Sex and Cancer: The Mind

“Not everything that is faced can be changed, but nothing can be changed until it is faced.” –James Baldwin

We've been hearing from many women who are receiving treatments for various forms of cancer: What about us, they ask. Post-menopause is one thing, but what about post-cancer treatment? Or mid-treatment? How do we maintain intimacy when we are going through chemo or radiation or when surgery has changed our bodies and the way we feel about them?

We sat down to discuss these very difficult questions with our pal and counselor, Mary Jo Rapini. Her practice gathers couples referred before, during, and after cancer treatment to talk about sexuality and intimacy and how to maintain physical expressions of love when we are sick. This is a big subject, with many possible angles, so we will break it down into two pieces: the mind and the body.

Here's part of what Mary Jo told us:

I see lots of women with breast, ovarian, and uterine cancer in my practice. I ask to see her first, before meeting with the couple together. Women have a strong protective instinct; they will put up walls when they get sick, in part to protect themselves, but also to protect their loved ones, to avoid burdening them. I will coach her to share this crisis. That protective sense turns out to be too distancing. Whatever she is going through, whatever she decides for her course of treatment, the people who love her are in it with her. Their world is changing too, and it’s important to respect that and bring them along on the journey, consult with them. It's important to have a team in this fight.

When a couple comes to me mid-treatment or post-treatment, they walk through the door with the goal to restore their sex life. The first thing I do is to slow them down, to hit the reset button. I give them a list of things to think about that goes like this:

1. Focus on the positive.
2. Take intercourse off the table until you have the energy for it, but don’t stop thinking about sex. Don’t stifle your own sexual thoughts out of guilt. Tell your partner, I still really desire you and wish I could make love to you.
3. Remember sex is more than intercourse.
4. Discuss your fears of the cancer.
5. Consider buying your partner something sexy or feminine that will help her feel like a woman.
6. Be a good listener and let her set the pace.

My focus for couples at this important time is to feel pleasure and relaxion first, before working on feeling excited. Excitement is exhausting, and exhaustion can lead to failure and frustration. I ask them to just flat out remove the goals of intercourse and orgasm from the picture. I promise we will get to these, eventually, but for now, let’s not worry about it.

I had an aneurysm that nearly cost me my life. For me, orgasms changed a lot. For one thing, they made my head ache. With a clip on arteries in my brain, and my blood flow trying to figure out a new path—orgasm took a lot out of me. Sex didn’t give me the energetic feeling I used to have. Instead, orgasms robbed me of energy for the rest of the day. A lot of my cancer patients tell me that intimacy tires them, so planning is important.

A recovering cancer patient has to plan how she will spend the little energy she has on home and health and relationships. This is a very important adjustment, especially if a couple has always enjoyed a spontaneous sex life in the past.

I prescribe a lot of hand-holding and hugging. We know the importance of hugging now, how it builds and maintains bonds for us. Most men will tell me that when their partner is sick, this is what they miss more than anything. The worst thing people can do when they can’t have sex is to withhold all touch. When a couple only touches as a pre-cursor to sex, touch can be loaded with expectations, and we need to break through that. We need to experience touch as a pleasure in itself.

During treatment, during chemo and radiation, just take intercourse off the table, but replace it with lots and lots of touch. Hand holding, back scratching, feather-brushing, rubbing hair, petting. Have fun touching, kissing, necking, without the worry of failure. Just revel in closeness.

Once you’ve gotten this connection really going, add water. Because water is relaxing. Shower together. Or take a bubble bath (but stay away from very strong scents). Light candles, bring in soft music. Focus on enjoying each other. Wash each other. Especially, wash each other’s feet. When something feels especially good, say so.

When you are in treatment for cancer, self exploration is really important. Experiment with self touch, especially where you have had surgery. Touching helps you deal with grief of loss and letting go. If you have lost a breast, you need to feel that void and be able to grieve it. Whether to include your partner in this exploration is entirely your choice, but it can very helpful for both you and your partner to join in this exploration and support you in your grief.

With any kind of an illness, the ill person asks, “Who am I now?” A serious illness changes the self, sometimes just a bit, but often profoundly. And if one self in a couple changes, then it follows that the couple’s sense of couplehood changes. Talk together about the changes you experience and notice.

A healthy partner often feels guilty about wanting sex; he knows a sick partner doesn’t have energy for sex. The healthy partner is a caretaker and not a lover right now. Talking about that is very helpful and important. Getting a counselor to talk with both or either of you during this time of adjustment can be the best investment you’ve ever made.

If you are sick, don’t underestimate your lover. We are all pretty good at putting our sexual needs on the shelf, as long as we feel loved. The most helpful way to show your love is through touch. Touching can make talking more available. Some things you hate to tell your partner. But if you are touching them while you talk, there are moments when the communication is so authentic, you will find you can say anything. And that is the sound of real intimacy.