How to Overcome Barriers to Intimacy During and After Cancer Care

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Topics include: Living Well

Although cancer patients, survivors and care partners may experience challenges to their sex lives after diagnosis, many don’t seek the support they need. Cancer does not mean the end of enjoying sex and intimacy, so how can patients deal with the physical and emotional impact of treatment? What strategies can patients and caregivers use to revive their sexual relationships? World-renowned sex therapist and founder of Will2Love, Dr. Leslie Schover, provides guidance and tools to help navigate changes in intimacy from treatment. Watch now to learn more about maintaining sexual health during and after cancer care. 

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:                

Hello and welcome back to Patient Power.  I'm Andrew Schorr in California.  Joining us once again is the founder of Will2Love, really world?renowned sex therapist, counselor, expert, Dr. Leslie Schover.  Leslie, welcome back to Patient Power.   

Dr. Schover:

Well, thanks, and it's been just so much fun doing these interviews, so thanks for having me again.   

Andrew Schorr:

Okay. Well, let's get to the heart of the matter for many people who are dealing with cancer.  Many people don't seek any help related to their fertility issues, their intimacy issues, their sexuality issues.  How come?  Is it just that the cancer is so overwhelming?   

Dr. Schover:

Well, I think that's part of it, and I think we also have a kind of—still a little stigma in our society about seeking help for our reproductive problems. When it comes to sexuality in general, not just with cancer patients, it looks like maybe a quarter or less of people who experience sexual problems, and that's a lot of people, ever seek help from a healthcare professional.  

Also, our insurance system isn't very good for this state.  You know, you can usually if you have insurance get reimbursed to see a gynecologist or a urologist, but seeing a mental health professional like a trained sex therapist often gets excluded from coverage, and that makes it harder for people, too.  

Andrew Schorr:

Hmm. But really people shouldn't suffer, and I know we're going to talk about that in one of our segments that we do with you is people should speak up.  People deserve to have these issues dealt with so they can have a better life.   

Dr. Schover:

That's right.  And one thing that we're working on with Will2Love is trying to help hospitals and cancer centers do a better job of identifying these problems and referring people to someone in their system who should be able to help.  And, in fact, the American Society of Clinical Oncology has a new guideline for practitioners that says that everyone with cancer should be asked if they have a problem with sexuality as well as fertility.  And if they do, they should be referred for multidisciplinary care, and that's really important because these problems are not just medical and not just emotional but a combination of all.  

Andrew Schorr:

Okay. So our message to our viewers is speak up, ask for help, be out front with this, because you deserve to really have a full life, and dealing with cancer is hard enough.  Don't make it harder as it really has tamped down your intimacy or if you're concerned about, if you're younger, about fertility issues, you've got to speak up about this, men and women.  Okay.   

Leslie, so people see ads on TV or in the newspaper or a friend tells them about it, pills, potions, laser treatments, all these kind of things. What do you make of this because people are often looking for an easy fix, if you will.  

Dr. Schover:

And I don't blame them.  I mean, it would be great if we had some really excellent, easy fixes for these problems, and there certainly are some tools we have that are helpful like the right kinds of vaginal moisturizers with lubricants for women and some of the medical treatments for erection problems for men.  But, you know, again, our TV commercials and our society promotes the idea that there's going to be a magic pill or something, a magic vibrator that's going to just turn your sex around and everything will be fine.  

And, you know, unless you're having sex with yourself, which is one great way to have pleasure, you're more often probably having sex with a partner, so it takes two, and there's no one magic pill or vibrator that's going to make everything better.  It takes work and practice.  

Andrew Schorr:

So the bigger question that we all ask, those of us going through cancer or recovering from cancer, having a partner who is dealing with it, is what can we do at home?  What are some strategies for things we can do at home?  And then we'll talk about getting outside help.   

