Sex Concerns for Men and Women With Cancer

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Topics include: Living Well

Going through cancer treatment, dealing with side effects, and managing the symptom burden can put a strain on intimate relationships, but people living with cancer still deserve to enjoy fulfilling sex lives. Here to advise patients on navigating sexuality with a cancer diagnosis is Dr. Leslie Schover, clinical psychologist and the founder of Will2Love. Dr. Schover shares how to manage the physical challenges treatment can bring and maintain affection with your partner. Dr. Schover also discusses the emotional changes patients go through that effect desire, body image, and sexual communication skills. Watch now to find out more.

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Transcript

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 to Patient Power.  I'm Andrew Schorr.  I want to welcome back one of our experts who devotes their time to a key issue related to what so many cancer patients are affected by, and that is sex, sexuality.  That's Dr. Leslie Schover, who has been a clinical psychologist for so many years.  She was at MD Anderson, Cleveland Clinic, and now she's the founder of a wonderful website that services on these issues, Will2Love.com.  Leslie, thanks for being with us on Patient Power once again. 

Dr. Schover:

Thanks for inviting me. 

Andrew Schorr:

Leslie, let's dive right into it.  So sex, sexuality is often not discussed with oncologists, your oncology nurse.  There's a real gap.  So what is so important for patients to do so that it's put on the table, and they can have a frank discussion with their provider and hopefully get some help? 

Dr. Schover:

Well, it's really important to bring up the topic yourself if your healthcare provider doesn't bring it up.  Now, sometimes you can get a disappointing outcome.  I think oncologists and oncology nurses really want to help people, but sometimes they have very little training in managing sexual problems, and sometimes they're apt to be a little dismissive like, well, we'll deal with that later, or, well, go ask your gynecologist, and that's not very helpful. 

So if you get an answer like that, a good question might be, well, is there anyone else in this healthcare system who does have special knowledge in this area so that you could give me a referral?  Or what about someone out in the community, is there somebody you have sent patients to who you think does a good job? 

Andrew Schorr:

So let me talk about being a two-time cancer survivor.  I have thought about it, bring up an issue, libido.  So you're tired, whether you're going through treatment or you're worn out with the anxiety or you're tired from the fight, you know, the cancer, so you just don't have a lot of energy to think about it or want to do it.  What do we do about that?  Or even afterwards, you're sort of woe is me, or I'm recovering, and it also, I would think, would affect your relationship with a partner, too. 

Dr. Schover:

And you know, by "libido," I think as a sex therapist I prefer the term "sexual desire," because libido has been a little bit used in confusing ways to include erections and all kinds of other things. 

But loss of desire is one of the most common problems for men and women.  And, you know, it's often you've got more than one cause.  Fatigue, which you mentioned, is a big one.  Also, people may be nauseated or in pain, and it's hard to get in the mood for sex when you feel like that.  And people feel like their body and their whole persona has changed.  They don't feel like a sexual person anymore, and they fear that maybe their partner won't find them attractive.  And those are all emotional and physical issues that can affect desire. 

And on top of that, there are often medical changes from cancer treatment.  For example, many women have vaginal dryness and pain when they try to have sex and, boy, it is hard to look forward to sex when you know once you get started it's going to hurt.  Or men have trouble getting or keeping erections, and they feel a sense of shame and helplessness, and that can affect their desire as well.  And we know that people are on all kinds of prescription medications, some of which can also damp down sexual desire.  Sometimes people are drinking too much as a way to cope with their cancer, and that's another factor that can decrease desire. 

So in our self-help tools that we use with men and women we have something called My Desire Checklist, and I think it has 12 different factors and ask a person, go through each of these little paragraphs, do you think this applies to you?  And when they check yes and then they submit, they get a table with each factor that they checked and some possible remedies that they could seek if they think that's part of the problem. 

But, you know, people want a magic pill like the desire pill that's going to make everything better, and none of the pills that we have work terribly well in that respect, and you can see why. 

Andrew Schorr:

Let's talk about body image for a minute, and I want to just share a story that I will never forget.  We were doing a town meeting actually about breast cancer, and afterwards the host, who had had a breast removed, shared this story about something that meant so much to her and her relationship with her husband in a recovery after she'd had a breast removed.  And that was, she was in the shower, and she was enjoying the shower. But they had not had any sexual relationship or intimacy, and her husband came into the shower with her, and they had sex.  And that was just—sounds quite interesting, of course, but it meant so much to her that he wanted her and he wanted to express his love for her and her affection.  So it's a—communication is a key issue, too, isn't it? 

Dr. Schover:

And, you know, sexual communication is for many people not their greatest skill, and a lot of people who are in long-term relationships. And we're talking about an older bunch of people here who may have been together for a long time, may have made love the same way, you know, at 11:30 at night on Saturday, you know, for 20 years with the same kinds of what we call foreplay and the same position for intercourse, and now all of a sudden they have this big challenge.  And how are they going to talk to each other or show each other what would feel good and be open to not seeing sex as, well, we've got to return to the way it was before but as exploring some new ways to feel close and give pleasure to each other?  So that's a great example. 

