Intimacy & Cancer: That Thing Called Love

At some point, when you are feeling better from your  treatments, you and your partner or spouse may be ready for intimacy. Often, as we all know, even on a good day, we don’t always have feelings of desire at the same time.  It is no different when you are dealing with cancer. It helps  to have open lines of communication. Your partner may  be concerned that voicing a wish to be intimate again will be a source of stress and upset for both of you.

Tell your  partner how you are feeling about intimacy and just as important, let him/her share their feelings with you. Invite  them to ask questions. Many partners need reassurance that the person with cancer still has an interest in being intimate, and vice versa. Remember, intimacy isn’t only about physical attraction but how you and your partner or spouse thinks about your relationship together.

If you have advanced or metastatic thyroid cancer and are undergoing chemotherapy or radiation  treatment, ask your doctor or nurse when it is safe for you to be sexually active. This requires that your blood chemistry be at values that insure you have enough red, white and platelet blood cells.

If you are undergoing chemotherapy or radiation therapy always use a barrier when having sex. This most often is  a condom but can also be a dental dam that covers the vaginal wall. Barriers also protect both genders from any source of infection and women from pregnancy.


Consider different types of sexual expression other than  those that require penetration. Sensual massage focusing  on the whole body as well as the genitals is a safe alternative.  If you are a women who has trouble lubricating, ask your  oncologist or gynecologist to suggest different lubricants and moisturizers that do not contain any of the forms of estrogen.  If you are a man having trouble getting an erection, ask  your oncologist or urologist to prescribe an appropriate  erectile dysfunction medication.

If you find it difficult to have an open conversation about intimacy with your loved one consider couple’s counseling to help you both learn to cope.

Thyroic Cancer and Sexuality

Some of the possible effects of cancer and its treatment on sexuality are described here. Please remember and keep in mind  that it is very difficult to accurately predict how cancer and its treatment will affect you -individually-, and for some thyroid cancer patients and survivors who have difficulty metabolizing synthetic hormones  this can become a life long challenge you may need help with as you adapt to hormonal changes after the loss of a major endocrine gland.

Some people may need to adapt to changes and develop new ways of giving and receiving sexual pleasure. If you have a committed, loving partner, cancer does not mean your sexuality will be destroyed. With support and clear communication, you will often still be able to enjoy a fulfilling sex life no matter what type of cancer you have or the treatment you receive.

There are four main ways that cancer or its treatment can affect your sexuality:

(1) physical ability to give and receive sexual pleasure

(2) thoughts and feeling about your body (body image)

(3) feelings, such as fear, sadness, anger and joy roles and relationships.

The links between these four areas are important. If there is a problem in one of them, it may have an impact on another. When someone becomes ill, it can affect their ability to feel good about themselves sexually, or their physical ability to give and receive sexual pleasure. If this has happened to you or your partner, it might be helpful to understand that some changes will only be temporary.

Even if the changes are long lasting, or permanent, you can find ways to adapt sexual techniques that are no longer possible or discover new ones. You can learn to feel good about yourself sexually despite the cancer and the possible side effects of the treatments.

• Tiredness - Many people with cancer say that they feel washed out and almost completely without energy for many months or even years. This may be to do with the cancer itself, or sometimes the treatment. This tiredness can make people lose interest in sex during and after cancer treatment.

• Mismatch in sex drive - In many relationships one partner may be more interested in sex than the other. Cancer can exaggerate this. If one partner has a change in their level of desire, this can be upsetting when there is the added complication of cancer.

How will cancer affect my sex life?

Sexual feelings and attitudes vary greatly among people under any circumstances. This is also true during illness. Some people have little or no change in their sexual desire and energy level because of cancer. Others find that their interest declines because of the physical and emotional stresses of having cancer and getting treatment. Stress may include concerns about changes in appearance; worry about health, family, or money; or the results of treatment side effects, including fatigue and hormone changes.

