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Cancer affects sex life by causing physical and mental limitations. Faced with cancer, other spheres of life cease to occupy us. We lose interest in hobbies, work, meeting friends, but also intimacy and sex. On the other hand, we want to have a close, loving and kind person with us. We talk to the psycho-oncologist Mariola Kosowicz, MD, Ph.D.
When faced with an illness, especially one with uncertain prognosis for the future, the last thing patients think about is sex. Only a few throw themselves into the vortex of activity, wanting to prove to themselves how much they can still. Most of them focus on saving lives.
Cancer changes relationships with loved ones. What happens then?
MARIOLA KOSOWICZ: Some people discover the brutal and painful truth about their life with a partner, others get even closer to each other. Intimacy is usually only associated with sex, which is a mistake. Being in an intimate relationship with another person means having access to the deepest layers of their personality, needs, dreams, limitations.
And it is possible only when we trust ourselves. In a mature relationship, when sex takes a back seat, people can show each other warmth and emphasize mutual attractiveness. In less mature relationships there is emptiness and a feeling of abandonment.
Cancer causes people to lose their attractiveness and not feel like having sex.
M.K .: It doesn't have to matter. Attractiveness in a relationship should be based on intellectual, emotional, spiritual, physical and sexual attractiveness. Mature partners talk about their needs and concerns and look for a solution together. However, if the relationship is based solely on physical attractiveness, then a change in appearance caused by, for example, removal of the breast, may be the reason for its termination.
Sexual fulfillment during cancer treatment can be achieved by caressing and touching.
M.K .: Of course it is. Sex is not only the sexual act itself, but more than that. Knowledge of the partner's erogenous spheres, touch, caresses, tenderness, kiss are among other things thanks to which partners can feel sexually fulfilled. Everything is acceptable as long asthat both partners trust each other and find fulfillment in it. One thing is for sure, caresses between partners are always possible, regardless of physical problems or medical history.
Cancer therapy affects your physical condition. Can it weaken the patient's sexual performance?
M.K .: Yes. In men, treatment of cancer can cause erectile dysfunction due to damage to muscles and blood vessels, or endocrine disruptions. The higher the radiation dose and the larger the pelvic area that has been irradiated, the greater the risk of developing erectile dysfunction. They are associated with damage to the arteries that supply blood to the cavernous bodies of the penis.
After chemotherapy, men usually retain an erection, but erectile dysfunction and a decrease in libido appear. These symptoms disappear 2 weeks after the end of treatment. This phenomenon is related to the lower than usual secretion of testosterone.
Hormone treatment can also have a negative effect on your ability to have sex. Hormonal balance is also disturbed by antiemetics.
Aversion to sex can be caused by not accepting your own body.
M.K .: The psychological aspect of women is very important. Any emotion or thought that blocks the excitement can deprive a woman of the urge to have sex. Many patients feel unattractive due to mutilating surgery, hair loss, skin changes, and many other side effects of the therapy. The treatment reduces libido, because nausea, fatigue and pain appear. The latter is a very common problem in women after pelvic surgery, radiotherapy or endocrine disrupting treatment.
How is a woman's sexual experience affected by a premature menopause?
M.K .: Artificially induced menopause is much more turbulent than the usual one. After removal of the ovaries or irradiation of the ovaries, the body lacks estrogen, which contributes to atrophic vaginitis, hot flushes, etc. But most women do not lose the ability to orgasm. A lot also depends on the scope of the performed operation.
After a radical hysterectomy, i.e. removal of the uterus and surrounding tissues, women forget that sexual activity is still possible. Pelvic radiotherapy can cause pain. After irradiation and healing of wounds, the vagina may shorten or significantly narrow. But the formation of adhesions can be stopped by stretching the vaginal walls during intercourse or by using a special dilator.
Sexual needs when confronted with cancer lose their importance.
M.K .: Unfortunately, we live bydiagrams. We can say that we live by heart, also in the sexual sphere. That is why most of us think that at a certain age or illness it is not appropriate to think about sex.
I remember one of the dying patients. Her wish was for her husband to lie down next to her, naked. And I remember the reaction of the staff when her wish was granted. Some respected it, others were outraged. This example shows how much different our attitudes towards intimacy, towards rapprochement, towards sex, how we instrumentally treat this sphere of life and how we underestimate it.
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