Here is the second part of our talk with Mary Jo Rapini, a therapist who specializes in intimacy counseling (the first part focused on the mind). She often receives referrals from oncologists who have treated women and men for cancers that, post-treatment, require a re-thinking, re-learning, re-framing of their intimate life. Says Mary Jo:
When a couple is referred to me, it’s usually because the cancer part of their life is now under control. That is, they have their diagnosis, understand staging, and have been receiving treatments, with some evidence that treatments are working. Until that point, survival is the critical concern for most couples.
This time of diagnosis and sheer survival can actually bring couples closer — they realize that what they used to argue about is petty. On the other hand, really bad relationships will many times get worse. Women who are sick might ask themselves what they're doing, what happened in their relationship. When that’s the case, my first step is figuring out the emotional environment. Where is this couple now, at this moment in time?
When we do come around to talking about intimacy in the relationship, my first concern is with pain. Painful sex is a really common problem for survivors. Low energy is another problem. People receiving treatments or recovering from extensive treatments have very low stores of energy.
Women recovering from surgery and radiation for any kind of cancer, including breast or uterine cancers, may be adjusting to new losses and scars that affect body image, sensation, mobility, or all three.
And while thinking about restoring sexuality may be pretty far from her mind, the truth is that reengaging with a lover has been shown to really help with recovery. Sex is very healthy—for our bodies and our minds—and a loving intimacy is certainly one of the best things we have to live for.
Get help. Your intimate life may have been perfect your whole lives, your relationship sound, your commitment to one another unshakable, but still a good counselor can give you things to think about, assignments and exercises that can help you to re-engage after harrowing course of treatment. Consider it a gift to yourselves, a reward for surviving.
Planning is everything. Spontaneous sex was great when you were teenagers, but now things are different. Intimacy is best now when it is anticipated and planned. Choose a day of the week when nothing much else is going on. Choose a time in that day when you are likely to have less pain. Be sure you have an hour of pain medication in your body before engaging in cuddling and caressing.
Set a new goal. Sexuality is often so goal-oriented we forget that sex is good for more than just orgasm. When orgasm is difficult to reach—for either of you—why not take it off the table and enjoy the benefits of sexual intimacy without it? Massaging erogenous zones is extremely pleasurable—provided there is no pain—whether we achieve orgasm or not. It still circulates blood, increases healthy hormone production, and helps couples bond to one another. Set a new goal: bonding and intimacy. Use that vibrator to make one another purr, and let purring be enough for a while.
Become a prop master. Pillows, pillows, pillows. If you spend any time in a hospital, you will notice that nurses really know how to use pillows to prop people into comfort in bed. Well, we can use them too, to prop us into comfortable positions for intimate caressing and lovemaking. We may not have needed them before surgeries or treatment, but may really need them now, when a slight change in position or angle may make a huge difference in comfort and painless lovemaking.
Patient exploration is the key. Most of us don’t know how our bodies will respond to treatment. Our mileage varies. So patiently exploring how treatment may have changed our sense of touch and taste and smell, in addition to pain and pleasure—this takes time. Be a scientist about it. Experiment, experiment, with all the patience of a field biologist!
Use a light touch. When we get chemo, our skin can become very sensitive. Chemo changes the epidermis of the skin. Our sense of touch shifts. That’s where things like feathers, mitts, and lotions become so important as tools for exploration, because your body is different on chemo. Figuring out those changes is the work ahead for both of you.
Some of the chemos are so toxic any intercourse would be too rough on fragile tissues. That’s a good time to think about a different form of expression, beyond intercourse. Find new ways to connect.
Wetness now, more than ever. Most women can’t handle intercourse during treatment. Chemotherapy can be very drying, and our skin, our vaginal tissues, are just too fragile. But if you are going to try intercourse during treatment, lubrication is extremely important. Try a lube that has a trace of silicone. I especially like Yes for this purpose. A little bit of silicone can give that lube sticking power. Too much is hard for a dry vagina to clear on its own.
Slow down. Pretend you are new lovers, virgins, even. Go very slowly. Be prepared to relearn everything about to make love to each other. Kissing can change. Taste can change. Relax, take interest, explore, report, and learn.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.