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Keeping Your Sex Life Going
In the United States, sex is all too often viewed as something only for the young and healthy. Too often sex appeal is judged only by a skin-deep sort of beauty rather than according to kindness, maturity, or a sense of humor. Most people, of course, cannot be “a perfect 10.” When people are treated for cancer, their self-esteem often falls to a “1” or “2.”
All people tend to think less of their physical beauty compared with others’. After cancer treatment, it is very easy to focus only on the part of the body that has been affected. For example, a man who has had a laryngectomy may fear he will not be able to find another partner because he has lost his voice.
Sometimes friends and lovers do withdraw emotionally from a cancer patient. But when a wife cannot bear to look at her husband’s ostomy appliance, for example, she is often showing deeper feelings. Perhaps she is angry because she has to take over her husband’s usual tasks of paying bills and doing household repairs. His illness may remind her of how sad she would feel if he died. It is easier not to love him so much. She also may be more aware of her own chance of death. Yet all these feelings get blamed on a scar that mars one small corner of her husband’s body. The husband, in turn, feels like a sexual failure. Similar conflicts can occur when the female partner in a relationship has had cancer.
Coping With Changes in Appearance
The keys to feeling good about yourself begin with focusing on your positive features. Try to limit the damage cancer can do to your appearance, your energy, and your sense of well-being. When you are going through cancer treatment, you can feel more attractive by disguising the changes cancer has made and drawing attention to your best points.
The following mirror exercise can help you adjust to body changes:
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What do you see when you look at yourself in the mirror? Many people notice only what they dislike about their looks. When they look in the mirror, they see pale skin, hair loss, an ostomy appliance, or skinny legs. They fail to see a classic profile, strong-
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Find a time when you have privacy for at least 15 minutes. Be sure to take enough time to really think about your appearance. Study yourself for that whole time, using the largest mirror you have. What parts of your body do you look at most? What do you avoid seeing? Can you catch yourself having negative thoughts about the way you look? What are your best features? Has cancer or its treatment changed the way you look?
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First, try the mirror exercise when dressed up. If you normally wear clothing or accessories to disguise changes from cancer therapy, wear them during the mirror exercise. Practice this 2 or 3 times or until you can look in the mirror and see at least 3 positive things about your looks.
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When you are comfortable seeing yourself as a stranger might see you, try the mirror exercise when dressed as you would like to look for a lover. If you’ve had an ostomy, for example, wear a bathrobe you like. Look at yourself for a few minutes, repeating the steps in the first mirror exercise. What is most attractive and sexy about you? Pay yourself at least 3 compliments on how you look.
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Finally, try the mirror exercise in the nude, without disguising any changes made by the cancer. If you have trouble looking at a scar, bare scalp, or an ostomy, take enough time to get used to the area. Most changes are not nearly as ugly as they seem at first. If you feel tense while looking at yourself, take a deep breath and try to let all your muscles relax as you exhale. Don’t stop the exercise until you have found 3 positive features or at least remember the three compliments you paid yourself before.
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The mirror exercise may also help you feel more relaxed when your lover looks at you. Ask your lover to tell you some of the things that are enjoyable about the way you look or feel to the touch. Explain that these positive views will help you feel better about yourself. Remember them when you are feeling unsure.
Changing Negative Thoughts
Your thoughts can make a sexual experience good or bad. Become more aware of what you tell yourself about how sexy you are. You may be setting yourself up for failure with thoughts like, “A man who can’t have erections is no good at all in bed.” Almost all of us put ourselves down as lovers now and then.
Write down the 3 negative thoughts you have most often about yourself as a lover. Some may be connected to your cancer treatment, but other thoughts may have started years ago.
Now write down a positive thought to counter each negative thought. For example, if you said, “I always climax too quickly during intercourse,” you could substitute the statement, “Even though I climax quickly, I always satisfy my lover through caresses after intercourse.” The next time you are in a sexual situation, use your positive thoughts to override the negative ones you usually have. If you have a favorite feature or talent, this is a good time to indulge yourself a little and play it up.
If negative thoughts intrude and you find yourself overwhelmed or discouraged, you may want to talk with your cancer team about working with a mental health professional. This can be very helpful as you adjust to your new situation.
Coping With Appearance Changes Because of Chemotherapy
The most obvious change in those receiving chemotherapy is the loss of hair. You may also lose weight and muscle mass if you are sick to your stomach and have a poor appetite. You may be pale, and you may also have a permanent catheter placed in your shoulder or arm.
Some physical changes caused by chemotherapy can be disguised or made less obvious. If you are just starting chemotherapy, you may want to shop for a wig before your hair begins to fall out. Wigs are warm and not really comfortable, so you may decide to save your wig to wear outside the home or hospital. You can collect hats or caps for private times. You may decide to wear a hat or cap instead of a wig in public. Many men feel a wig is just too much trouble, especially since it is not easy to find one that looks natural.