Andrew Schorr:

Now, where is information for that?  Try this or try that, say this, say that.  Is that on Will2Love, or what would you recommend? 

Dr. Schover:

Well, yes.  In our self-help programs we have a lot of information about sexual communication, and since those programs are accessible through—right now through our study with the American Cancer Society, people who want to participate in the study can access that.  Otherwise, they are available right now for a small subscription fee. 

But if you want to have some free information, the American Cancer Society's website, cancer.org, has downloadable booklets and there are print versions at a lot of cancer centers too, Cancer and Sexuality For Men With Cancer or For Women With Cancer, and their partner.  And they have not as in-depth information as we do, but certainly... 

Andrew Schorr:

Let's tick off some other typical situations.  We talked about the loss of desire or a feeling about body image where you're just not attractive.  So we talked about other ways of doing things.  You mentioned about also vaginal dryness, you mentioned about erectile dysfunction.  So there are ways to help with those.  For instance these sort of physical things, right? 

Dr. Schover:

There are very specific treatments for menopausal, vulva and vaginal dryness and for erection problems for men. 

Andrew Schorr:

So abstinence, if you will, just because you want to avoid the pain or the man feels he can't perform, that can be overcome.  And then you can have the communications, and you can feel better about yourself.  Even if maybe you have a scar or a breast removed or something that changes your body image, doesn't mean you can't have a life with a partner. 

Dr. Schover:

And one of the big mind/body kind of changes you need to make sometimes is in our culture tends to treat sex as a performance, and I get really upset now. because younger people are so deluged with online erotic videos and the stories which tend to really perpetuate that idea that sex is a big performance.  You know, one person submits or pleases the other, and, you know, you have a certain kind of orgasm in a certain order, and that's what good sex is supposed to be. 

But what we really need is an attitude that sexuality is a way to feel close to your partner, express caring and affection, give each other pleasure in varied kinds of ways, whatever works for you, and that it doesn't have to follow this sexual script that our culture prescribes. 

Andrew Schorr:

So what you look at people who are being treated with cancer, being diagnosed, I have friends with leukemia and sometimes they're not trying treat it right away, and they have this watch-and-worry time.  Sex seems to go in the background for people who are survivors long term.  Do you feel it's really all right that sex can still be a part of our life? 

Dr. Schover:

I think—I don't think there's any right or wrong here.  Some people are sexually inactive and they may not be in a relationship.  It may not bother them very much.  Or if they're in a relationship the crucial thing is that both partners are in the same ball park as far as whether they want to have a sex life or not.  But I also think no matter how old you are or no matter how ill you are that having a sex life is part of your quality of life if you choose. 

Andrew Schorr:

So we have an audience of patients and partners watching.  So give us some clear steps we can do to get this happening for us.  What do we do, whether it's around the visit when we go to the clinic, and what we can do ourselves so that we can get to a better place when it comes to sex? 

Dr. Schover:

You know, we've talked a little bit about how to bring up the topic with your oncology team.  One thing I think that's important is what can you do yourself to get sex back into your life when there's been a period of inactivity.  And I hear a lot of patients say, oh, you know what, we're going on a second honeymoon and we'll have sex again then.  And that always strikes me as a really bad idea because, you know, if sex doesn't go well you're just going to ruin your nice vacation and you've put a lot of pleasure on yourselves. 

So what I think is it's important to take time out of our busy daily lives and not wait until 11:30 Saturday night when you're exhausted, but take some time in the morning or a nooner, if you can.  Since a lot of cancer patients are older, they may be retired and not working full time. 

But do something to make the atmosphere fun.  Put on music you like.  Put candles in the bedroom.  You know, serve each other grapes.  I don't know, whatever, whatever you enjoy.  And have the goal be just to start by giving each other nongenital body touch and exchanging time to give each other a back rub or a foot rub or a face rub or all-over body caressing and not worry about what it's leading to, whether you're getting sexually excited or whether anybody is going to have an orgasm. 

In fact, we suggest that you skip the breast and genitals and just enjoy—do the mindfulness of noticing what it feels like when you just lie back and let your partner touch your body and for the partner to notice what you enjoy about touching and how you can vary the ways you're touching.  And use experiences like that that are relaxed and not goal oriented.  Get back in the habit of being close to each other. 

Andrew Schorr:

So, great advice from a veteran sex therapist and clinical psychologist.  Well, we have to have you back, Leslie.  And what I'd say to our audience is send in questions, specific ones,

frank ones, tell it like it is for you, and we'll pose these to Leslie, and we'll dig deeper, if you will, on what's such an important issue that has not been discussed enough. 

I know all of us dealing with cancer, it can be terrifying at different times.  Fortunately, more of us are living longer and living better, and we have the right, I say, if this is what you want to have sex and a feeling of sexuality about yourself and with your partner, be part of it. 

Leslie Schover with Will2Love and with so many years of experience at MD Anderson Cleveland Clinic.  Thank you so much for being with us on Patient Power. 

Dr. Schover:

And I'll look forward to the future dialogues. 

Andrew Schorr:

Okay.  You got it.  I know we'll get questions and comments.  I'm Andrew Schorr.  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 April 19, 2018