How to Have the Sex Talk During and After Cancer

Sex and intimacy after cancer can often become an afterthought. Many people are focused on fighting their disease, but don’t realize that sexual health matters, too. And it’s not a challenge that is hopeless.

As more and more people are becoming cancer survivors, cancer centers now have health care professionals who can aid those in need of sexual health advice following treatment. Sharon Bober, Ph.D., founder and director of the Sexual Health Program at Dana-Farber Cancer Institute in Boston, understands these concerns. In an interview with CURE during the 11th annual Joining FORCEs Against Hereditary Cancer Conference held Oct. 19-20 in San Diego, she shared tips on how to have patients’ voices be heard and debunked those “magic pill” myths.

What questions should a patient ask before, during and after treatment?

I think it’s very important that patients feel comfortable asking someone on their medical team whether it’s a doctor or a nurse about sexual health. I say that because often providers do not bring up the topic first. We know that it can be a topic that may feel taboo or uncomfortable, including for providers, and often patients get the message that if nobody’s asking then it might not be something that they should talk about. I’m here to say that that’s not the case. Patients really need to bring up the topic even if nobody else is, especially if they have any concerns or changes that are bothersome or distressing in sexual health.

I think we need to think about sexual health like any other review of our system. So, when people go for treatment and are asked about nausea, pain or fatigue, they should also be asked about sexual health. That’s not always the case and that’s where it’s perfectly fine for a patient to say, “Actually, there is something else we haven’t talked about. I’m concerned about changes in sexual health or changes that might be coming or changes that have happened and I’m not sure what to do about it.”

Are there ways couples can overcome the sexual side effects of cancer? What about single people who may be dating?

It’s important to think about sexuality and sexual function really at the intersection between mind, body and relationship. It is not typically only about one factor but when a couple, whether they are married or dating, is dealing with changes in sexual function as a couple they are also dealing with changes in roles and changes in styles and patterns of behavior. There may be an expectation or worry that you don’t want to make your partner feel bad but on the other hand it’s hard to talk about. It’s very important for couples to take time and say, “Listen, this is a part of our life which is different and it is OK for us to talk about it.” That’s really the first step.

For single people, it is important to appreciate that we are not only about our body parts. Sexuality is more than just one body part or any one part of something that has changed. And that recognizing when we go dating and we start to meet people everybody brings something to the table whether it’s cancer, depression or something in the family — all of these things are part of what makes us human. It’s important to realize that because you may have had cancer that is not going to be the reason why you can’t have a successful relationship. It just means that you are going to want to find a partner who is sensitive, who is going to be caring and who is going to be open to hearing about this.

Are there any proclaimed sexual health “cures” that patients should stay away from?

We live in a culture where everything is focused on a pill. We live in a culture where we want everything in 140 characters in a Tweet or we want to have something quick and easy. The truth is when it comes to sexual function it is often at the intersection of a variety of different things that are going on. From my point of view, that’s great news because it means that there are ways we can improve the relationship, we can improve how someone thinks and feels about themselves, we can also improve the mechanics around, for example, vaginal dryness or erectile function. But it doesn’t have to be only one thing that you have to find or that there is a magic pill. It’s important for people to focus on communication and intimacy and enhancing desire. It’s important, for example, for women on the other side of menopause, they are not expected to have spontaneous desire. Desire becomes something we have to cultivate. We need to stick with evidence-based intervention. And although we sort of would like to think if I could just go with the magic cure, that will work, but there’s no magic. On the other hand, it is powerful and magical to have an intense sexual relationship with someone that you love.

Is there anything else that you would like to add?

There is help available. The good news is that there are a number of resources that people can access online, such as the National Institutes of Health and American Cancer Society. We now have much more to offer than we used to.