Illustrations by Julie McLaughlin
Relationships can make all the difference in the life of a person with cancer. Social support has a major impact on quality of life. For certain cancers, research has shown that marriage can be more beneficial to survival than chemotherapy.
While the experience of cancer can certainly bring couples closer together, it can also challenge the relationship. For many people facing a cancer diagnosis a major relationship concern is around sexual health and intimacy. Questions like: “Will I still feel sexy after a mastectomy?” “Will prostate cancer cause erectile dysfunction?” “Will I still want to have sex?” and thoughts like: “I guess we just won’t have sex anymore” roll around the minds of patients with sexual health concerns. The Oncology and Sexuality, Intimacy and Survivorship Program (OASIS) acknowledges these questions are common, normal and emerging to the forefront of cancer treatment. The OASIS program recognizes the strain cancer can put on a relationship and an individual’s sexual health and offers support for cancer patients and their partners to reconnect.
Treatment for many cancers, not just those related to reproductive organs, can lead to physiological concerns like vaginal dryness, loss of libido or erectile dysfunction. Dr. Jill Turner, a psychologist with the OASIS program based out of Edmonton, says the emotional impact of cancer on sexual health should be considered, which includes changes to people’s sense of self, energy levels, body image, mood and interest in sex. These factors can influence the desire for a sexual relationship and consequently how a couple is used to relating to one another. “For some couples,” says Turner, “having a regular sex life — whatever that means to them — is a bit of a bond that can help cement a relationship, and when that changes there can be lots of different fallout from that.”
Turner sees patients for concerns around body image, changes in mood, adjustment, and the impact of cancer on their relationship or libido. “Sometimes it’s looking at the health of the relationship, but also how people communicate, their sense of fun together, exploring what some of the challenges and barriers are. And sometimes we see people one-on-one. We look at other kinds of mood-related things that could also be impacting their relationship,” she says. “It’s difficult to be in a relationship if one person is feeling significantly depressed or anxious or having trouble adapting to health-related changes.”
Turner and her team address a range of patient concerns but lists lack of libido, painful intercourse and vaginal dryness as the three most common.
Amy Driga, occupational therapist with the Edmonton program says that a concern may only emerge if there is a mismatch with a partner’s expectations or desires. Driga adds that not all patients experience these strains on their relationship and distress is not an all or nothing phenomenon.
The multi-disciplinary OASIS program adopts a tailored approach to address each patient’s unique needs. The team addresses the direct physiological impact of cancer and cancer treatment on usual sexual functioning (for example, vaginal dryness and dyspareunia), explores functional solutions to problems causing interference in usual sexual activity or offers counselling or assessments to patients or couples. “Sometimes there are simple straightforward solutions like using vaginal moisturizers,” says OASIS program radiation oncologist Dr. Erica Wiebe. Other times it’s a matter of helping couples solve problems. “We sometimes tend to get kind of rigid in what our sexual lives look like or we get into habits. So trying to think outside the box and trying new ways of connecting sexually can be helpful. I think that communication and then exploring what the expectations are and also trying to be flexible and adaptable to the situation without losing that sense of fun can be helpful.”
The OASIS program aims to create an environment where patients feel safe and comfortable talking about sexual health and can get the information they need. It also focuses on staff education to increase the knowledge and comfort of health-care providers on this topic. Ultimately the OASIS program team wants patients to understand that changes in their sexual health functioning are normal and that, according to Wiebe, “although it may be difficult or can create challenges for couples that there are ways of navigating it to minimize the impact on a relationship … relationships can come out the other side just as healthy or stronger than before.”
How to Stay Intimate When Sexual Health Changes
1. Get creative
Things like sex toys, lubricant or new positions can help overcome barriers such as lack of desire, dryness or uncomfortable penetration.
2. Take the pressure off
Do so by focusing on non-sexual ways to connect. Physical touch, including kissing, hugging, holding hands or date nights can help you feel close without the pressure of sexual activity.
3. Don’t give up
It can be hard to adjust to the changes in your body and to your sexual activity, but if being sexual is something that’s important to you, try to keep an open mind, practice acceptance and have fun.
The OASIS program, provided by Alberta Health Services and CancerControl Alberta, is available in Calgary and Edmonton. Learn more at myhealth.alberta.ca