Some people find that they feel even closer to their partners during this time and have an increased desire for sex. Even though pregnancy may be possible during cancer treatment, it may not be wise because some treatments could cause birth defects. Many doctors tell men and women to use birth control throughout their treatment.

If your sexual desire and energy levels change during treatment, keep in mind that this is normal and can happen for a number of reasons. Some common reasons are stress, fatigue, and other treatment side effects. Body image issues may also play a part. If you have had surgery for a cancer in the pelvic or stomach areas, it may make intercourse difficult or painful for a time. Some women have vaginal dryness, and some men have problems with erections (erectile dysfunction) as a side effect of some treatments. If possible, discuss these concerns with your cancer care team and your partner.

If you were comfortable with and enjoyed a healthy sex life before starting treatment, chances are you will still find pleasure in physical intimacy during your treatment. You may find that intimacy takes on a new meaning and you relate differently. Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important.

Good communication is the key to staying sexually active or resuming your sex life with your partner. Your partner's concerns or fears are normal, and they can have an impact on your sex life. Some partners may worry that physical closeness will hurt the person who has cancer. Others may fear that they might "catch" the cancer or be affected by the radiation or chemotherapy. Catching cancer is not possible, but talking about issues like these can clear up many problems. It will also help you find out what different things you can do to make the sexual contact something you can both enjoy.

A healthy sex life can be hard to maintain when there are so many physical and emotional factors involved. Get as much information from your doctor and other resources as you can so that you understand what you can and cannot do before, during, and after treatment. For more information, you may order the free booklets Sexuality for the Man With Cancer and Sexuality for the Woman With Cancer by calling your American Cancer Society at 1-800-227-2345.

Suggestions to Cope with Sexual Problems during and after Cancer Treatment

It is important to let your partner know if you do not feel interested in sex. It can be helpful to explain how you feel, so that they do not feel rejected. You can also suggest what you are happy to offer as an alternative – such as, 'I don’t want to have sex but would love to give you a cuddle’.

If your partner is feeling frustrated it may be helpful for them to reduce the frustration through masturbation, either with you or alone.

If you have fatigue (continual tiredness that is not relieved by rest) and don’t have much energy, it might help to make love differently. Less energetic positioning, where your weight is well supported, can reduce strain. You may prefer quicker sexual contact rather than longer sessions. These are things you can talk about together.

If the tension is building between you, you may find it helpful to get support from a counsellor who specialises in offering help in these circumstances. It is not unusual for a person diagnosed with cancer to feel uninterested sexually and you should never feel pressured to have sex if you are not emotionally or psychologically ready to do so as a result of your cancer diagnosis, treatment or changes to your hormonal functioning or body image as a result of it.

Pain During Intercourse

Pain during intercourse can occur after pelvic surgery or radiation to the area. It may also occur if medicines reduce the production of natural lubrication or in cases of thyroid cancer treatment when hormonal function is disrupted and/or imbalanced.

Pain can reduce sexual feelings and reduce desire. Often, an experience of pain can lead to a fear of pain, which can in turn lead to tension. This tension can then distract the person from achieving arousal, prevent lubrication and cause further pain.

There are many reasons for pain. It is important to let your partner know what is painful so that you can explore other positions or ways of making love. Often, the cause can be treated simply. If you have pain, it is important to tell your doctor, who can examine you to find out why and suggest solutions.

If you have pain or are worried about pain, it may helpful if you take control over the depth and speed of penetration try to ensure your partner, and/or you, are close to orgasm before penetration make love after pain medicines have been taken use pillows and cushions to help you feel more comfortable and supported make love side by side, to reduce body weight on a sore scar area.

Vaginal Problems

Cancer treatments, such as chemotherapy, hormonal therapy, or radiotherapy to the pelvic area, may cause changes to the vagina that can lead to dryness, narrowing, ulcers and infection. These changes may lead to pain during intercourse.

1) Vaginal Dryness: This can be helped by a number of creams and gels that can be put directly into the vagina.

