Sexuality by Carole Moretz, RN, Pys.D

 

Woman's cancer changes sexuality. I know because I survived a cancer that involved my cervix, ovary, and breast; and I listen to the stories of other woman who ride the unpredictable cancer waves. When I say that sexuality changes, I mean that everything we associated with being sexual is altered in complex ways as our bodies, minds, spirits, and relationships respond to the disease's shifting demands. Being sexual includes: the sense of one's self in one's body, one's identity as a woman, and one's ability to give and get sexual pleasure. Sometimes, we think about intimacy as being synonymous with sexuality and certainly the two ideas are closely related. For now though, perhaps we can talk about sexuality from the skin inward to our conscious ways of knowing ourselves. The consideration of intimacy or sexuality from the skin to the connection with the other might be left for another time. It is, after all, that very understanding of ourselves as powerful, sexually healthy humans that cancer threatens first.

 

When talking about being at home in our bodies, I mean that familiarity, easy sense of life force and robustness of energy that unfolds as we live, move through space, and interact with the world around us. As we change over time, our bodies accommodate gradually, beneath our awareness; and we are continually at home. Within a certain range, we feel pretty much the same today as we did yesterday. This provides a sense of assurance that we are capable of just doing the things we intend to do with predictable effort. The ability to just settle into our bodies and to experience ourselves without noticing ourselves is essential for sexual pleasure. In fact, the most common reason that some of us have trouble enjoying sex is that we are always self conscious—always worried about whether we look right and perform right. Cancer and its treatments sometime make us feel like aliens in our bodies. There are incisions, draining areas, scars, and tactile memories of pain associated with surgeries. Chemo often drains energy, has non-descript symptoms called malaise, sometimes alters our sense of taste, and may make the whole surface of our skin feel different to ourselves and to others. Likewise, radiation treatments tire us and may burn areas of our skin surfaces. Psychologically, especially during treatment, our focus is on surviving and figuring out how to navigate the ever changing landscape of new symptoms.

 

Just when we think we are getting comfortable again, a new somatic experience occurs. Far into recovery, we struggle with longing for the easy predictable home of the body that we remember while being dismayed with and grateful for the new body we actually have. Sexual recovery in this vein involves coming home to and preferring the new body. That means learning to prefer the feel of scarred skin surfaces and areas of numbness, accepting one's present level of robustness, recovering from worrying about what our sexual partner thinks about the changes in our beings, and becoming conscious of what we need and want given our new selves. Only then can we recover that easy sense of being in which we can surrender to sexual pleasure.

 

Gynecologic cancer often challenges feminine identity. Many of us will complain, "I just do not feel like a woman anymore". For some, the treatments pre-empt fertility before the completion of child-bearing. Many experience premature menopause and are faced with the losses associated with a transition that should occur later in life. Almost all of us experience shifts in our roles as mothers, wives, and daughters. Cancer dashes many dreams. Chief among them is the dream of an easy decision to have a child in the future. Even if eggs are saved and the uterus is left intact, conception becomes complicated. Let's face it—there is nothing very romantic about the exam table and a variety of invasive instruments. If the capacity to have a biologic child is interrupted because eggs could not be harvested or the ability to carry a pregnancy was nullified because the uterus was involved in the treatment, the route to parenthood becomes even more complex. The well-meaning advice of others about adoption or being satisfied with the present family muddies the numerous issues connected with alterations in fertility.

 
Begin to Address This Issue
  1. Become familiar with the options surrounding fertility for you in particular. Avoid rejecting any particular avenue at the onset of your deliberations.
  2. Discuss or record your thoughts and feelings about the options and begin to reduce issues from one big problem—it seems impossible to have a baby now—to smaller problems that might be solved—we might have to get a donor egg.
For most women, menopause is a gradual process spanning 8 to 10 years. For many survivors of gynecologic cancer, menopause is an abrupt process that happens with surgical removal or chemical ablation of the ovaries. This abrupt menopause contributes to the issues previously discussed about feeling different in one's body. It is generally thought to be the major contributor to loss of sexual interest and to vaginal dryness and pain that are common among survivors. In addition, the loss of bleeding in younger women can be associated with worry about loss of value and worry about aging. The topic of menopause in general is beyond the scope of this writing. The issues of dryness and pain are covered in Increase Libido. There is no clinical explanation that fully accounts for the loss of sexual interest in cancer survivors. Many will point to hormonal depletion. However, the ratio between estrogen and testosterone changes in a way that might favor increased sexual interest.
 
Exercises
Exercises for recapturing sexual pleasure
Increase Libido
Suggestions to increase libido
Cancer Recovery
Coping with the aftereffects of treatment and the new directions of your life