When you first learned you had cancer, you probably thought mostly of survival. But after awhile other questions may have started coming up. You may be thinking “How ‘normal’ can my life be, even if the cancer is under control?” Or even “How will cancer affect my sex life?”
Sex and sexuality are important parts of everyday life. The difference between sex and sexuality is that sex is thought of as an activity – something you do with a partner. Sexuality is more about the way you feel, and is linked to your need for caring, closeness, and touch.
Feelings about sexuality affect our zest for living, our self-image, and our relationships with others. Yet patients and doctors often do not talk about the effects of cancer treatment on their sex lives or how a person may feel as a sexual being. Why? A person may feel uneasy talking about sex with a professional like a doctor or even with a close sex partner. Many people feel awkward and exposed when talking about sex.
Here, we offer you and your partner some information about cancer, sex, and sexuality. This information applies to all women with cancer – regardless of sexual orientation. We cannot answer every question, but we will try to give you enough information to help you and your partner have open, honest talks about your sex life. We will also share some ideas about talking with your doctor and your cancer care team. Lastly, we will give you a list of other places to get help in the “Additional resources” section. These are other good sources of more information.
Keep in mind that sexual touching between you and your partner is always possible, no matter what kinds of cancer treatment you have had. This may surprise you, especially if you are feeling down or have not had sex for awhile. But it is true. The ability to feel pleasure from touching almost always remains.
The first step is to bring up the topic of your sex life with your doctor or another member of your health care team. You have a right to know how your treatment will affect nutrition, pain, and your ability to return to work. You also have the right to know the facts about your sex life.
What is a normal sex life?
People vary a great deal in their sexual attitudes and practices. This makes it hard to define "normal." Some couples like to have sex every day. For others, once a month is enough. Many people see oral sex (using the mouth or tongue) as a normal part of sex, but some believe it is not OK. “Normal” for you and your partner is whatever gives you pleasure together. Both partners should agree on what makes their sex life good.
It is normal for people with cancer to lose interest in sex at times. Doubts and fears, along with cancer and cancer treatment, can make you feel less than your best. At times, concern about your health may be much greater than your interest in sex. But once you get back to your normal routines, your interest in sex may begin to return.
It is also normal to be interested in sex throughout your life. There are some who think sex is only for the young, and that older people lose both their desire for sex and their ability to “perform.” Those beliefs are largely myths. Many men and women can and do stay sexually active until the end of life. No one should have to apologize for still being interested in sex at any age. (See the “Additional resources” section for more on sex and aging.)
Still, it is true that sexual response and function may change with aging. For example, more than half of men over age 40 have at least a little trouble with erections. For some of these men the problem is severe. Many women also notice changes as they get older, sometimes even before menopause begins. A decrease in sexual desire and problems with vaginal dryness may increase during and after menopause.
Sometimes, sexual problems center around anxiety, tension, or other problems in a relationship. Other times, they may be the result of a physical condition, a medical condition, or medicines that cause or worsen sexual problems. But most symptoms can be treated. We now have medicines, therapy, surgery, and other treatments that can help people deal with most kinds of problems they may have. If you want to keep your sex life active, you can likely do so.
If you are in a relationship and one of you has a sexual problem, it affects both of you. If you are dealing with sexual problems, it works best when your partner can be part of the solution.
What is a healthy sexual response?
The sexual response of women and men has 4 phases:
- Desire
- Excitement
- Orgasm
- Resolution
A person usually goes through the phases in the same order. But the sexual response can be stopped at any phase. For instance, you don’t have to reach orgasm each time you feel the desire for sex.
Desire is an interest in sex. You may just think about sex, feel attracted to someone, or be frustrated because of a lack of sex. Sexual desire is a normal part of life from the teenage years onward.
Excitement is the phase when you feel aroused or “turned on.” Touching and stroking feel much more intense when a person is excited. Excitement also results from sexual fantasies and sensual sights, sounds, scents, and tastes. Physically, excitement means that:
- The heart beats faster.
- Blood pressure goes up.
- Breathing gets heavy.
- More blood is sent into the genital (or “private”) area, and the whole area, including the clitoris, swells. (In a man, the surge of blood creates an erection, or a stiff penis.)
- The vagina becomes moist and gets longer and wider, opening up like a balloon.
- The skin of the genitals (“private parts”) turns a deeper color of red.
- The body may sweat or get warmer.
Orgasm is the sexual climax. In both women and men, the nervous system creates intense pleasure in the genitals. The muscles around the genitals contract, in rhythm, sending waves of feeling through the body. Men ejaculate (or release) semen when these muscles contract. The person feels pleasure and satisfaction.
Resolution occurs within a few minutes after an orgasm. The body returns to its unexcited state. Heartbeat and breathing slow down. The extra blood drains out of the genital area. Mental excitement subsides.
If a person becomes excited but does not reach orgasm, resolution still takes place but more slowly. It is not harmful to become excited without reaching orgasm, though it may feel frustrating. Some women and men may feel a mild ache until the extra blood leaves the genital area.
Refractory period. Men have a certain amount of time after orgasm when they are physically unable to have another orgasm. This time, called the refractory period, tends to get longer as a man ages. A man in his 70s may need to wait several days between orgasms. Women do not have a refractory period. Many can have multiple orgasms, one after another, with little time in between.
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