It’s a good idea for a couple to discuss how each of them feels about wearing a wig or head-covering during lovemaking. There is no right or wrong decision. Men often feel ashamed for caring about being bald. However, it can be just as upsetting for a man to lose his hair during cancer treatment as it is for a woman.
Disguising weight loss, paleness, and infusion catheters is also a challenge. In general, clothes that fit well look better. Wearing something too tight or too baggy will just draw attention to your weight change. High necks and long sleeves can hide a catheter but may be too hot in the summer. Look for thin fabrics that will be cool while covering you.
Sometimes the changes in your body are so upsetting that you can’t relax or think positively. Rather than feel like a failure, take this as a good clue that some counseling from a health care professional would be helpful.
Overcoming Depression
Staying active is a good way to fight depression and reduce stress. Consult your doctor on the kinds of exercise that are right for you. As long as you don’t overdo it, exercise should help you feel vital and healthy. You can also reduce the pain and nausea that some cancer treatments cause by learning skills to help you relax. Many methods of relaxation can be learned from video or audio tapes, although training by a mental health professional is probably most effective.
If depression persists, there are medications that can help restore interest in sex. What doctors call “clinical depression” has a number of symptoms. These include lack of interest in sex, lack of interest in things that usually give you pleasure, and even not being able to feel pleasure at all. Often these feelings are in addition to not being able to sleep, changes in eating habits, fatigue, trouble concentrating, and feeling worthless and hopeless. Depression can be treated with medicine to improve your sleep, appetite, energy, ability to feel pleasure, and, in turn, your self-esteem and desire for sex. This is something to discuss with your doctor.
Some of the newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may cause difficulty achieving orgasm. There are measures that can be taken to improve these potential side effects. If this is something that is distressing for you, talk to your doctor about it. There are other antidepressants that may not have that effect on you.
Dealing With Grief and Loss
It is common to experience grief over the loss linked to your cancer diagnosis and treatment. You may also notice sadness, anger, and hostility toward those close to you. Cancer changes your sense of self, that is, how you think of your body and yourself. This can disturb your well-being, and affect how you see yourself sexually. It can also impair your ability to maintain your relationships. Grief is a normal response as you give up your old ideas of yourself and begin to develop new ways to cope with your changing circumstances. It may take time for you to recognize these losses and changes. This, too, is normal. It can help if you can share your grief with someone close to you. If there is no one near you that you want to confide in, you might prefer to see a mental health professional. Just as it is important to attend to pain in your body, painful feelings are also worthy of care.
Rebuilding Self-Esteem
Feeling attractive is just one part of your self-image. Dr. Wendy Schain, a psychologist who counsels men and women who have had cancer, describes self-esteem as a set of bank accounts.
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One account contains the net worth of your physical self – what your body can do and how you look.
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The second account is your social self – how easily you get along with others and the emotional support you can count on.
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The third account is the sum total of your achieving self – what you have done in school, work, and personal and family relationships.
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The fourth account is for your spiritual self – your religious and moral beliefs and the strength they lend you. During your life you make deposits in your accounts, but when a crisis like cancer arises, you must also make withdrawals. Going through cancer treatment has costs in terms of your physical ability to function, your relations with others, your career goals, and sometimes your faith in the fairness of life.
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When one of your accounts becomes low in funds, you may need a “loan” from one of the others to balance your account.
Try to be aware of the costs of cancer in your life. Make a special effort to get new deposits for the accounts that remain active. That way, a drain from one area of your self-worth will not bankrupt you entirely. If your cancer treatment has affected your looks, focus on the caring you receive from friends and family who react to you on a deep level of intimacy. If treatment interrupts your work, use some of your energy to enrich your social life or your spiritual life.
Although you may sometimes feel that all your accounts are getting low, a more careful look can show some areas where income is still flowing in.
Good Communication
The most important part in resuming sexual activity with a partner is good communication. Men often react to cancer by withdrawing. They fear their partner would feel burdened by sharing fear or sadness. Unfortunately, through trying to protect each other, each suffers in silence. No couple gets through cancer diagnosis and treatment without some anxiety and grief. Why not discuss those fears with one another, so that you shoulder the load together rather than alone?
Sexual sharing is one way for a couple to feel close during the stress of an illness. If your partner has been depressed and distant, however, you may fear that a sexual advance comes across as a demand. You can bring up the topic of sex in a healthy, assertive way. It is usually not helpful to accuse (“You never touch me anymore!”), or demand (“We simply have to have sex soon. I can’t stand the frustration!”). Instead, try to state your feelings positively (“I really miss our sex life. Let’s talk about what’s getting in the way of our touching.”).
Overcoming Anxiety
Many couples believe that sex should always happen on the spur of the moment, with little or no advance planning. If you feel awkward and nervous about trying some sexual touching, however, that perfect moment may never arrive. After an illness, a couple needs to schedule some relaxed time together and start their lovemaking slowly.
Part of the anxiety about resuming sex is caused by the pressure to satisfy your partner. A relaxed way to explore your own capacity to enjoy sex is to begin with self-stimulation, or touching yourself. Masturbation is not a necessary step in resuming your sex life, but it can be helpful. By touching your own genitals and even bringing yourself to orgasm, you can find out if cancer treatment has changed your sexual response. You can also learn whether there are painful or uncomfortable areas without having to worry about frustrating yourself or your lover.