• Replens® is a non-hormonal cream available from most chemists. It is applied 2–3 times per week and works for about three days at a time. The cream binds to the vaginal wall and the water held within it reduces dryness and boosts the blood flow in the vagina.

• Ovestin®, Ortho-gynest®, and Premarin® are available on prescription from your doctor. They contain very small amounts of oestrogen and can be used as a cream or a pessary. The effect in the vagina is short lasting. The amount of oestrogen in this product is considered to be so small that it does not cause any hormonal influences elsewhere in the body.

• Vagifem®, also on prescription, is a gel which contains a small amount of oestrogen. It can be used twice a week. A small research study has shown that Vagifem can increase the amount of oestrogen circulating in the body. Because of this risk, Vagifem may not be recommended for women who are taking aromatase inhibitors, such as anastrozole (Arimidex®), exemestane (Aromasin®), or letrozole (Femara®). Your specialist or breast care nurse can give you further advice and information about this.

• Water based lubricants such as KY Jelly, Senselle®, Astroglide® and SYLK® which can be bought at a pharmacy or most major supermarkets, can help to increase moisture levels, making sex easier. Some women prefer to use glycerine as it is cheap and not embarrassing to buy due to its many uses.

2) Vaginal narrowing:  This may happen after radiotherapy to the pelvis and sometimes after surgery. After your treatment you will usually be advised to use vaginal dilators. These are plastic tubes of varying sizes which you can be inserted by yourself or as part of joint sexual touch. The dilators prevent the two side-walls of the vagina sticking together, and are used with lubricants. They are available from your doctor or specialist nurse at the hospital. An alternative way to prevent vaginal narrowing is to have regular intercourse or to use a vibrator.

3) Vaginal Ulceration: Radiotherapy can also cause sore areas (vaginal ulcers) which may bleed slightly. These can take weeks, or sometimes months, to heal. If you have any unusual bleeding after intercourse, you should to tell your doctor and ask for an examination.

4) Vaginal Infection: Some women find that they are prone to getting vaginal thrush infections while having radiotherapy or chemotherapy. This is because there are changes in the acidity in the vaginal area, which allow the normal organisms in the vagina to overgrow. You may have thrush if you notice a creamy-white discharge, or an itchiness in the vaginal area which gets worse if you scratch. This is easily treated. The medicines can be bought from your chemist. If you have had sexual contact, your partner may also need to have treatment.

Penetrative sex is perfectly safe during radiotherapy or chemotherapy if you are not affected by any of these vaginal side effects. You should use effective contraception if there is any risk that you could become pregnant, and your doctor can advise you on the best method for your situation.

Lowered Sex Drive in Women

• Sildenafil (Viagra®) and similar drugs can be used to raise women’s sex drive. They may also increase vaginal lubrication leading to reduced pain during sex, more arousal and increased ability to achieve orgasm.

Erectile Dysfunction After Cancer Surgery

Many men have erection difficulties after cancer surgery or radiotherapy to the pelvic area, but the treatment may not be the only factor. Studies have found that men commonly find they have sexual problems after operations that have nothing at all to do with their genital area. Your cancer operation, therefore, may not be the cause of all your sexual difficulties.

There may be psychological factors involved, which you are not consciously aware of. Some men find that they can have full erections with time. Even if they cannot, a half-erect penis can still be effective for making love. The positioning for this may be better with the partner on top guiding the penis inside.

If you have had an operation that has damaged the nerves that control erection, this need not be the end of your sexual life. You do not need to have a hard penis to give your partner pleasure. You may find it helpful to increase your range of sexual activity to include oral sex, mutual touching, increased masturbation, or use of a dildo or vibrator to increase your pleasure and that of your partner.

1) Medicines, pumps, implants and injections: If you have problems getting or maintaining an erection there are many options to help you. Remember that these will give you a hard penis, but will not necessarily increase your feelings of arousal.

