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Facing cancer as a couple

Author: Nancy Christie

There’s no denying that a cancer diagnosis changes everything. The impact can be felt in every area of a person’s life—from the physical to the psychological, the spiritual to the emotional. Cancer can affect not only how patients feel but also how they feel about themselves, which can have an impact on current and future intimate relationships with partners or spouses.

Many factors contribute to a patient’s ability to maintain or create fulfilling intimate relationships in the wake of a cancer diagnosis, including others’ reactions to the situation and the patient’s own sense of self-worth. Though this aspect of the cancer journey can present challenges, striving for honest, meaningful communication can help ensure that cancer doesn’t shut the door on intimacy and love.

Cancer and body image

When Neil Coker was treated for Hodgkin’s lymphoma, the hair loss that resulted from cancer treatments was not the biggest physical change to which he had to adapt. For the martial arts enthusiast, it was the loss of muscle mass and diminished fitness level—along with an extensive thoracotomy scar—that had the biggest impact on his body image. “I’m not happy with my physical appearance,” Neil says of the changes that cancer treatment has wrought. “To the extent that I could, I’ve stayed active, but I am not able to get back to the level of physical fitness I had before cancer.” Neil had been dating his now-wife for about nine months when he was diagnosed, and he says he doesn’t feel as attractive as he did prior to the diagnosis.

Fortunately, he adds, “I found a woman who understands what I’m going through. And when I complain about how I look, she says, ‘You look fine to me!’” Sueann Mark, PhD, associate professor at the Institute for Advanced Study of Human Sexuality and a breast cancer survivor, says that concerns over body image are a common issue for cancer patients as they adapt to their bodies’ “new normal” and the impact of those changes on their sexuality. “New sensations, loss of sensation, loss of functioning, scars, limited mobility, and a whole host of other changes mean that sexuality will not be the same.”

Dr. Mark says that these changes, while challenging, can also open new doors. “Whether you are in a relationship or starting a new one, you have the opportunity to build a new sexual relationship from scratch,” she says.

New Relationships after Cancer Cancer patients who are single at the time of their diagnosis may confront difficult emotional challenges and questions as they navigate the dating scene while adapting to the physical and emotional changes resulting from their diagnosis and treatment. Barbara Alterowitz, who together with her husband, Ralph (himself a prostate cancer survivor), founded the Center for Intimacy after Cancer Therapy, and they have jointly written several books on cancer and sexuality. Barbara says that self-esteem and body image can play a major role for these patients. “Overcoming that feeling of inadequacy or lesser self is a huge thing,” she says. “We’ve seen many instances where people have felt they are less of a person, who say, ‘I am damaged’ or ‘I don’t want to burden somebody else.’”

Once a patient makes a connection and begins a new relationship, Barbara says, other questions emerge, including, When should I tell? How should I tell? What’s my partner’s likely reaction? How will I feel once we start making love?

Experts agree that there’s no hard-andfast rule about when and what to tell, although informing a potential partner early in the relationship can serve two purposes: it opens the door to a more in-depth discussion as the relationship develops and also, says Dr. Mark, weeds out those who can’t handle being with someone who had cancer. “More important than when you disclose is how you do it,” Dr. Mark adds. “Be prepared to educate the other person about your diagnosis and treatment, keeping in mind that he or she will pick up on your outlook and take cues from you. If your disclosure is full of shame and fear, the other person may be put off. If you talk about your experience with cancer as something that is part of your history but doesn’t define you as a person, you will put the other person at ease.”

For Neil, sharing the news of a cancer diagnosis with his then-girlfriend wasn’t an issue. “It was fairly easy for me to tell her because we had been dating for nine months and were living together at the time, so she was the first person I told. I never really put a whole lot of thought into [telling her]. I guess I took it as, I’m going to tell her, and if she can handle it, great; if not, well, I’ve got more important things to worry about.”

Maintaining relationships after cancer

Though Neil and his wife have weathered many storms since the initial diagnosis— including several recurrences and treatments—cancer continues to occupy a major place in their lives as they strive to maintain a healthy, happy relationship. “Every once in a while, especially when it’s time for scans, I think, What if? Is it going to come back? What are we going to do this time?” says Neil. “If any symptoms arise that might mimic the symptoms you had when you were diagnosed, you think, Oh, I hope it isn’t. It weighs on your mind and affects your attitude and daily productivity level. And then, when someone asks, ‘Is something wrong?’ you say, ‘No!’ and get snappy with them.”

