Virtually every person with cancer is concerned about the ability to continue to have a satisfying sexual relationship with his or her partner, yet this important concern often goes unmentioned. Health-care professionals are sometimes as uncomfortable about discussing sex as patients are in bringing it up. Yet the continuation of as normal a relationship as possible is, for many people, a key factor in the recovery process.
The progress of the disease itself, the side effects of treatment (such as nausea and fatigue), the lack of privacy for hospitalized patients, and the anxiety, fear, and anger that go with the diagnosis of cancer can all contribute to loss of sexual desire or the inability to function sexually. If the patient’s oncologist, primary care physician, or an oncology nurse does not volunteer information about what the person can expect of his or her particular type of cancer and treatment, then the patient should request it. Being prepared and knowing which symptoms will be temporary and which will last longer or be permanent will relieve much of the anxiety and allow the patient to begin to make adjustments.
The other important person to share this information with is the patient’s partner, who may be feeling some of the same anxiety and frustrations, who may feel very left out, and who may be afraid to initiate sexual contact. Neither the patient nor the partner can assume that the other will be aware of needs, fears, and frustrations unless they are openly expressed. The importance of communication seems so obvious that we are hesitant to mention it, yet lack of it may be at the root of sexual problems.
Unless their family is complete or they are not planning on having children, the couple must also share their feelings regarding parenthood. They should seek information about the immediate and long-term effects of treatment on the reproductive organs, so that decisions regarding parenthood can be made. For example, it may be possible for a male patient to deposit sperm in a sperm bank prior to treatment. If permanent sterility is anticipated, they should feel free to seek counseling to help them deal with its consequences.
- Couples who wish to have children should seek genetic counseling. To avoid stillbirths and birth defects due to chromosomal damage to the ova of a female patient, or to allow the male patient’s sperm count to return to usual levels, the couple must wait up to two years following completion of treatment before attempting to conceive. During treatment and during the waiting period, they should use an effective means of birth control, such as one of the following:
- Condoms, used with a vaginal lubricant if the female partner is the patient.
- Diaphragms used with spermicidal jelly or foam, and checked for size by a gynecologist if there has been a weight loss of ten pounds or more.
- Oral contraceptives, other than those containing high progesterone level, which present an increased risk of Candida albicans, a common vaginal infection. Oral contraceptives should be avoided by female patients who have estrogen- or progesterone-dependent tumors.
- Intrauterine devices (IUD). These are not advised if the female partner is the patient, since they present a risk of bleeding and infection.
Continuation of sexual relationships during and after treatment will take understanding and adjustment. The couple should realize that sexual interest and drive may be diminished or absent during this time and that the male patient may suffer temporary impotence. The patient should avoid alcoholic beverages, narcotics, or sedatives for an hour or so prior to intercourse in order not to further decrease sexual interest or fulfillment. The couple should not forget, as some people tend to, that intercourse is only one part of a fulfilling sexual relationship. Kissing, caressing, just holding each other can be very satisfying. Sometimes it is more satisfying, because there is no urgency and no pressure to perform.
The patient and his or her partner may find sexual relations easier if they change the time or the position. If fatigue increases in the early evening, having intercourse in the midmorning or early afternoon may help. If a man finds it too strenuous to be on top, or if a woman finds her partner’s weight too much for her, they might try having intercourse with the man lying on his back and the woman kneeling astride him. Or they might try lying on their sides, the man behind.
If the female partner is the patient, she should use a water-based lubricant such as K-Y Jelly to compensate for any loss of vaginal lubrication and to protect against injury to the mucous membranes. She should report any suspected vaginal infection, noticeable by the presence of redness, swelling, foul-smelling discharge, or itching, to her doctor and should avoid intercourse if the mucous membrane lining the vagina becomes irritated.
A woman with cancer should also tell her doctor when her menstrual period is expected. The doctor may prescribe oral contraceptives to be taken throughout chemotherapy treatment to prevent menstruation when there is a risk of thrombocytopenia. She should also inform the doctor if she suspects she is pregnant.
Women with cancer of the uterus, cervix, or vagina may suffer additional sexual problems as a result of the cancer itself or radiation treatment to this area. These include vaginal discharge, which may be bloody and foul-smelling; decreased vaginal lubrication; bleeding and discomfort or pain during sexual intercourse; and the growth of adhesions from fibrous tissue in the vagina, called vaginal fibrosis. A sanitary napkin—not a tampon—should be worn while the drainage continues and the woman should cleanse the vaginal and rectal area following each pad change. Many physicians recommend a douche at least once a day with a table-spoon of white vinegar in a quart of warm water.
Vaginal fibrosis can usually be prevented by having regular intercourse. If a woman does not have a regular partner or anticipates a prolonged disruption in her sexual relationship, she should speak to her radiation therapist or gynecologist about using an obturator a cylindrical device used to dilate the vagina. In the absence of intercourse, the obturator should be inserted at least three times a week for a year following radiation therapy. The physician or nurse can explain its proper use.