Sex during chemo: tips and solutions to the unspoken problem
When a person receives a diagnosis of cancer, they automatically feel insecure and afraid, they have sense of helplessness and despair, with negative thoughts and fear of dying. The need for chemotherapy reinforces these ghosts. Instinctively, we tend to preserve what is vital: we cannot stop eating, sleeping, having basic hygiene. But sex ... sex is not vital! It does not constitute a prerequisite for survival, and so it's frequently left out. For most people (including those under treatment and some health professionals) a woman doing chemo has no sexual fantasies, and she is not desired, neither sexy nor attractive. Thus, in other people’s thoughts, she must not have sex. The reality, however, is very different!
In healthy women, the prevalence of sexual problems is ~40%, but it reaches 80% in those with cancer. In these, the sexual response depends on a number of factors: social, cultural, religious, what type of cancer they have, what type of treatment is required, personal characteristics and pre-existence of any sexual difficulty. Staying sexually active during chemotherapy is important because it helps women to feel loved and wanted, improves self-esteem, induces relaxation and reinforces that we are not alone. Ultimately, sex during chemo helps to maintain an adequate quality of life and sense of normality.
But several side effects of chemotherapy can decrease sexual activity. For example, it causes fatigue, so patients might feel tired in general and have less energy for sex. It can also decrease sexual desire and stimulation, causing discomfort (and even pain) during intercourse and difficulty in achieving orgasm. However, most sexual complaints arising at this time is not due directly to chemotherapy, but other factors linked to the disease and the stigma of treatment, such as the emergence of depression, concerns about body image, change in hormones (including menopause), or previous difficulties on the (sexual) relationship of the couple. Those who abstain from sex mourn the loss of intimacy.
In the practice, we can see a higher incidence of genital atrophy (dryness, less elasticity and moisture of the vagina), making it difficult or even prohibiting penetration. The relationship needs more foreplay so that sex is not painful. Currently on the market there are many useful products for women who have cancer and undergoing chemotherapy, such as genital moisturizers, lubricants and hormones specific for vaginal use. But remember that sex is not just about penetration. Our sexuality is much greater than that. It also includes giving and receiving affection, kissing, hugging, cuddling and all other expressions of sexuality, which are essential for a couple to remain close.
Interventions at this point should be to reduce the suffering and improve not only the quantity, but the quality of life in general, including the sex life. If you are experiencing some difficulty in the sexual sphere, or have been diagnosed with cancer and are doing chemotherapy, talk to your doctor about your fears, anxieties, doubts and alternatives to minimize any undesired effect. They can certainly help. And, if necessary, seek help from a specialist in the sexology area (a new specialty now called “onco-sexologist”). It is important to remain sexually active during this period. The couple must encourage their communication, sharing desires (or lack thereof) and using this phase to improve their relationship as a whole. They often need to renew vows, reinvent a life together, re-prioritize and re-negotiate sex to reinvigorate the relationship. They need to reinvent themselves and live a life of sexual resilience.
Some tips to improve sex during chemo:
Communication is essential. You need to be able to talk to your partner about body and mind changes, how you are feeling and what you want and expect, especially when it’s about sex.
Plan! It doesn’t sound romantic to plan when you are going to have sex with your partner, but you might feel more inclined to do so on the days you feel more energetic. For example, you should have more energy on the days before the next cycle of chemo. Maybe arrange a date night and have some fun.
Sex is not just penetration. Remember to spend a good amount of time cuddling and kissing before sex, so you can both relax and enjoy it.
Use lots of lubricant, even before a problem arises. Both chemo and chemo/medication induced menopause can cause vaginal dryness, so make sure lubricants are always available before sex becomes painful, so you don’t get traumatised.
Importantly, don’t pressure yourself that you need to have sex during this difficult time, or that you need to perform well. Do what is enjoyable and feels right.
