Regardless of what we do in our lives, every gesture or movement is a certain type of sexuality. The body is sexuality, and in the face of cancer, the body image changes a lot and is often disturbed. It takes an enormous amount of work for patients to work through the new body image and learn to re-perceive their sexuality. Marcelina Dzięciołowska talks to psycho-oncologist Adrianna Sobol
Marcelina Dzięciołowska: Is the topic of sexuality among cancer patients something common?
Adrianna Sobol, MA, psycho-oncologist: Sexuality in the face of cancer is a taboo subject. Patients are ashamed to talk about it, they feel embarrassed and do not know who to report it to. Moreover, the medical staff is not prepared for this type of conversation. Recently, I had a patient undergoing sarcoma therapy, who told me that she was absolutely unable to get close to her husband because of fear and anxiety, and the matter was additionally hindered by vaginal dryness.
What did you tell her?
I replied that she had to talk to her attending physician about this, to which the patient replied: “But when, how? After all, this meeting is attended not only by the doctor, but also by the secretary - I am ashamed. " Doctors on their own initiative do not take up this topic, and the patient and his family, faced with the disease, concentrate so much on the area of treatment that they completely forget about the sphere of sexuality.
And yet the disease also affects sexuality, changes in sexuality are therefore part of this disease …
The disease affects our body, some part of it - it changes its image. Look at women who have mastectomy, women who have had their reproductive organs removed, men who have had their testicles removed or who have prostate cancer, or patients who have had a stoma - something has changed in their bodies.
And sexuality is strongly connected with our physicality …
Many times after such experiences, women say that they do not feel attractive, they do not feel well in their bodies. A disease that affects our sense of security, stability, and self-confidence - it affects everything, it also affects sexuality.
Like this onedo patients react to sexuality after this type of surgery?
Women after surgery often ask me when they are to show their partner their scar after surgery, if they should show it at all. A person who is confronted with this disease feels as if something has been taken from him. And behind this is also the process of getting to know myself a new way, a new sense of who I am.
And here the role of a doctor who could guide the patient and advise how to go about it is missing, right?
There is a great need for cooperation between psychologists, psycho-oncologists with oncologists and gynecologists for women, and urologists for men, to give space to talk about sexuality.
Where to start then? How to make friends with your "new" sexuality?
It is important that each person ask themselves: Am I only the body or is my sexuality only the body? What is my body made of? Because if I do not have breasts, but still have nice legs, a beautiful smile, a charming look, I can feel, I can move, it is important that in this process of mourning after myself and after our body has changed, let me not concentrate only on losses, but take a look at what we still have.
What about people who do not see external changes caused by the treatment process?
I remember long conversations with "mermaids", that is women after the removal of their reproductive organs, who do not see anything outside, their body is intact on the outside, but inside there are no organs that testify to their functions and functions. reproductive possibilities …
They also struggle with "loss" …
It is a great process of going through it in your head, sorting it out. This is the perfect moment to open a discussion: What is my body? In working with patients, I often do an exercise during which I ask them to write down what they like about their body and what they can appreciate it for.
Even he althy people find it difficult to be satisfied with their physicality, beauty … Usually we only see our "shortcomings", right?
Everything we do in life is made up of different beliefs that are activated in different life situations. You can write down these things to check for any misconceptions. This is a very good example for working with women. For example, when a woman in the fitting room tries on a dress - what does she feel then? What emotions does this situation evoke in her? What kind of behavior does this translate into? It should all betranscribe.
So the first step is to find what makes us feel bad about ourselves …
What if you tried to find an alternative thought and belief would affect your behavior and well-being? During such work with patients, concentration on what is inside is born, focusing on these values helps a lot.
What are the results of this type of exercise?
It often turns out that this sexuality is most based on awareness, on seeing, on touch, on closeness. It turns out that this type of sexuality is more conscious, it results from a need, the idea of sexuality. This is a kind of love act that expresses itself in all sorts of forms. This completely changes not only the patient's approach, but also often his partner's approach to the subject of sexuality. However, this does not change the fact that the image of the body enters the entire space of the relationship.
The situation of the body image and sexuality translates into the way the entire relationship functions …
In my book "Tame Cancer" I called it "a compound pinched by cancer" because suddenly it turns out that the patient is self-constrained, deprived of femininity or masculinity. Once the patient's wife came to me and cried because she needed closeness, and her husband would shut himself up from her and hide in his shell, and she did not need sex, but only closeness, she felt rejected. It was a drama of two people because there was also rejection in his head, maybe also anger, at what had happened. And it was enough to learn yourself step by step again, learn to name your needs, which in the face of the disease could have changed a lot.