• Tablets of sildenafil (Viagra®) help to produce an erection by increasing and restricting the blood supply in the penis. They are usually taken an hour before lovemaking, and then, following direct sexual stimulation, an erection will occur. These tablets should be prescribed by your GP. However, they may not be recommended for you if you have heart problems and/or are taking certain drugs, such as nitrates. They can cause side effects for some people which include heartburn, headaches, dizziness and visual changes. A possible side effect is that occasionally the erection lasts for more than a couple of hours and there is a danger of damage to the tissues of the penis.

• Vardenafil (Levitra®)tablets are similar to Viagra. They normally work within 25–60 minutes. The most common side effects are headaches and flushing of the face.

• Tadalafil (Cialis®) tablets can be used. They can be taken up to 36 hours before lovemaking. Your doctor may be able to prescribe them on the NHS. Tadalafil works by increasing the effects of one of the chemicals produced in the body during sexual arousal. It should not be taken by people who are taking certain heart medicines.

• Injection of a drug such as alprostadil (Caverject®, Viridal®) or papaverine directly into the penis, using a small needle, causes an erection. The drug restricts blood-flow and traps blood in the penis, causing an instant erection. Some experimentation is often needed at first to get the dose right.

One of the possible side effects is that if too much of the drug is given, the erection stays for too long and there is a danger of damaging the tissues. Some men who use these injections say that the head of the penis is not as hard as the shaft. The injections are prescribed by your GP. Usually this method is recommended to be only used once a week, which may not be enough for some men or their partners.

• Pellets of alprostadil (MUSE®) can be inserted into the penis. The pellet melts into the surrounding area and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is initially uncomfortable.

• Vacuum pumps (sometimes called vacuum constriction devices) can also be used to produce an erection. The pump is a simple device with a hollow tube that you put your penis into. Pumps are either operated by hand or battery, and draw blood into the penis by creating a vacuum in the tube. Once the penis is full of blood, a rubber ring is placed around the base to keep the erection. The vacuum is released and the pump removed. The erection can be maintained for about 30 minutes. Once you have finished making love the ring is taken off and the blood flows normally again.

The advantage of vacuum pumps is that they don't involve inserting anything into the penis, but it does take a couple of weeks or so to get used to using one. It is particularly helpful for people who are not able to take other medicines. Your penis may feel slightly colder than usual to your partner because the blood is not moving around. The other important thing is to wear the ring for only half an hour at a time. The pump can be used as many times as you want, providing you allow a half hour between each use so that the blood can flow properly.

• Penile implants  are sometimes used after all other methods have been tried. There are two main types that have to be inserted during an operation. The first type uses semi-rigid rods that keep the penis fairly rigid all the time, but allow it to be bent down when an erection isn’t needed. The second type involves a hydraulic device that, when activated, causes an erection. Your doctor can discuss penile implants with you.

If you think any of these options might be useful to you, your doctor can give more information or you can contact an organisation.

Support Self Image and Physical Changes

Body image is the mental picture we have of our own appearance. This image is drawn from what our body actually looks like, and also from how we think we look. Throughout life, our body image is constantly changing. Our body image can be altered whether or not a cancer or its treatment causes change to our appearance.

Changes in body image can cause feelings of distress that go far beyond the physical effects of a cancer and its treatment. When there has been a change in body image which is sudden and dramatic, you may feel abnormal. You may also have feelings of shame, embarrassment, inferiority and anger. When the change is a visible one, these feelings can be reinforced by the reactions of other people.

1) Hiding changes: If the change can be hidden under clothes, for example, a colostomy or mastectomy, it is common to react by trying to pass as normal. You might hide the change, avoid looking at it, and conceal it from others. This avoidance can lead to you feeling increasingly anxious about the thought of someone finding out.