“Treatment affects body, mind, and soul, and weathering the ups and downs together requires communication and compassion on both sides,” says Dr. Mark, adding that sexual interaction, an important part of the relationship, can be a challenge for couples after a diagnosis. “Patients are often seeking confirmation that they are still desirable, and partners are often afraid that they will cause pain if they try to initiate any sexual activities. If the couple doesn’t talk about it, no one will be satisfied.”

Bridging the gap between caregiver and partner is probably the biggest challenge facing couples, she adds. “Separating these roles, making space for caregiving and the space to be a couple, is extremely valuable.”

The shock of the diagnosis and the threat of death can lead to a mutual retreat from each other into a sort of semiisolation, which can then block a couple from resuming their intimacy and sexuality, points out Ralph Alterowitz. “The big bridge to get across is to start communicating with each other: talk about your feelings; find out if both of you are ready to resume intimacy and sexuality. Intimacy, feeling nurtured and close to your partner, should be there.”

Dr. Mark encourages couples to “continue to be as sexual as possible during treatment to maintain a sense of intimacy outside the rigors of treatment. This likely will require a new imagining of what sex means to you. The key is to redefine your sex life beyond penetration and orgasms to include intimate, sensual pleasures like kissing, exchanging massages, and sharing fantasies. Think of your sex life like a hot-water heater: you need to keep the pilot light going even if you’re not going to take a shower.”

Most importantly, don’t put a relationship on hold, says Jan Latona, PhD, who together with her husband, Gary J. Stricklin, PhD, authored Love Is a Journey: Couples Facing Cancer (AuthorHouse, 2005). Both Dr. Latona and her husband know firsthand the challenges cancer can pose to a relationship. Dr. Latona lost her first husband to cancer, and Dr. Stricklin himself is a cancer survivor. The two now counsel other couples dealing with cancer.

“It always needs to be nourished in some way,” says Dr. Latona. “A person’s spouse or partner is there the whole time. The efforts to support the intimate relationship are the responsibility of both the patient and the partner. Loving activities (appropriate to the level of health) need to be initiated by each person—exactly as that balance is necessary during healthy times.”

It’s the “partnership touch”—separate from the caregiver touch—that can help keep alive the intimacy and the sense of sexual connectedness that is essential in a relationship. “Many touches become functional touches,” says Barbara Alterowitz, but it’s “the loving touch that is just so essential to keep—holding hands, the loving touch on the shoulder, hugging. The act of being physically close and touching someone is so important. From the moment we are born, touch tells us that we are loved. We are so needy of that, especially during a time when we are going through a crisis. I think the loving touch is the most important thing other than talking. Stay emotionally and physically connected. When people stop touching, that’s really dangerous.”

Embrace the opportunity for connection

While there’s no denying that cancer has challenged their marital relationship, Neil says that it has also made him view being in a relationship differently than before he had cancer. Cancer, he says, “changes your perspective of what a good relationship is. You learn what’s really important. My wife could have packed up and left, but she stuck by me. We faced down the tough times, and we’ve seen that when we stand together we can deal with the tough times life throws at us. Cancer shows you what is really important.”

As Neil’s experience illustrates, a cancer diagnosis creates opportunity for perspective and a deeper connection for both patient and partner. Dr. Latona says that recognizing the impact of the diagnosis on both people in the relationship is key: “Both people in the relationship have needs that must be validated and honored so that they can contribute to the health and the joy of the relationship. The chemistry of a love relationship is a very balanced formula that includes giving and receiving. This looks different during a cancer journey than at other times, but with understanding and flexibility a couple can complete their cancer journey in a richer, fuller relationship than they had before.”

Resources

Online

  • American Cancer Society cancer.org Sexuality for the Woman with Cancer Sexuality for the Man with Cancer (800) 227-2345
  • Center for Intimacy afer Cancer Therapy
  • renewintimacy.org (301) 983-9702

Books

  • Love Is a Journey: Couples Facing Cancer by Jan Latona, PhD, and Gary J. Stricklin, PhD (AuthorHouse, 2005)
  • The Lovin’ Ain’t Over for Women with Cancer by Barbara Alterowitz and Ralph Alterowitz (CIACT, 2012)
  • Saving Your Sex Life: A Guide for Men with Prostate Cancer by John P. Mulhall, MD (Hilton, 2008)
  • Intimacy with Impotence: The Couple’s Guide to Better Sex after Prostate Disease by Ralph Alterowitz and Barbara Alterowitz (Da Capo Press, 2004)
  • Intimacy afer Cancer: A Woman’s Guide by Sally Kydd, PsyD, and Dana Rowett (Big Think Media, 2006)
  • Be a Survivor: Your Guide to Breast Cancer Treatment by Vladimir Lange, MD (Lange Productions, 2009)
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