Although most of us learned as children that masturbation was wrong, or at least something to hide, it is not at all harmful. Most men and women have tried touching their own genitals at some time in their lives. Many people who enjoy good sex lives with their partners still masturbate. Men and women in their 70s and 80s often still enjoy self-stimulation.
If you feel at ease with the idea, try stroking not just your genitals, but all of the sensitive areas of your body. Notice the different feelings of pleasure that you can have.
Resuming Sexual Activity With Your Partner
When you feel ready to try sexual touching with your partner, pick an occasion when you have both time and privacy. You may want to set the scene to be especially relaxed. For example, you could light the room with candles or put on some soft music. Although you may feel a little shy, let your partner know, as clearly and directly as you can, that you would like to experiment with some sexual activity.
You could even “make a date” to have some time alone together. You might say, “I feel ready for sex again, but I’d like to take things slowly. Would you be in the mood tonight to try a little touching? I can’t promise that it will go smoothly, but we can have fun trying.”
It is a good idea for couples to put some limits on their touching the first few times they try sexual activity after cancer treatment. We advise starting with a special session devoted to all-over body touching. Each partner takes a turn touching and being touched. One partner lies face down on the bed, allowing the other partner to touch the entire back, from toes to scalp. After about 15 minutes, the partner lying down turns over so the front of the body can be touched.
While being touched, your job is just to be self-centered and tune in to your own feelings. Don’t worry about your partner’s thoughts or feelings. When you are doing the touching, enjoy the shape and texture of your partner’s body. Try many types of touching, varying light stroking and a firmer touch, as in a massage.
The first time you try a touching session, avoid the breasts and genitals. Your goals are to feel relaxed and to experience sensual pleasure. It is not important to get sexually excited. If you agree on these goals before starting, the touching should not be frustrating. This type of session takes the nervousness and pressure out of being close again.
If you both feel relaxed during the first touching session, you can add some genital touching the next time. Over several sessions, partners can slowly spend more time on genital touching, until each one can reach an orgasm through stroking with a hand or through oral sex, if that is comfortable for both of you.
Many couples don’t talk much about sex. After cancer treatment, however, your sexual routine may need to change. This calls for clear communication. This is not the time to let embarrassment silence you. Be sure to let your partner know, either in words or by guiding with your hand, the kinds of touches you like best. Try to express your desires in a positive way. For example, “You have the right place, but I’d like you to use a light touch,” rather than, “Ouch! That’s too rough!” Delay having intercourse until both partners really feel ready for it.
If cancer treatment has caused an erection problem, intercourse may no longer be possible. Yet a couple can enjoy all the other parts of sex. It would be a shame to give up touching and caressing, just because one aspect of lovemaking has changed.
Making Intercourse More Comfortable
If you still have some pain or feel weak from cancer treatment, you may want to try new lovemaking positions. Many couples have found one favorite position, particularly for intercourse, and rarely, if ever, try another.
However, if you are feeling weak or out of breath, the usual position may take too much effort. You may be able to enjoy intercourse more if both of you lie side-by-side, either facing each other or with your partner’s back next to your front side. Or, your partner can be on top.
Another position that may work well for some couples is for the woman to sit astride her partner. This allows her to move more freely while her partner relaxes or touches her with his hands. You can look at this as a good opportunity to learn other approaches to enjoy sex with your partner.
The drawings on these pages show positions to help in resuming intercourse after cancer treatment.
There is no magic position that is right for everyone. You and your partner need to find the one that is best for you. Small and large pillows can help as supports. Seeing the humor in figuring out the best way to have intercourse can help lighten up your efforts.
Rekindling Sexual Interest
Everyone has sexual thoughts or feelings now and then, but we often ignore or forget about them. If you have not noticed any interest in sex lately, try keeping a “Desire Diary.”
Every day for a week prepare a sheet of paper that will become your Desire Diary. Take it with you wherever you go. When you have a sexual thought or feeling, write it down. Note the time of day and whether you were alone or with someone. Also note what you did about the thought. An example of one man’s Desire Diary is shown below.
Although the man did not have any sexual activity, he felt desire a few times during the day. Sometimes just keeping track of your desire will increase the number of sexual thoughts and feelings that you notice. You might also find that certain settings or people help you feel more sexual. Perhaps you think about sex most often in the evening, or when you are at work, or in the presence of your partner. Once you have noted some patterns, you can work at putting yourself in the situations that spark a sexual mood.
Some people feel more sexual if they get some exercise, if they plan a relaxed evening out with their partner, or if they make special efforts to look and feel sexy. Think about the things that have helped to get you into a sexy mood before. Try looking at erotic pictures, reading a story steamy with sex, or watching a video with a romantic or sexual plot. Fantasize about a sexual encounter. Picture it as you would like it to be. How can you make your daydream come true?
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