Having a stoma, or having a breast removed, is likely to cause a significant change in the way you feel about your body. If this is true for you then you could try making love in underwear or partly-dressed rather than completely naked. Changing the lighting level during sex can also help to build your confidence about how your body looks. It may help to lie on your side for lovemaking to prevent pressure on scars or stomas. Facing away from your partner, not towards, may also help.

2) Talking about your feelings around body image: The most important thing is to tell someone your fears, rather than hiding them and letting them grow into something bigger. The more able you are to face the things you have been avoiding, the better. However, it might be very important to have spent some time thinking through your worst fears, and planning a way of managing this to help build your confidence.

If you are the partner of someone who has changes in their real or perceived body image, it may also take you time to adjust to and accept the changes. You may need to talk through your own fears.

REMEMBER YOUR DOCTOR IS THE BEST SOURCE OF INFORMATION FOR YOUR INDIVIDUAL SITUATION

Cancer Symptons Women Ignore

As women routine tests like pap smears and mammograms are important, but don't rely on tests alone to protect you from cancer. It's just as important to listen to your body and notice anything that's different, odd, or unexplainable. You don't want to join the ranks of cancer patients who realize too late that symptoms they'd noticed for a long time could have sounded the alarm earlier, when cancer was easier to cure.

Here, some signs that are commonly overlooked:

1. Wheezing or shortness of breath. One of the first signs lung cancer patients remember noticing when they look back is the inability to catch their breath. "I couldn't even walk across the yard without wheezing; I thought I had asthma, but how come I didn't have it before?" is how one woman described it.

2. Chronic cough or chest pain. Several types of cancer, including leukemia and lung tumors, can cause symptoms that mimic a bad cough or bronchitis. One way to tell the difference: The problems persist, or go away and come back again in a repeating cycle. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm.

3. Frequent fevers or infections. These can be signs of leukemia, a cancer of the blood cells that starts in the bone marrow. Leukemia causes the marrow to produce abnormal white blood cells, which crowd out healthy white cells, sapping the body's infection-fighting capabilities. Often, doctors finally catch leukemia in older adults after the patient has been in a number of times complaining of fever, achiness, and flu-like symptoms over an extended period of time.

4. Difficulty swallowing. Most commonly associated with esophageal or throat cancer, having trouble swallowing is sometimes one of the first signs of lung cancer, too.

5. Swollen lymph nodes or lumps on the neck, underarm, or groin. Enlarged lymph nodes indicate changes in the lymphatic system, which can be a sign of cancer. For example, a lump or an enlarged lymph node under the arm is sometimes a sign of breast cancer. A painless lump on the neck, underarm, or groin can be an early sign of leukemia.

6. Excessive bruising or bleeding that doesn't stop. This symptom usually suggests something abnormal happening with the platelets and red blood cells, which can be a sign of leukemia. One woman with leukemia described bruising in strange places, such as on her fingers and hands, as well as red spots on her face, neck, and chest. Another noticed bleeding gums. The explanation: Over time, leukemia cells crowd out red blood cells and platelets, impairing the blood's ability to carry oxygen and clot.

7. Weakness and fatigue "I kept having to sit down at work, and one night I was too tired to drive home," said one woman in describing the fatigue that led her to discover she had leukemia. Generalized fatigue and weakness is a symptom of so many different kinds of cancer that you'll need to look at it in combination with other symptoms. But any time you feel exhausted without explanation and it doesn't respond to getting more sleep, talk to your doctor.

8. Bloating or abdominal weight gain—the "my jeans don't fit" syndrome. While this might sound too common a phenomenon to be considered a cancer symptom, consider this: Women diagnosed with ovarian cancer overwhelmingly report that unexplained abdominal bloating that came on fairly suddenly and continued on and off over a long period of time (as opposed to for a few days each month with PMS) is one of the main ways they knew something was wrong.

9. Feeling full and unable to eat. This is another tip-off to ovarian cancer; women say they have no appetite and can't eat, even when they haven't eaten for some time. Any woman who experiences noticeable bloating or weight gain numerous times (the diagnostic criteria is more than 13 times over the period of a month)—especially if it's accompanied by pelvic pain or feeling overly full—should call her doctor and ask for a pelvic ultrasound.

