The Guide to Getting It On (164 page)

Outside of the effects of chemotherapy and the invasiveness of treatment, there’s nothing about cancer itself that makes a person want sex any less than anyone else does. In fact, the latest study on this subject expected to find that certain cancers or certain kinds of treatments would be correlated with having less sex a few years down the line, but the biggest factor turned out to be the quality of the person’s relationship. No doubt, chemo was a bitch and took a toll, and missing certain key hormones can be a challenge, but at the end of the day it was the relationship that counted most when it came to having and enjoying sex.

Advice from Anne

Sex educator and cancer expert Anne Katz recently phoned with some thoughtful reminders for readers of
The Guide:

• Medical students get about two hours of sex education, with most of it focusing on penis problems. It’s easier for many oncologists to talk about dying than sex. You, the patient, will need to be the one to ask about sex.
  
• Lack of desire and lack of libido can be huge in cancer patients, but it’s not only from having your body nuked or poisoned. Imagine what it is like for a patient with cancer in her pelvis to lay there with her legs wide apart and a bright beam of light shining on her anus or vulva while several strangers crowd around to administer treatment? In order to cope, she learns to go somewhere far, far away in her mind. It is not always easy to come back when it’s time to have sex with a partner.
  
• Body image issues are immense—how do you tell a perspective mate you are missing a certain body part, or you have this large scar? When do you tell a date “I can’t have children”?
  
• With childhood cancer survivors, their whole lives have been medicalized. Some can more easily tell you their white cell count than how they feel. Many often have to face lifelong screenings for secondary cancers.
  

Making Adjustments

One of the things that makes sex enjoyable is that it’s fun. But when you hear the word cancer, “fun” is one of the last things you think about. So the job for a cancer patient and his or her partner after the diagnosis is how to make sex fun again. This you will both need to work on!

So let’s get the bad news out of the way first. A healthcare provider named Peggy McKeal, Ph.D. LMHC, who has lots of experience with sex and cancer sums it up for us. While she talks about women with cancer, what she says applies just as much to men with cancer:

“Remember, women are often the family caretakers. Nothing is supposed to happen to them. And then they need time to deal with the treatments. Imagine surgery that yanks out organs that produce the hormones that help make you want sex. And then imagine having what you are told all your life is a huge part of your sexuality disfigured. Now let’s go one step farther; imagine erogenous zones that aren’t erogenous anymore. Nipples that are gone and a scar left; desensitized skin, or skin that feels uncomfortably odd.

“Abdomens that have a running scar and your tummy no longer sends rushes of desire when caressed, but feels numb right down into the mons pubis. Desensitized erogenous zones all over the body due to hormone loss. (That nibble on the neck no longer makes goose bumps.) Think about body image from weight gain that will absolutely not go away due to hormone loss and cancer treatments. Think about wanting to want to have sex, be sexual, but not being interested, unable to fantasize due to hormone loss. (Yeah, that actually happens.) And then imagine trying to, but not getting turned on, and when/if you orgasm it is an incredibly quiet whisper instead of a shout. Imagine damage done to your body by radiation that makes touch or penetration painful and provokes anxiety. There are solutions that help improve things. Silicone dilators, lubricants, vibrators, time, time, time, and compassionate understanding from a partner. There are hormones that can be replaced IF your cancer is not fed by estrogen. Women who have been diagnosed with cancer and undergone treatment may be experiencing all of these things, or only some. And they feel sad, guilty and angry. They want to want. A lover who is blissfully calm, understanding, nurturing and incredibly patient is a wonderful human being.”

Okay, so you see what you are up against? You’ll need to both explore and find new places where touch feels good. Reread the accounts of the women at the start of this chapter. That’s exactly what they did. Look at how important love and sex has been to them. The question is how the two of you approach it, your patience, and your ability to make sex fun again.

Next, if you are boyfriend or husband, get yourself a copy of
Breast Cancer Husband.
In fact, the following suggestions are from Marc Silver’s rock-solid and highly-recommended book
Breast Cancer Husband, How to Help Your Wife (and Yourself) Through Diagnosis, Treatment and Beyond:

• A husband is often concerned about flirting with his wife who has cancer, for fear she will think he is pressuring her for sex. But not flirting with her can easily become a signal that she isn’t sexy anymore. His hesitancy to touch and play with her remaining breast if she had a mastectomy can also become a signal to her that she is no longer attractive to him. Or he might fear hurting her if she’s got drainage bulbs hanging out of an incision following surgery.
  
• She has breast cancer, not dementia. She knows her partner’s sexual desire didn’t suddenly melt away with the discovery of her cancer, and the chances are, hers didn’t either. At some point, hopefully sooner than later, the two of you need to talk about sex. Get your signals straight that it’s okay for him to pursue sex with her, and for her to pursue sex with him, and that it’s okay for either of you to say “yes” or “no” without feeling uncomfortable about it.
  
• Adjustments will need to be made in the way you have sex, but maybe that will be one of the hidden pluses in all of this. Maybe you’ll start exploring new ways to enjoy sex with each other, in addition to the old. (You’ll see that in the next section, where a guy with brain cancer and his partner use sex to feel closer in times of fear and distress.)
  
• Radiation can do a number on the skin of a woman’s chest. If it feels okay, it might be a nice way for the couple to keep physically connected for her partner to rub lotion on her chest a couple of times a day. (The same can be true with radiation in her pelvis. Rubbing her vulva and vagina with lube or an oil that her healthcare provider approves of can help with tissue that’s lost its elasticity.)
  
