• For many women one of the most devastating parts of a cancer diagnosis is the loss of intimacy due to the many interventions used to treat cancer. For women who are past menopause and over the age of 50, these treatments and interventions are coupled with the normal physiologic changes that occur at this stage in life and can further impact intimacy and relationships.

    Finding a new normal and exploring a sexually fulfilling experience is an important part of the survivorship process and requires establishing new norms after a diagnosis of cancer comes into to the picture. Clean communication between you and your partner is the best way to approach this new phase of your life with gusto and a renewed vigor!

    The best way to approach sexual intimacy after a diagnosis of cancer is to address it from a threefold approach.

    1. Understand your “new normal”

    One thing that I always try to impart to patients after they are diagnosed with cancer is that their bodies will be different somewhat than before we started treatment. This includes the effects of the three classes of treatment: surgery, radiation and chemotherapy. Surgery changes one’s body by causing scar tissue to form after removing tumors; this can cause abdominal pain and painful scars to form that make sexual functioning difficult. Radiation uses powerful x-rays to kill cancer cells but can cause the vagina to be become dry and rough as well as cause problems with urinationnone of which helps a women to feel sexual! Chemotherapy often the most dreaded part of cancer treatment, causes profound fatigue as well as inhibition of many of the hormones that make a woman feel sexual. The loss of hair and nausea also certainly done help a women feel like being intimate, either.

    It is important to note that it is perfectly reasonable to have apprehension about sexual relations while being treated for cancer. Most women that we studied had a significant decrease in their libido and sexual satisfaction. But once cancer has been treated and women are in remission, there is a renewed desire for intimacy that many women want. Closeness is needed to fend off fears—of recurrence, desirability, and more. It is incredibly important for women to reconnect with their partners.  

    Commonly, women need to establish a “new normal” with their partners in which sex, while still pleasurable, must be modified to a new body that is healing from an onslaught of cancer treatments. This includes emphasizing the importance of foreplay and real intimacy that sometimes does not include intercourse but rather re-connecting as people. In one of the patient stories we feature in Sex and Cancer, we explore a patient with an ovarian cancer that spread dramatically. She made the difficult decision of having her vagina removed to offer her a chance for cure. This obviously changed the way she approached sex with her husband as she approached her 50th birthday, but they thrived by connecting as people and not just as lovers. Intimacy and closeness for them involves rides on his Harley, quite evenings with wine, as well as unique ways to achieve orgasm (and yes they both have them!)

    2.  Use a new set of enhancements

    One of the keys to a satisfying sexual relationship after age 50 with cancer is making sure that the body is “tuned up” for sex. Just as we spend significant energies into making sure our cars are “tuned up” for that long road trip, we need to make sure that our bodies are ready for satisfying sexual encounters after a diagnosis of cancer. Some tips in this regard are

    1. Ensure the use of a good lubricant. Sex is more pleasurable for men and women when the body is well lubricated and this is vital in post menopausal women and especially in women with cancer. A high-end lubricant placed in the vagina before intercourse enhances pleasure for all involved. (A trip to an adult store to purchase one can also help put one in the mood.)
    2. Manage expectations, sexually. Not every sexual or intimate encounter requires intercourse. Some of the most intimate and satisfying encounters involve touching, embracing and simply lying naked together. This can be very satisfying and ultimately lead to intense intercourse. Talk with your partner about what you would like and let things evolve naturally without expectations.
    3. Connect with each other emotionally not just physically. This is probably the most important part of sexuality with cancer. Many women after a diagnosis of cancer feel very vulnerable and scared. Emotional intelligence and connection are vital to regaining control and the safety of making things work well.

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    Article by: Saketh Guntupalli

    Saketh Guntupalli, MD, FACS, FACOG, is Vice-Chairman for Clinical Affairs and Quality in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine at Denver. He is the principal investigator for the Gynecologic Oncology Group (GOG)/NRG research consortium for the University of Colorado and also serves as the director of the fellowship program in gynecologic oncology. Board certified in gynecologic oncology and obstetrics/gynecology, he is the recipient of two large grants to examine sexual dysfunction in women with cancer as well as post operative quality outcomes. Guntupalli also serves as director for the Placenta Accreta Response Team (PART) at the University of Colorado Hospital. He has a focused interest in minimally invasive surgery, such as robotics and laparoscopy, as well as novel, molecular therapeutics in the treatment of gynecologic cancer. He has authored over 40 clinical papers in journals such as the Journal of the National Cancer Institute, Obstetrics and Gyneoclogy, Gynecologic Oncology and The International Journal of Gynecologic Oncology.

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