10. Pelvic or abdominal pain. Taken by itself, pelvic pain can mean a lot of things. In fact, because it's a common symptom of fibroids, ovarian cysts, and other reproductive tract disorders, doctors don't always think of cancer when you describe pelvic pain. Make sure your doctor looks at all possible explanations and does a full exam, since pain and cramping in the pelvis and abdomen can go hand in hand with the bloating that often signals ovarian cancer. Leukemia can also cause abdominal pain resulting from an enlarged spleen.

11. Rectal bleeding or blood in stool. "I thought it was hemorrhoids" is one of the most common things doctors hear when diagnosing colorectal cancer. Blood in the toilet alone is reason to call your doctor and schedule a colonoscopy.

12. Unexplained weight loss. If you notice the pounds coming off and you haven't made changes to your diet or exercise regime, you need to ask why. Weight loss is an early sign of colon and other digestive cancers; it's also a sign of cancer that's spread to the liver, affecting your appetite and the ability of your body to rid itself of wastes.

13. Recurrent upset stomach or stomachache. As simple as it sounds, a good old-fashioned bellyache is what tipped off a number of lucky folks, whose doctors ordered ultrasounds and discovered early that they had tumors on their livers. Stomach cramps or frequent upset stomachs may indicate colorectal cancer; many cancer patients say their doctors thought they had ulcers.

14. A red, sore, or swollen breast. Everyone knows to check for lumps in the breasts, but too often overlooked are symptoms closer to the surface, which can indicate inflammatory breast cancer. Some women described noticing cellulite-like dimpled skin on an area of the breast. Others noticed that a breast felt swollen, hot, or irritated. Red or purplish discoloration is also cause for concern. Call your doctor about any unexplained changes to your breasts.

15. Nipple changes. One of the most common changes women remember noticing before being diagnosed with breast cancer is a nipple that began to appear flattened, inverted, or turned sideways. "My nipple started looking like it was turned inside out," said one woman. In addition, inflammatory breast cancer also causes nipple problems, such as itchy, scaly, or crusty skin on the nipple— so take any nipple changes seriously.

16. Unusually heavy or painful periods or bleeding between periods. Many women reported this as the tip-off to endometrial or uterine cancer. Unfortunately, many women also said their doctors weren't responsive, overlooking or misdiagnosing their complaints as normal perimenopause. Ask for a transvaginal ultrasound if you suspect something more than routine heavy periods.

17. Swelling of facial features. Some patients with lung cancer report noticing puffiness, swelling, or redness in the face. The explanation for this is that small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from the head and face.

18. A sore or skin lump that doesn't heal, becomes crusty, or bleeds easily. Most of us know to watch moles for changes that might indicate skin cancer. But other signs, such as small waxy lumps or dry scaly patches, are easier to miss. Familiarize yourself with the different types of skin cancer—melanoma, basal cell carcinoma, and squamous cell carcinoma—and be vigilant about checking skin all over the body for odd-looking growths or spots.

19. Changes in nails. Unexplained changes to the fingernails can be a sign of several types of cancer. A brown or black streak or dot under the nail can indicate skin cancer, while newly discovered "clubbing"— enlargement of the ends of the fingers, with nails that curve down over the tips—can be a sign of lung cancer. Pale or white nails can be an indication that your liver is not functioning properly, sometimes a sign of liver cancer.

20. Pain in the back or lower right side. As vague as this sounds, many cancer patients say this was the first sign of liver cancer, known as one of the "silent killers" (another is ovarian cancer). Breast cancer is also often diagnosed via back pain, which can occur when a breast tumor presses backward into the chest, or when the cancer spreads to the spine or ribs.

IF YOU HAVE ANY OF THESE SYMPTOMS PLEASE TALK TO YOUR DOCTOR.