Becoming Sexually Active Again – Expressing Yourself Sexually After Cancer Treatment
With all the possible effects of cancer treatment, the prospect of having a normal sex life may seem out of reach. But whatever your cancer, there are steps you can take that will help you increase your sexual enjoyment.
If You’ve Had an Ostomy People with ostomies and their partners have to learn about ostomy appearance, care, and control. Women may be comfortable wearing special undergarments that cover a pouch while still permitting sexual stimulation.
Specially designed and aesthetically attractive pouches are available.
If You’ve Had a Laryngectomy Laryngectomy patients should be acquainted with how to deal with sounds and odors escaping from their stomas. Wearing a stoma shield or a T-shirt will muffle the sound of breathing and will minimize your partner’s feeling the air that is pushed through the stoma.
If You’ve Had a Mastectomy After a mastectomy, you may be worried about how you look. Undressing in front of your partner or sleeping in the nude may feel awkward and uncomfortable. That’s natural, especially in light of the overemphasis our culture places on the sexual significance of breasts. Grieving over what you have lost is important. But with time and patience, most women overcome their self-consciousness and feel secure and comfortable with their bodies again.
Some women have found it helpful to explore and touch their bodies, including the area of the scar, while nude in front of a mirror. You may want to try this alone at first and then with a spouse, lover, or close friend. Share your feelings about your new body.
Be aware that your partner may not know what to say. Your spouse or lover may not know how or when to bring up the topic of sexuality and so may wait for you to do it. Your partner may be afraid of hurting or embarrassing you and want to protect your feelings. Sometimes this “protection” may feel like rejection. Although you might feel that it’s risky to break the ice and approach the topic yourself, most patients as well as their partners feel relieved once they’ve done it.
You both may also worry about pain. If your incision or muscles are tender, minimize the pressure on your chest area. If you lie on your unaffected side, you can have more control over your movements and reduce any irritation to the incision. If your partner is on top, you may protect the affected area by putting your hand under your chin and your arm against your chest.
If you feel any pain, stop. And let your partner know why you are stopping. If he or she knows that you’ll speak up when you notice any pain, you will both feel more relaxed and less inhibited in exploring and experimenting. Taking a rest or changing position may help you relax, and relaxing will usually decrease any pain. With communication and cooperation, you can work together to find positions and activities that give you the most pleasure.
Experimentation and time seem to be the keys to finding satisfactory ways of adapting to the loss of such a symbolically important part of the body as the breast. Talking with other women who have had mastectomies—women from the American or Canadian Cancer Society’s Reach to Recovery program, or support groups, for example—can provide support and encouragement as well as suggestions about clothes and prostheses.
Some women find breast reconstruction important for their emotional well-being, while others find that they learn to love and appreciate their altered bodies over time.
If You’re Having Trouble Reaching Orgasm The natural interruption in the ability to experience sexual pleasure after an illness may make having orgasms more difficult for some women. If this is a problem for you, learning to re-explore pleasurable body sensations may be helpful.
It is important to do this when you can be alone and not distracted by having to please or perform for your partner. So find a comfortable place where you can be alone—your bedroom or bathroom—and a time when you won’t be interrupted. Undress slowly and gently stroke your whole body. Then focus on the most sensitive areas—your neck, breasts, thighs, genitals, or any other area that feels good to you.
Use different kinds of touch, soft and light, firm and strong. Try moistening your hands with oil, lotion, or soap. Pay attention to the sensations you feel, and discover which ones are most pleasurable. Learning which kinds of touch feel best will help you heighten your sensation and will give you information to share with your partner. There are many excellent books on women’s sexuality that can help to make you comfortable with this kind of exploration.
If You’re Having Trouble with Erections Since some drugs can temporarily interfere with the ability to have erections, you may want to ask your physician about possible side effects of your treatment.
Physical and Emotional Causes If you can get an erection by masturbating or you wake up with an erection in the night or morning, it is most likely that anxiety or “trying too hard” is the cause, and it’s not a physical problem. If you are not sure of the cause, ask your doctor to refer you to a urologist or sex therapist or both for evaluation and treatment.
Taking the Pressure Off The more options you have for sexual expression, the less pressure there is on having erections. This in turn makes it more likely that they will happen. Many couples report that they have learned to have very pleasurable sexual experiences without erections or intercourse. Many kinds of sexual expression and stimulation do not require an erect penis. It may be reassuring to know that to have an orgasm, many women need or prefer direct stimulation by hand or mouth on or around the clitoris. This is stimulation that even an erect penis in a vagina can’t provide.
If you explore other kinds of sexual touching and expression for a while, you may discover that erections will return with time or that the increased variety of sexual options satisfies both you and your partner. Patience, communication, and time are critical factors in developing pleasurable sexual experiences.
Counseling If erections don’t come back and intercourse is important to you and your partner, ask your doctor to refer you to a sex therapist for counseling. Counseling will help you with relaxation techniques, with planning time for proper stimulation, and with methods for using visual stimulation and fantasy. Other cancer survivors who have had the same problem report that group counseling can also help.
A number of new medications for erection problems have come on the market in the last few years. Taken before a sexual encounter, these medications increase blood flow to the penis, resulting in an erection. The first of these, sildenafil (Viagra), became available in late 1997, followed by vardenafil (Levitra) and tadalafil (Cialis).
They differ in onset of action, duration of action, and interaction with food. Sildenafil and vardenafil should be taken on an empty stomach for optimal effect, have an onset of action of thirty to sixty minutes and a duration of action of about four hours. On the other hand, tadalafil can be taken without regard to meals, has an onset of action of about forty-five minutes and a duration of action of twenty-four to thirty-six hours. Side effects include headaches, visual disturbances, and flushing.
While considered generally safe for most men (including those using most blood pressure medications), sildenafil, vardenafil, and tadalafil should not be used by men taking nitrates. Medical clearance is essential prior to use of these drugs. Other medications are becoming available, so discuss the appropriateness of their use in your case.
If even with the help of these medications you are still not getting erections, the counselor may refer you to a urologist. Together with you and your counselor, the urologist can explore another option, such as use of a vacuum pump, injection therapy, or a penile implant.