So it is very important to recognize that disease changes everything and you should not follow pre-disease patterns in any sphere of your life. You have to learn it all over again, otherwise
I am reminded of an action we organized with the OnkoCafe Foundation - “Let yourself feel like a princess for once”. It was attended by patients from the gynecological oncology ward of the Bródno Hospital. A beautiful session was prepared for them, the women were dressed up as princesses from the old era, all the ladies wore wigs, beautiful costumes, and had a beautiful makeup.
They looked amazing, moreover, photos from this session are available in our social media, on our website. It was amazing. how did they talk about it, what was happening in them then, what was the process. Many of them admitted thatthey forgot that they are the beautiful person all the time, the kind who can please. It was not artificially created, everything came out naturally, and thanks to this they realized that they had fallen back into the sphere they wanted to awaken again.
The disease changes the image of self-perception, and such beautiful actions allow patients to feel sympathy for themselves again!
It is something that often appears in the entire course of oncological treatment that patients are so focused on recovery that they forget about every other sphere of life, and the body and sexuality are an integral part of , something that builds our motivation.
There are studies that sexual satisfaction also translates into issues related to finances, success, prosperity, optimism and many other issues that we so badly need throughout the treatment process. This sexuality is also something that paralyzes the relationship very often. Very often, in a relationship "pinched by cancer", walls suddenly appear, because these two do not talk to each other, because they are not open to each other, because they avoid each other, because the disease paralyzed them, because both are very afraid, so they run away to other spaces of life or they suffer alone.
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The patient should not tame the disease and the new body image by himself, but discover it together. Many times during my consultations I talk to patients and say that it is often the patient in this area who sets the limits, that it is the patient who has to invite his partner so as not to lose the sexual sphere.
Why is this the role of the patient?
Because the other person is often so paralyzed that he thinks he can't, doesn't fall out and isolates himself. Often, there are also, most often, completely erroneous beliefs, thoughts and slogans on the part of women, statements that "since I am so deficient now without breasts or ovaries, he may have someone on the side, I agree to it"
Please see the level of self-sacrifice behind it, but above all of self-rejection. This is exactly what you need to work on, because there is no one specific template, one sentence, or password that could do the job. The work to be done is different in each case, because every situation is different.
This is a kind of re-feeling. Often, during patient training, e.g.they draw their sexuality, and it doesn't really express itself in the breasts or the uterus - it's somewhere else entirely. Because we function culturally in symbols, where women and sex are associated with breasts, we simplify everything, everything is so fast.
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A few years ago, I was delighted when the Rak'n'roll Foundation launched the KancerSutra campaign, which primarily says that cancer patients can have sex.
This is something that is never talked about
This is a bigger taboo than anything else. Cancer patient! You can have sex! KancerSutra was supposed to be such an openness, an action that was to show that the patient should not forget about himself, he does not have to lose anything, he may still feel pleasure, he may want to have sex, he may talk to his doctor, partner, may visit a sexologist or psychologist, if he feels any difficulty in this area.
Cancer patient, don't forget about it!
What was very visible during our campaign "Let yourself feel like a princess" showed that how we think about ourselves is how others see us. Working with the image of the body is of course a huge challenge, because it is associated with the experience of mourning and building a new identity. It hides behind closing one chapter and starting another.
Often this sexuality in the face of cancer during or after treatment is a bit like the first time. Everything is so new, uncertain, it is accompanied by a lot of emotions, but step by step you can open up to it, you can build something new, beautiful and important, not only in the treatment process, but also in the context of the whole life.
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If the patient allows himself to enter the treatment process consciously and thinks about what he can get out of this situation, he will certainly experience a new quality of life. The disease verifies everything and forces changes, if we clean our head and our emotions, change the quality of life, it will also translate into the quality of our feeling, being and also sexuality.
Expert
Adrianna Sobol, psycho-oncologist, lecturer at the Medical University of Warsaw Psycho-oncologist and lecturer at the Medical University of Warsaw at the Department of Oncological Prevention. He works at the LuxMed Oncology Cancer Hospital in Warsaw. She is a member of the Board of the OnkoCafe Foundation - Together Better, a psychotherapist and founder of the Ineo Psychological Support Center. Has created an online training platform He alth Begins In The Head. Author of numerous publications in the field of psycho-oncology and he alth psychology. Co-author of the book "Tame cancer. Inspirational stories and a guide to emotions" (Znak, 2022). She acts as an expert in television programs, co-creates campaigns and social campaigns. He conducts numerous trainings and workshops in the field of psychology and personal development.