Intimacy challenges

How do intimacy and relationship challenges affect cancer patients?

The stress of living with cancer may have a negative effect on a patient's interest in sex and capacity for emotional intimacy. Every patient’s experience is different. For some, a healthy sex life may be difficult to maintain because of the physical and emotional impacts of treatment. While intimacy and sex are closely related, many patients may find that during treatment and recovery, they put more emphasis on the emotional connection rather than physical intimacy in a relationship.

Men and women also deal with intimacy and relationship struggles differently and experience sometimes widely varying challenges. For some women, cancer and its treatments may cause a range of symptoms that interfere with sexual function and physical intimacy, including:

  • Body image issues
  • Pain during intercourse
  • Loss of libido (sex drive)
  • Vaginal dryness
  • Loss of sexual function or sensation
  • Emotional issues (e.g., anxiety, depression and guilt)
  • Fatigue
  • Onset of menopause

Breast cancer surgery may also result in lost physical sensation, possibly limiting pleasure. Some cancer treatments may also trigger menopause, prompting hot flashes, mood swings, loss in libido and vaginal dryness or tightness. Some pelvic surgeries, like those to remove the uterus, ovaries or bladder, may reduce vaginal lubrication and sensation, contribute to loss of vaginal elasticity, and cause pain. Radiation therapy to the pelvic area can cause changes in the vaginal lining, making intercourse painful.

Some men experience their own challenges. Surgeries for prostate, bladder and colorectal cancers, for example, can damage nerves and blood vessels, causing erectile dysfunction, and problems with ejaculation and orgasm. Radiation therapy to the pelvis can damage the arteries that bring blood to the penis, resulting in incontinence or difficulty getting and keeping an erection. Chemotherapy may interfere with testosterone production in the testicle, which an impact sexual function. Hormone therapy for prostate cancer may decrease a man’s hormone levels, reducing the ability to achieve an erection or orgasm.

Symptoms vary from patient to patient but may include:

  • Erectile dysfunction, or difficulty getting or keeping an erection
  • Loss of libido (sex drive)
  • Concerns about sexual performance
  • Body image issues
  • Emotional issues (e.g., anxiety, depression, guilt)
  • Fatigue

How likely are cancer patients to experience intimacy and relationship challenges?

According to the Yale School of Medicine, an estimated 85 percent to 90 percent of the 6 million female cancer survivors in the United States may suffer from intimacy issues. Up to 60 percent of prostate cancer patients experience erectile dysfunction after surgery, according to Evan Pisick, MD, a Medical Oncologist at Cancer Treatment Centers of America® (CTCA) in Illinois. He also said patients undergoing radiation have a 25 percent to 50 percent chance of impotence.

How may integrative care help?

Sex and intimacy issues are often difficult topics for many patients. But discussing these issues is the first step in dealing with them. Several supportive care therapies may improve intimacy and relationship issues by helping patients address some of the underlying problems. These include:

Behavioral health

Behavioral health therapists may offer counseling to help patients address fears or concerns about intimacy and resuming sexual activity after cancer treatment. In the context of a counseling relationship, patients may explore and understand their feelings, discuss ways to deal with loss of sexual function and changes in the body, discover how their mind and body can work together to help their healing, and learn healthy communication and coping strategies. For patients experiencing body image issues involving hair loss, visible tumors, scars or lost body parts, talking about these issues with a professional may help patients recapture their sense of self and inner confidence.

Learn more about behavioral health

Oncology rehabilitation

Oncology rehabilitation may provide physical and occupational therapy techniques that address functionality and body image issues. Therapists may perform hands-on manipulation to reduce the appearance of scar tissue, for example, and tissue massage or vaginal dilation may also bring relief. Fatigue may be better managed with exercises designed to improve libido and performance. Stretching and strengthening are other tools that may improve comfort and positioning during intimate experiences.

Learn more about oncology rehabilitation