Sex and Cancer

Cancer is not sexy, but you can still be sexy and have cancer. With an increasing number of cancer cases and cancer survivors, we have numerous wonderful support groups and therapists who specialize in cancer. I will therefore bypass many of the issues linked to cancer and rather focus on the less addressed issue of sex and cancer.

I have had the privilege of working with many cancer survivors over the years, and I have also supported people with cancer in their process of treatment that did not succeed. These experiences have given me some insight into what a person goes through in the journey toward survival or death.  Some of my clients that deceased came to me specifically because of my expertise in sex. They wanted to maintain the sexual part of themselves to the last minute because it made them feel like human beings, and they felt that sex was a life line. And perhaps keeping their sexuality alive gave them some extra time, we will never know.

Courage isn’t having the strength to go on – it is going on when you don’t have strength.

Napoleon Bonaparte

Scars after surgery

Regardless of what type of cancer you are dealing with, if there is surgery there are scars. Breast cancer and prostate cancer impact your sexuality in a direct way, but any scar on your body or face can interfere with how you feel about yourself sexually.

Although it can be difficult it is important that the scars get acknowledged as soon as possible, and then attended to. Scars that are left untouched and ignored can eventually become a source of pain, shame, pulling and movement restrictions.

Can scars be erotic? Of course they can. It depends on what lenses you look through, and what intention you have when you touch. If you look through erotic lenses, the scars become sexy. Similarly, if you give and receive touch with an erotic intention, the scars can become a site of sexual or sensual pleasure, just like any other body part.

Erotic pleasure is not limited to the genitals and the breasts; every inch of your body can be a source of pleasure, if you let it.  Accepting and integrating the scars as part of you is an important part of your erotic healing process. You don’t have to like your scars, but you have to accept them, and if you have a partner, let him or her get acquainted with them.  Scar tissue is alive, and is changeable in response to touch and therapy. The body is always striving to heal itself, and you can facilitate this process by touching your scars as well as having your partner gently touch them.  When you are ready, extend an invitation to your scars to be part of your sexual life, and try to stay open to the experiences that emerge if they accept the invite.

Nipple or no nipple

Men and women, straight or gay, all have a relationship to nipples. From being a site of survival and nourishment in the first stage of life, nipples become highly erotic zones in adulthood. If the mastectomy leaves you without nipples it can be a huge loss, and a source of grief as well as shame and embarrassment. Before you can tolerate to look at yourself without nipples or feel sexy without nipples, you might have to mourn the loss of what they represented to you; visually, sensorial and sexually.  If you have a partner, he or she, might have to mourn this loss with you as it impacts you both in various ways. The step of mourning is often skipped because you are encouraged to be positive, and your partner is urged to be encouraging. I believe that acknowledging the truth of the loss allows you to heal and move on. There is still a breast that is sensitive to touch and caress, but if compared to pre-surgery, the sensation is probably different. It can take a while for the sensation to come back, but in the meantime it is essential that both giver and receiver are curious about what kind of sensation can be felt on any given day. In other words, try to let go of the idea of what you used to feel, or should feel, and stay with what you actually feel.

Sexual desire and cancer

Sexual desire is a result of many variables, and it is a bit mysterious as it can emerge when you least expect it, and be out of reach when you most want it. Desire is not like hunger, it doesn’t just present itself with predictable intervals; sometimes we have to kindle desire to make it appear. The latter is often the case after cancer and other illnesses.

The mere thought of sex or sexual desire, while you are dealing with cancer and treatment, might be nauseating. You might feel sick, weak, angry, depressed, asexual and so forth, and none of these feelings are compatible with sexual desire. It can be beyond challenging to feel sexy with drains coming out of your armpits or a colostomy bag attached to your stomach. So, is it better to forget about sex for a while? For some people it might be, it depends on each person’s unique situation. But if you yearn to feel desire, then it is worth putting in the effort.

I frequently hear from clients that they cannot engage in any sexual encounter because they lack desire. The reason for the absence of desire is often attributed to changes in hormones, body image, discomfort, pain, tiredness, stress and so forth. These reasons are all valid and true, and yet the question that remains is whether or not we have any control over the feelings of desire, and I will say, yes, we do.

Common thinking is that desire must precede the erotic encounter, thus if there is no desire there is no sex. The flip side of the above mindset is that if there is action, desire will emerge. In practice, the latter means that you choose to respond versus reject a move from your partner, even if you don’t feel excited at that moment. Or alternatively, you agree to meet for an “intimacy date” as a means to awaken the desire. While the latter can be structured in many ways, the essence is to agree to a time and place, have a clear agreement of what is ok and what is off limits, and then show up even if you feel bloated, tired, out of sorts and so forth.

Through the action of being together in a nice setting with an intention to connect and be present, some sense of desire might start to arise. In order for this to be a good experience, it is best not to have an agenda for what you should be feeling, or used to feel, but be willing to feel the sensations and emotions that is happening moment to moment. Keep in the forefront of your mind that you and your partner are there to support each other, honur your limits and fears, and rediscover each other. Kindling desire after cancer takes time, courage and patience, but it pays off as it supports your healing process, and can help mend potential rifts in the relationship with your spouse or partner.

Painful sex and cancer

Pain and sex is a bad combination because as humans, we tense up when we are in pain, and when we are tense, sex hurts. Cancer causes pain, but the intensity and type of pain vary according to the type of both cancer and treatment.

If surgery was part of your cancer treatment, you most certainly have scars, which means a hardening of the fascia (connective tissue) on the site of the surgery. However, it goes beyond that, because the fascia wraps around and in between every organ, muscle, nerve and bone of your body as a continuous web. The practical implications of this are that a tightness or hardening of one fascial area will have ripple effects throughout the body by pulling on other areas. Imagine the fascial web like a spider-web, if you give a little tug in one end, the whole web will vibrate or maybe even tear. That is how sensitive your fascial web is. The fascia is also full of free nerve endings, which, when stimulated by mechanical or chemical stimulus, convey to the brain a sensation of pain such as burning, stinging, itching, cutting, or aching.

Depending on where and how many surgeries you have had, the size of your scar(s), your age, level of fitness and the quality of your rehabilitation, the impact on the fascial web will vary.  For example, pain in the pelvic region; nothing shows up on an x-ray or MRI, yet the pain is real and makes it impossible to have sex. If you are a female, your vagina tightens up, lubrication stops, and penetration hurts. If you are a male, as soon as you get erect your pelvic floor is on fire, and as a result, you lose your erection.  For both parties, now there is a fear response associated with having sex, and just the thought of it can trigger the pain.

From a physiological point of view, the pain is real and can be rooted in, for instance, previous surgeries in the abdominal region. The fascia surrounding the abdominal organs is continuous with the fascia of the pelvic floor. If you have scar tissue deep in your abdomen, it can pull on the fascia surrounding your vagina or your penis, and when either one gets aroused, the pull can trigger the nerve endings in the pelvic fascia that are messengers of pain. Similarly, the fascia of the inner thigh is connected to the fascia of the testis. Consequently, tightness or injury of the inner thigh muscles (adductors) can cause pain in the testis during the movements of sex.

From a psychological point of view the trauma of experiencing painful sex is profound and does not get easily erased. Because our brains are designed for protection and survival, painful sex, especially if more than once, raises a red flag in the brain. The reality of this is that every time the prospect of sex arises, your brain is on alert, and unconsciously you tense up and feel pain.

The solution is not expanders if the vagina is tight, or painkillers if the erection hurts. The solution is manual work on the fascial scars and surrounding tissues, breath-work to relax the sympathetic nervous system, and mind/body work to undo the fear response attached to having sex.