Relationships, Intimacy, & Sexuality

Relationships                                                                             Photo Credit: apdk (flickr)

A July 2010 study from Yale researchers found that childhood cancer survivors are 20-25 percent less likely to marry compared to the general population, with childhood brain tumor survivors facing even steeper odds. The good news, however, is that the divorce rate for childhood cancer survivors who do marry is about the same as the general population.

Of course, remaining unmarried throughout adulthood is a perfectly acceptable choice for someone to make. But the statistical difference between childhood cancer survivors and their siblings/peers suggests that there are other factors at work here aside from the lures of bachelorhood. The hard truth is that some childhood cancer survivors have to work much harder than their peers to overcome barriers of intimacy, sexuality, and self-esteem, often as a result of long-term effects from their disease or treatment. As with all aspects of your survivorship, remember that there are tools and resources out there to help you overcome some of these challenges.

Even without complications, the time from adolescence to young adulthood is a tough time. During this period, people often struggle with self-esteem, worry about how they compare to others, and experience increased sexual interest and puberty. As a result, teens and young adults tend to focus more on appearance and body image.

It's important to strengthen your self-esteem so that you can form healthy, productive dating relationships. Below are some ideas for creating positive self-esteem:

• Create your own space.
• Exercise and eat well!
• Find your skills.
• Surround yourself with positive people and don't compare yourself to others.
• Learn to laugh... especially at yourself.
• Say positive things about yourself.
• Make a list of past successes,
• ...And future goals.

Single?

Fear of rejection or failure often prevents cancer survivors from re-entering the dating world after treatment. Remember that everyone - even your healthy peers - face the same fear every time they ask someone out for coffee. But if you're wary of dating again anytime soon, don't stop yourself from having a social life. Go out with your friends regularly and be open to meeting new people - including a new relationship. But be sure that you're ready to handle rejection if it does come your way. If your self-esteem is suffering, work on that first - otherwise, you might be in for a big set-back on your road to emotional well-being.

A suggested exercise is imagining in your mind the absolute worst thing that you could hear from someone that you might be interested in dating when you tell them about your cancer. Now, figure out how you would cope with hearing that - could you handle it maturely, with confidence and conviction in your self-worth? If so, then you're ready to step back into the dating world.

The biggest question cancer survivors have when they are meeting new people and considering a relationship is "When do I have the cancer talk?" There's no single right answer. Some people want to get it out in the open on the first date so all their cards are on the table - but depending on how recently your treatment ended, you may well scare someone off before they've gotten a chance to know you. On the other hand, if you wait too long to reveal your cancer history, a new partner might feel like you've been dishonest with them. Whenever you choose to have the talk, try to make sure you have the privacy and time to finish it without interruptions. Your partner will likely have a lot of questions. You should ask questions back, like "how are you feeling about what I've told you so far?" It should be a two-way conversation and a time for both of you to learn a lot about the other person. Let your new partner know that if they need some time to process the news, you'd be happy to talk to them about it again in a few days.

Sex & Intimacy in a Relationship

Photo Credit: hipposrunsuperfast.com (flickr)

Concerns

Sexual intimacy occurs at different times for different people. Mostly it occurs within the confirmed of a committed relationship. When you're in such a relationship, you may experience sexual concerns caused by fertility issues and health worries. 

Your cancer and treatment may have had an impact on your physical appearance, sometimes by significant measure. Long-term physical effects such as weight loss or gain, surgical scars, or any change in your physical appearance may affect your overall self-esteem and make you uncomfortable in a sexual relationship. 

The key to overcoming confused feelings about being sexual is to be honest with both your partner and your doctor. Discussing reproductive issues and sexual concerns can be embarrassing and scary. However, the benefits of an open discussion far outweigh keeping these concerns to yourself. Discussing these issues and working to feel good about yourself will help you have healthier and happier relationships.

Sex Drive:  Ability and Desire

Your ability and desire to perform sexually can be affected by both physical challenges or psychological challenges, and it's important to pinpoint the cause-and-effects of your unique situation.

Emotionally, you might be suffering from depression, guilt, fear, or embarrassment. Sometimes, low self-esteem leads people to engage in sex less frequently, feel more anxious about sex, have difficulty becoming aroused or deriving pleasure from sex, avoid sex, or engage in it too freely or dangerously.

Physically, hormonal treatment during or after cancer treatment may have had side effects that affect your sex drive, including vaginal dryness or a decrease in testosterone. Sometimes, survivors who experienced surgery or radiation in the pelvic area may actually experience physical pain during intercourse. Men may have more trouble becoming aroused and/or reaching orgasm. 

Even after cancer treatment ends, some of these side effects, such as tiredness or pain, may linger for months or even years. A zap in energy can often correlate to a zap in sex drive. Oftentimes, these effects are temporary, but if they persist, you may benefit from seeking out medical and/or psychological assistance. A professional counselor can help you sort through your feelings about sex and provide guidance in helping you to reach a more healthy level of intimacy with your partner.

Possible Solutions

• If you are suffering from fatigue, talk to your partner about sexual positions that will require less energy or strain. Know your limits, start with limited sexual activities, and work your way slowly to longer sessions of intimacy.
• If you are suffering from pain during intercourse, it is important to talk to both your doctor and your partner about how and where it hurts. Often, simply changing the position and using enough lubrication can help significantly. For both men and women, make sure you are as excited as possible before engaging in intercourse. 
• There are medications available for both men and women to increase sex drive, increase vaginal lubrication or the ability to maintain an erection, and increase the ability to achieve orgasm. Talk to your doctor about what options are available to you.
• Remember that your masculinity or femininity is not determined by the presence of your testicles, your breasts, or your sex drive. You've spent a lifetime becoming the man or woman that you are -- cancer can't take that away.
• If you're embarrassed about your physical appearance, you should work with your partner and a professional to increase your comfort level with your body. In the meantime, however, talk to your partner about small things may make you more comfortable being intimate, like turning the lights down or keeping a shirt on. Just be sure you don't become too reliant on these crutches - they shouldn't become a permanent way to avoid the larger issues.
• Men - If you experience persistent erectile dysfunction that lasts more than several months after treatment ends, talk to your doctor. There are tests available to check blood flow to the groin and also to determine if you are experiencing normal erections while you sleep - which would indicate that your problem is psychological more than physical and might be helped by a sexual counselor.
• Women - If you are having trouble reaching orgasm, consider new methods of arousal and foreplay. If you find yourself experiencing pain or discomfort, work on Kegel exercises to strengthen your vaginal muscles and learn how to relax them. If problems persist, don't hesitate to talk to your follow-up provider and/or your gynecologist.

Above all, is important to be well informed about possible sexual and/or fertility problems - and to be willing to talk about these concerns with your partner and your health team. 

For more on intimacy and sexuality, click the images below for PDF presentations - one given at the April 2010 RTA-Houston conference by MD Anderson staff and a survivor, and the other given at a 2008 RTA-DC conference. For a fuller picture of sexuality and intimacy issues, take the time to browse both of these terrific presentations.

Resources and News Articles

For our complete list of intimacy resources, visit here.

Childhood Cancer Survivors Less Likely to Marry, Yale Researchers Find (Yale University, 7/15/10)