• For some women, chemo can make intercourse extremely painful. No matter how wet she might have gotten before, have a couple of different kinds of lube handy for when you start having intercourse (each has a different feel, which is why you should try a couple of different brands). Be sure to coat both the head of the penis as well as the insides of her vagina. Otherwise, if she has painful intercourse, it might start a nasty chain reaction where her vagina automatically tenses up whenever it senses an erect penis in the neighborhood. (Semen is actually somewhat corrosive on a good day. So don’t hesitate to start using a condom if that helps.)
  
• If you have access to a swimming pool, swimming-pool sex can be really nice. (As is mentioned elsewhere in
  The Guide,
  sex in water can actually end up being dry sex because the water can wash out a woman’s natural lube. An excellent work-around is store-bought silicon-based sex lube or a vegetable oil. Coat your respective genitals with it before getting wet, so to speak.)
  
• Sexy, short lingerie like a silk camisole or peignoir can help her feel less conscious about any missing chest real estate.
  
• If she’s receiving chemo and she feels like having sex (which might not be too likely) the man should probably wear a condom for the first day or two. That way, he won’t risk getting a rash on his penis from any of the chemo that is in her vaginal lubrication. For the same reason, he should avoid giving her oral sex for the first couple of days after she receives chemo, unless he’s got a tumor himself and you’re doing couples’ chemo.
  
• Think about her physical state now compared to a few weeks before her diagnosis. If she’s undergoing chemo and has had surgery, chances are she’s bald and missing a big part of what Hugh Heffner tried to convince the world is the most sexy part of a woman’s body. She may have scars that she didn’t have and she isn’t exactly feeling like she did when she was twenty and the tease of the town. While it would seem weird to her if you didn’t acknowledge the new realities, this is also no time to hide your sexual desire for her. And if she’s way too tired from chemo to even think about sex, ask if she’d like a foot rub or if she’d like you to massage her fingers.
  
• If you end up going for months when she doesn’t want sex and you’ve been masturbating a lot, still try to keep a physical and sensual connection. This will make it easier to reconnect sexually when the effects of the chemo and/or radiation are starting to fade.
  
• One of the biggest casualties to breast cancer can be romance. It’s hard to be romantic when so many new and mostly unwelcome things are suddenly intruding on your lives. Keep in mind that if you put romance on hold during the worst of your cancer saga, you’ll need to rekindle it as soon as you and she are able.
  
• Life can have its unfortunate contradictions. One woman who loves her pubic hair might lose it all during cancer treatments, while another who goes through the hassle of shaving herself bare every day won’t lose any of it!
  
• When there is sexual desire but little energy, think about ways to make adjustments. For instance, what if you find a comfortable position where he can have his penis inside of her vagina without thrusting while she uses a vibrator? He might then need to masturbate after she’s had an orgasm, but you still get the sexual and physical intimacy without her needing to expend much energy.
  
• If a woman is feeling bad about the way she looks and particularly unsexy, she should try not to assume that this is how her partner feels about her. And he should know that even if he still finds her to be sexually desirable, she might be so turned-off by her current condition that she assumes he is as well. This is one more example of just how important it is to talk to each other about sex.
  
• If her vagina is too tender to handle but a minute or so of intercourse, she can get him close to coming with oral sex or by hand, or he can jerk himself off until he’s just about to come, and then they start intercourse. Also, a finger on or in his anus during intercourse might help him to come sooner.
  
• You might need to change your thrusting depth and rhythm during intercourse. Experiment and give each other a lot of feedback.
  
• Birth control is a must for any woman who is not past menopause. Check with your physician(s), as they probably won’t want you using hormonal methods.
  
• Squeezing your breasts, sexual touching, and sexual activity will not spread cancer or impact your recovery in a negative way! Having orgasms does not alter or negatively impact your estrogen balance. Being wet sexually and having orgasms are just as good for you during and after cancer treatment as before.
  

From a Young Couple

We recently received an email from a young woman whose boyfriend has brain cancer. He’s 20, and she’s not yet. He’s had multiple brain surgeries, radiation, and now chemo.

Because of his nausea and problems with stamina, she’s on top during intercourse more than before. And some of the things he used to love her to do before his cancer can make him feel nauseated now. But she says as long as they give each other lots of feedback, they still enjoy sex, which shows that you can cut into a person’s brain, nuke it and poison it—it won’t necessarily stop them from wanting sex. In this case, his orgasms help him to feel better after chemo, assuming he’s able.

She says, “Sometimes we have sex just to feel closer in a hard time like after we heard he was going to need a second surgery. It’s comforting to be that close to the person you love and know that nothing is going to happen to them right then, even if outside of those moments you are living in constant fear. Sex has shifted to being almost totally focused on what feels best for him and I wouldn’t have it any other way.”

She didn’t mention anything about her own emotional journey, but it’s worth noting that modern medicine is, by necessity, so focused on the person with the cancer that we sometimes forget that his or her lover can be suffering just as much. The lover may feel way too guilty to even allow themselves to be conscious of how much emotional pain they are in. (This is a reminder to healthcare professionals, who are sometimes pretty overwhelmed themselves.) As for the details of how this couple approach sex and cancer, here it is in her own words:

“We ended up trying me on top more because he didn’t have to move as much and it can be less physically trying for him. He has less stamina so it’s nice for him to be able to have sex without ending up completely exhausted. I was tentatively afraid that I would cripple him if I were on top, but it turned out to be a very successful position. He actually likes it best out of all the positions we’ve tried.

“Communication has turned out to be key because he has sudden nausea or pain sometimes, but if sex is done correctly (with proper communication and being cautious not to over-do it) it can actually make him feel better. Sometimes we start but he needs to rest and then we keep going in a few minutes. He lets me know if something I’m doing is good or if it’s making him feel worse because some of the things we did before aren’t good anymore (for instance I used to kiss him on the stomach and back and he used to love it but now it can make him nauseated.) Sometimes things like that feel good and sometimes they don’t.