genglob magazine

When patients are diagnosed with cancer, they have many thoughts, fears, and questions, and most want to learn more about their disease and treatment. There also are practical issues to consider—paying for treatment, finding transportation, keeping a job, and juggling family responsibilities. Patients are dealing with huge decisions and coping with stressful changes.

It’s understandable that sexuality may not be the primary focus for many cancer patients, at least not right away. Sexuality is an incredibly personal topic, and each person’s experiences, feelings, and expectations are unique. But at some point, whether because of sexual changes, relationship issues, or difficulties with fertility, patients realize the impact of cancer on their sexuality.

Each patient’s cancer journey is unique, so it’s impossible to know what your experiences will be. You may undergo permanent changes in your body, physical discomforts, emotional struggles, and problems with fertility. But no matter the diagnosis or prognosis, you deserve the best quality of life, and this includes care of your sexual health. By learning about how your sexuality is likely to change and getting suggestions for healing, you become a partner and advocate in your own care.

In a series of articles we would explore this topic and try to answer some of the questions in your mind.This is the first article in this series and we would explore the following questions:

What is sexuality?

What is a normal sexual response?

How can my cancer and cancer treatment affect my sexuality?

What is sexuality?

When you think of sexuality, your first thought may be the physical act of sexual intercourse. But sexuality goes beyond engaging in sexual activity.

As a human being, your sexuality is a part of your physical, emotional, intellectual, and social self. It affects how you think of yourself and how you relate to others, as well as how they relate to you, and it is a part of you throughout your entire life.

Since every person is different, it is difficult to define “normal” sexuality or sexual activity. Many factors may influence your sexuality, including your gender, sexual orientation, hormone levels, age, and personal perspectives, such as your views on sex and your religious beliefs and values.

You may have certain definitions of how you think a man or woman should look and behave, and these expectations play a part in your sexuality, too.

It’s important to recognize what is normal for you—what makes you feel comfortable and satisfied—and that it may be different from what is normal for someone else. And it’s equally important to remember that cancer and its treatment may cause changes in your sexual function, but they cannot take away the life experience and emotions that make you a sexual person.

What is a normal sexual response?

A “normal” sexual response involves a person experiencing one or more of the following phases:

• Desire
• Arousal
• Orgasm
• Resolution

Cancer and cancer treatment can cause changes in any phase of the sexual response. Understanding these phases may help you explain your experiences to your doctor or nurse. This may help them diagnose changes and prescribe remedies to help you.

Desire

Desire happens when you feel interested in someone sexually. For example, if a man or woman walked by, you may feel an attraction to that person or begin to imagine that person as a partner. Desire may also come from feelings of sexual pleasure and tension in your body, or from a sexual fantasy. The more you think about sex, the more frustrated you may feel if you do not have a chance to have sexual pleasure. All of these feelings can be called “desire.”

Lack of desire is the most common sexual problem for all cancer patients. You may think, “I used to think about sex, but now it doesn’t seem important to me,” or “I want to have a sexual relationship, but I don’t feel desirable or sexy,” or “I just don’t feel like having sex anymore.”

Arousal

Arousal is sexual excitement, which may be caused by touching, stroking, fantasizing, or seeing or hearing sexual sights and sounds. Your heartbeat, pulse, and blood pressure rise. Your breathing may become deeper and heavier. In both men and women, blood flows into the genitals as part of sexual arousal.

• For women, arousal includes both mental excitement and the physical response of vaginal lubrication and expansion. The vagina becomes moist and expands. The outer genitals, including the clitoris, swell and turn a deeper color.
• In men, the penis becomes erect, and arousal includes getting and maintaining an erection sufficient for intercourse.

Most often, loss of desire and trouble getting mentally aroused go together. Instead of feeling good, sexual touch may seem annoying or you may feel “numb.” You may find yourself thinking that your body isn’t responding the way it is “supposed to.” But sometimes you feel turned on in your mind, but your body does not respond physically. You may feel interested in sex, even excited, but also frustrated that you have vaginal dryness if you are a woman, or do not get a firm erection if you are a man. Problems with physical arousal are often caused by damage to the body from cancer treatment.

• After cancer treatment, or just with normal aging, women may respond more slowly to sexual stimulation, produce less or insufficient lubrication, and may feel that breast or genital caressing does not bring pleasure.
• Changes with arousal in men include not being able to get or sustain an erection, having an erection that is not firm or reliable, or not having erections as frequently as desired.

Orgasm

A person who reaches a sexual climax has an orgasm. For men and women, this means a rhythmic contraction of the genitals, which causes intense, pleasurable feelings throughout the body. Overall, you may feel satisfaction, pleasure, and gratification.When women have an orgasm, the vaginal walls contract, and often waves of pleasure are felt in the clitoris and outer vagina. Many women enjoy reaching more than one orgasm, while others prefer to have one intense climax.

• When men have an orgasm, they experience an ejaculation, when the penis releases semen.

When changes with orgasm occur, men and women may find that it takes a longer time to reach orgasm, more stimulation is needed, or that orgasms cannot be achieved at all.

• Women may find that the clitoris or vaginal opening feels less sensitive. Some women have pain with sex or distracting thoughts about cancer or feeling unattractive. It takes some mental focus on pleasure for a woman to reach orgasm.
• After cancer treatment, some men experience “dry orgasms” in which muscles contract and they feel pleasure, but no semen comes out of the penis. Some men also find that their orgasms are weaker and less pleasurable.

Resolution

Resolution is when the body calms down and is no longer excited. Your heartbeat, pulse, and blood pressure return to normal, and blood drains from the genital area. Resolution happens rapidly after an orgasm. If a person doesn’t have an orgasm, resolution happens eventually but just takes longer.

Women can have one orgasm right after another, known as multiple orgasms. Usually men have to wait a certain amount of time after an orgasm before becoming aroused again. This time, called the refractory period, can increase with age or medical conditions.

How can my cancer and cancer treatment affect my sexuality?

Cancer and its treatment may affect your sexuality, but every patient is different. Some patients experience sexual changes in all of the phases of sexual response, while others experience none.

The most common sexual change for cancer patients is an overall loss of desire. Most men and women are still able to have an orgasm even if cancer treatment interferes with erections or vaginal lubrication, or involves removing some parts of the pelvic organs. However, it is common for patients to need more time or stimulation to reach orgasm.

Unfortunately, when sexual changes do occur, they generally do not improve right away; indeed, they may persist until a good remedy is found. Finding the most helpful remedy may take time and patience because sexual changes can be caused by both psychological and physical factors.

Furthermore, the sexual changes caused by cancer treatment may be long term or permanent. Talk with your doctor, nurse, or another healthcare professional before treatment to learn about what to expect from your cancer or cancer treatment concerning your sexuality. By knowing what may happen, you may be better prepared and more knowledgeable about potential sexual changes.

In the next article we would explore this question in more details.