can be a significant concern for patients wishing to have children. For instance, a young patient with testicular cancer may worry about his future ability to conceive. It is imperative for young patients who are undergoing intensive chemotherapy to discuss fertility concerns and consulting with fertility preservation clinic before starting chemotherapy.
Altered Body Image and Self-esteem:
Cancer and its treatments can significantly alter a patient’s body image, leading to decreased self-esteem and impacting their sexual relationships. A woman who has undergone a mastectomy may feel less feminine and struggle with intimacy. Fortunately, this specific issue can be more directly addressed with the help with our plastic surgeons.
Emotional Well-being:
The stress, anxiety, and depression often associated with a cancer diagnosis and treatment can significantly impact sexual desire and function. A patient may be too anxious about their diagnosis and prognosis to engage in intimate relationships. Counseling can be most effective and always best to plug in early with psychosocial support.
Impact on Relationships:
The patient’s relationship with their partner may be strained due to the emotional toll of the illness, affecting their sexual and emotional intimacy. A couple may struggle with changes in their roles and dynamics due to the disease. Remember that it is not just only the patient dealing with cancer but the spouse as caretaker that also goes through the journey.
Changes in Libido:
Cancer treatments can lead to changes in sexual desire. For example, a person undergoing chemotherapy might experience a decrease in libido due to fatigue and nausea.
Impact of Medications:
Certain medications, such as antidepressants or opioids, can cause side effects that affect sexual function. A patient on long-term pain management may struggle with opioid-induced sexual dysfunction.
Fear of Sexuality and Intimacy Post-Treatment:
Patients may fear intimacy or sexual activity after treatment due to pain, potential harm to the surgical site, or fear of rejection by their partner due to physical changes. For instance, a woman who has had a pelvic radiation may fear that intercourse could be painful.
In each of these situations, an oncologist can offer help by discussing these issues openly, providing information, offering reassurances, suggesting interventions (such as referrals to a sexual health specialist or a counsellor), and working closely with the patient and their partner to find solutions that will help them maintain their intimacy and sexual health. It’s also vital to remember that addressing these concerns isn’t a one-time discussion but an ongoing conversation throughout the patient’s cancer journey. Here are the key pointers that patients, families, couples, and caregivers might find useful in enhancing their quality of life amid these sometimes unspoken issues:
- Fostering Open Communication: The cornerstone of surmounting any challenge lies in the realm of open and honest conversations. It’s imperative to freely voice fears, desires, and limitations within the relationship, steering clear of judgment or pressure. Sincere dialogue nurtures understanding and fosters empathy.
- Engaging Professional Assistance: Tapping into the expertise of healthcare professionals, from oncologists and psychologists to sexual health specialists, can shed light on individualized solutions and coping mechanisms. They can provide tailored advice on physical changes, libido, and intimacy, allaying concerns, and suggesting strategies.
- Nurturing Emotional Well-being: The journey through cancer treatment leaves deep emotional footprints along with its physical ones. Therefore, it’s crucial to prioritize mental health by seeking counseling, joining support groups, or simply leaning on loved ones. Remember, this journey is shared.
- Innovating Intimacy: Exploring alternative expressions of intimacy beyond sexual intercourse can help maintain emotional connection and physical closeness. Experimenting with new techniques or using sexual aids may bring added comfort and connection. Remember, patience, compassion, and connection are vital.
- Empowering through Education: Gaining insights into how treatment impacts sexuality and intimacy can equip individuals and their partners with a better understanding of the changes they may face. Always ensure your information comes from reliable sources and reputable organizations.
- Promoting Self-Care and Self-Compassion: Self-care practices like relaxation techniques and maintaining a positive body image can contribute to overall well-being and self-confidence. It’s essential to recognize and honor the changes your body has undergone while understanding that you are still deserving of love and intimacy.
If you or a loved one are grappling with intimacy during cancer treatment, I encourage you to reach out to your healthcare team. You’re not alone in this journey. By working together, we can rise above these challenges and enhance the lives of all those touched by cancer. Remember, cancer doesn’t define you; it’s but a chapter in the larger narrative of your life. This journey of maintaining intimacy during treatment is unique and, with the right support and understanding, can become an empowering experience for you and your loved ones.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.