How cancer changes our psychology related to sex

• Psychological factors can impact motivation for and enjoyment of sexual intimacy

• Depression

• Anxiety

• Poor Coping

• Decreased Self-Esteem

• Changes in Body Image

Talking about sex can be hard

• Doctors often wait for patients to address sexual problems

• Patients wait for doctors to ask about sexual problems

• Couples often lack the language to discuss sex

Other relationship factors to consider

• Illness is often not an aphrodisiac

• Being in a long-term relationship, aging and childbearing are also often not aphrodisiacs

• Couples often cope with stressors differently

• Sometimes relationships become more focused on caretaker/patient than on erotic feelings

• Suffering can have different meaning for each person

The phases of the response style

• Desire - motivation to engage in sexual behavior

• Arousal - physical changes that increase motivation for sex

• Plateau - intensification of physical arousal

• Orgasm - a sudden and forceful release of sexual tension

• Resolution - the body returns to baseline

(KATZ, 2009)

Why women instigate or agree to sex

• To express love

• To receive and share physical pleasure

• To feel emotional closeness

• To please her partner

• To increase her own well-being

(KATZ, 2009)

Where does a woman’s sexual desire come from?

• The reasons for having sex combine with physical and emotional factors resulting in sexual arousal.

• Continued stimulation then allows the excitement and pleasure to build and finally leads to a desire to have sex.

• Openness to one’s partner + sexual stimulation = sexual pleasure and desire for sex

• Willingness comes from the experience of sexual satisfaction and non-sexual rewards

What is arousal?

• Muscle tension increases

• Heart rate quickens and breathing is accelerated

• Skin may become flushed (blotches of redness appear on the chest and back)

• Nipples become hardened or erect

• Blood flow to the genitals increases, resulting in swelling of the woman's clitoris and labia minora (inner lips)

• Vaginal lubrication begins

• The woman's breasts become fuller and the vaginal walls begin to swell.

The sexual plateau

• The changes that beganin phase 1 are intensified.

• The vagina continues to swell from increased blood flow, and the vaginal walls turn a dark purple.

• The woman's clitoris becomes highly sensitive (may even be painful to touch) and retracts under the clitoral hood to avoid direct stimulation from the penis.

• Breathing, heart rate, and blood pressure continue to increase

• Muscle spasms may begin in the feet, face, and hands

• Muscle tension increases

Orgasm! What actually happens?

• Involuntary muscle contractions begin

• Blood pressure, heart rate, and breathing are at their highest rates, with a rapid intake of oxygen

• Muscles in the feet spasm

• There is a sudden, forceful release of sexual tension

• In women, the muscles of the vagina contract. The uterus also undergoes rhythmic contractions

• A rash, or "sex flush" may appear over the entire body

The sexual resolution

• Body slowly returns to its normal level of functioning

• Swollen body parts return to their previous size and color

• Marked by a general sense of well-being, enhanced intimacy

• Some women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms

Addressing changes in body image

• Body image changes are a common first challenge that patients may need to overcome.

• Helpful outlets and interventions include:

  • Beauty focused programs such as Look Good, Feel Better

  • Consider boudoir photos ( for a great example visit Jenn Spain Photography on Instagram)

  • Look at Body Positivity classes and exercises to help you focus on what is good about your body (click here for a helpful article on body positivity)

  • Support groups or one-on-one discussions to connect to other survivors and share practical tips such as ways to address ostomy bags

  • Psychotherapy to address losses and changes in self-image

  • Consider decorative tattoos to enhance or cover scars or surgical sites such as breasts

Treating vaginal dryness

• Water-based vaginal lubricants

  • Astroglide

  • Liquid Silk

• Glycerin-based vaginal lubricants

  • K-Y Liquid

• Non-hormonal vaginal moisturizers

  • Astroglide

  • Replens

Addressing changes in vaginal health

Prescription creams for improving vaginal tissues

• Vaginal DHEA (Intrarosa; by prescription)

• Vaginal estrogen (by prescription)

• Pelvic floor exercises (Kegels)

  • Click here for Kegel instructions

  • Use tools (if appropriate)

Overcoming pain during intercourse

• Pain can be related to vaginal dryness

  • Use a lubricant and/or moisturizer (see links above)

• Vaginal dilators can be used to improve elasticity and to break down scar tissue

  • visit SoulSource for information about vaginal dilation for scaring or stenosis

  • Receiving education from a nurse or medical professional increases success with dilation

• Adding pelvic floor exercises (Kegels) may improve results of vaginal dilation (see above for tools and instructions)

• There are physical therapists that specialize in vaginal rehabilitation so ask your healthcare team for referrals.

• More stimulation before sexual intercourse can also help

Sex is more than intercourse

• Oral sex

• '“Outersex” - when a person puts a lube on their upper thighs and the penis is inserted between the thighs for stimulation

• Anal sex

• Manual stimulation - touching with hands

• Sensual touching - massage

• Masturbation

Some other strategies to try

• Relaxation exercises before sex can decrease pain and increase arousal response

• Masturbation is a way to reconnect with yourself sexually before involving your partner

• Using sex toys to explore your own sexuality (Amazon, Pleasure Chest)

• Try something new as a way to simply create movement

• Know that making changes often leads to feelings of anxiety, which is a sign of growth

• Intimacy and growth are both life affirming experiences

• Eat and sleep well

How to talk to your partner about sex

• Communication is a key to resuming a healthy sex life after cancer

• Focusing on connecting and touching rather than orgasm or intercourse can take the pressure off of both of you

• Try to focus on “I” statements and share your feelings

• Don’t try to read your partner’s mind and avoid blame
  

Considering couple’s therapy

• Facing a life-threatening illness can have an important impact on communication related to sexual intimacy

• Therapy provides a place to acknowledge and process losses that have come with cancer

• If challenges focus on communication then traditional couple’s therapy would likely be the best first step

• If the issues are primarily focused on changes in sexual intimacy then sex therapy is likely a better first step

• If the root of the problem is unclear then seeking sex therapy is like to be helpful

What is sex therapy?

• Sex therapy will focus on:

  • Communication around sex

  • Sexual positions to enhance intimacy while reducing discomfort

  • Ways to improve intimacy that are not focused solely on sexual intercourse

Restoring intimacy with sensate focused therapy

• Goal is to build trust and intimacy within your relationship, helping you to give and receive pleasure

• Each member of the couple takes turn being the giver and receiver of pleasurable touch

• Occurs in phases:

  • Phase 1: Non-Genital Sensate Focus

  • Phase 2: Genital Sensate Focus

  • Phase 3: Penetrative Sensate Focus

Sample sensate exercise: the hand rub

• Set a timer for 15 minutes

• One partner should give the other partner a hand massage.

• The partner giving the massage should focus on the experience of giving pleasure.

• The receiver of the message should focus on receiving pleasure and providing feedback about what feels good.

• After 15 minutes, switch roles

Sample sensate exercise: the gazing exercise

• Set a timer for 5 minutes

• Face each other and have a conversation

• Focus on maintaining eye contact

• Try to ask on another about your individual days

• Keep the focus on each of you as individuals and as a couple