“Women often shut down emotionally from their partners [after a cancer diagnosis] for a number of reasons,” says Maureen Ryan, sex therapist and nurse practitioner. “Maybe they’re scared; maybe they’re afraid of what’s to come. So they shut down and build a wall against intimacy.”
It makes sense. Survival has suddenly become a priority. You’re faced with complex decisions, a long and difficult treatment with a big question mark at the end. You may already be stretched emotionally and physically with a career and children at home, and maybe other obligations as well. The demands of a relationship seem overwhelming.
While you probably won’t be interested in sex for a while after treatment, staying connected—maintaining the bonds of intimacy—with your partner is critical. “Studies show that if you had a rewarding sex life pre-cancer, that’s the best indicator about your quality of life post-cancer,” Maureen says.
And if you didn’t, maybe this illness will be the catalyst that allows you to focus on what’s important as a couple. In a speech, sex therapist Emily Harrell points to a Canadian study of breast cancer survivors that found “almost half the couples felt the cancer brought them closer.”
Here are suggestions from doctors and therapists for keeping the flame alive through the tough times:
Talk. This is such a tired bromide, but without communication, what do you have left? Set aside time to talk when you usually feel good and are without interruptions—no cell phone, visitors, or television. You each need to share your thoughts, fears, and anxieties. You need to talk about decisions. You need to explain what you need. If either partner shuts down, the other will feel rejected and isolated. This is a fragile time. You need all the support you can get.
Talk about sex—how you feel about it, what feels good, and what you can’t tolerate right now. “It’s important to tell your partner that even if you don’t want [sex] right now, that you’d like to regain your desire again,” Emily says. “You’re hoping to one day feel the desire to be intimate again.”
And don’t forget to talk about the good stuff. “I think the biggest thing is not letting the cancer consume the relationship,” Emily says. “This can… happen to a lot of couples. Try to spend some time not focusing on the cancer.”
Touch. “We need touch from the moment we’re born until the moment we die,” Maureen says. Touch releases oxytocin—the cuddle drug—and that makes you feel better, like a big belly laugh. Touch heals and reinforces connection.
As Mary Jo Rapini mentioned, it’s important not to make assumptions about your partner’s motives for touching you. He’s probably not after sex, just the feeling of intimacy that can drain away without sex.
If touch is painful, Maureen suggests creating a body map. Draw a simple outline of a body, like a gingerbread figure, and mark the spots where you like to be touched. You can even prioritize what feels good, better, best. Also mark with a red X where you don’t want to be touched. This is a graphic, non-verbal aid for your partner.
Finally, sensate focus is a program developed by Masters and Johnson that incorporates gradually increasing levels of touch, from very light, non-sexual touching and increasing over time to include sexual touch. This can be a gentle way to introduce sexuality slowly and at a pace you can tolerate.
Move the goal posts. As we’ve said many times on MiddlesexMD, sex is much broader than the old penis-in-vagina experience. Explore new avenues of sexual satisfaction, from kissing and cuddling to erotic massage. Take it slow. Do what feels good. Take performance anxiety off the table.
Your body may feel and respond differently now, and sex may be different. But this doesn’t always entail less or loss. According to many couples, the sex can be better. In fact, a new study by the Duke Research Institute found that while cancer changes sexual intimacy and function, often for a long time after treatment, this didn’t correlate with a lessening of sexual satisfaction.
“Sex is about connection,” Emily says. “It’s about love; it’s about intimacy, and that can look a lot of different ways. I find that most rewarding skills that couples learn is not having goal-oriented sex, but really just exploring each other without judgment and experiencing each other and the emotions that they really feel for each other.”
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.