Dr. Schover:

Well, I think there are a number of things you can do at home.  The first is open yourself up to the idea that sex may not be your traditional, you know, having intercourse at 11:30 Saturday night after the news, and everything goes just like it's always gone for 20 years. But, you know, having sex may be sharing more varieties of touching, and if you haven't touched for a while starting with a face rub or a back rub or exchanging all?over body caressing.  It doesn't always have to include penetration for intercourse in a heterosexual couple or sex toys or anything else.  

Intimacy and sexual pleasure is what you make of it, and you may need to be more flexible now and discover something new that you haven't tried before.  And that takes making yourself a little vulnerable to your partner and risking a little rejection if you ask for something different.  

Andrew Schorr:

One of the things that I heard from a therapist a long time ago was one step people have to make, whether you're dealing with cancer or not, is making time where things can happen.  

Dr. Schover:

Yes. 

Andrew Schorr:

Because we get so busy, right?  So first is have a time when with whatever happens may happen, right?  

Dr. Schover:

Yeah, I often say make time to make time, or make time to make out.  Yeah, that is very important, and, you know, if you have teenagers at home you may need to put a do not disturb sign on your door and put on some music so you're not distracted.  Or if you have little ones still you might send them to grandma's to babysit overnight or something.   

But the important thing is carving out relatively small blocks from your daily life like little mini staycations to spend time with each other.  And it doesn't all have to be for sex either. Just sitting on the couch and watching a good movie and holding hands is a great way to start feeling closer.  

Andrew Schorr:

Well said.  Okay. So now let's talk about what do people look for professional help.  And I'm also going to pose a question that I think often care partners have is that—that they might talk to a professional about is worry that they're going to hurt their loved one.  They've had surgery, there's some issue, they're not feeling well, that somehow if they make an advance or even do some kind of massage that it's invasive somehow and not welcome.  So who do you go to and who do you talk about this with?   

Dr. Schover:

Well, in terms of who do you go to, I think for medical help with sexual problems some of the specialists that are—know the most might be a urologist who specializes in men's sexual problems or a gynecologist or sometimes a pelvic certified physical therapist who helps women.  And for mental health professionals the idea is to find someone who is trained in both psycho?oncology, which is working with cancer patients' emotional issues and also with working with sexual dysfunction.  And there aren't that many of us even across the country, and we tend to be clustered in big cities and the coastal areas too.  

But the issue that you brought up with worry about hurting the partners is a very good one.  That's a very common question people have.  And I think when you hold back out of fear of hurting your partner and you don't discuss it the person who does have cancer often may think, well, he or she isn't attracted to me anymore and doesn't want to be close.  So talking about these concerns and fears is a wonderful first step and saying, you know, I really miss our closeness.  I miss cuddling, I miss having sex, but I'm worried about whether you would welcome my, you know, making advances or whether you're too tired or just not feeling well or things would hurt physically, and starting an honest discussion.

Because very often the kind of gentle exchanging of touch and intimacy that's a great way to start when you've had a pause in your sex life is not likely to hurt your partner.  And there are only a very few situations where oncologists say sex is unsafe like—and it's usually more actual vaginal or anal penetration like after a pelvic surgery when you may not be totally healed in the first six weeks or if a woman has cervical cancer and has heavy bleeding or leukemia that could be triggered by sexual activity, or when people are having chemotherapy and they go through periods of really, really intense immunosuppression where they might be vulnerable to just any kind of closeness with another human.   

But most of the time it's not dangerous to have sex, and, in fact, I think it's truly very soothing and comforting.  

Andrew Schorr:

Right.  Well, I think just to sum up some of the points you made here is first of all, speak up to our listeners.  Speakup.  There is help available.  Have open communication, work it out, hopefully you can get to that with your partner, and don't necessarily think that intimacy is just tied to intercourse, and see it in a bigger way.  

But we have our continuing series with Dr. Leslie Schover, who is founder of Will2Love a wonderful website for you.  So stay tuned to fore segments as we talk specifically about some issues for women and then some for men.  

I'm Andrew Schorr with Patient Power with Dr. Leslie Schover.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on June 25, 2018