It occurs to me that I talk to my patients more about death and dying, than about sex.  It is not that I lack interest or an appreciation of the importance of intimacy, but like most physicians I fall into the trap of fighting the dread disease, instead of focusing on the wonders and power of wellness.  Still, we do not rise each morning planning for our demise, rather we focus on learning, sharing, creating and, for many the possibility and nature of sex.

Like everything else in the cancer journey, one enters into this part of life with a sexual history.  How we satisfy and share our physical needs through the rest of life forms the basis of how we deal with sex during illness.  It is critical to realize that for most people our intimate relationships are vital to deal with stress and receive support.  It is a cruel trick that when we need a gentle touch or powerful release to cope with the overwhelming burden of the cancer battle, our bodies or minds may abandon us.

There are a number of reasons that sexuality fails us at this time.  At its most basic, when you do not feel well, it is hard to be sexual.  Pain, nausea, weakness and a long list of other ailments, get in the way.  Many treatments can interfere with the physical act by impairing erections, blocking orgasm, causing dryness or simply making one exhausted.  Physical injury to our body can make sex, as we are used to experiencing it, very difficult.  Finally, fear is distracting and undermines our ability to communicate and share desire.

For both the patient and lover, there is an element of confusion and embarrassment. The patient, whose body has changed, may not feel attractive and may even experience shame, even though what has happened is in no way their fault.  For the lover who is likely attracted and interested, despite the changes which have occurred, there may be guilt that they desire sexual relations, despite all the patient is experiencing.  This turmoil of emotion and desire can create a cycle of poor communication and if not addressed can spiral and make even extra-sexual relations worse.

Despite the confusion and challenge, it is critical to realize that sex is very important. It is one way in which we feel good about ourselves. It is a path to love and support.  It is key to sharing and bonding.  It is a wonderful distraction in a world that, at times, really sucks.  Sex is not a sideshow in the cancer battle to be placed aside and perhaps returned to next year; rather maintaining this area of health and vitality is crucial.

Like so many other issues during illness, dealing with problems of sexuality requires communication.  This should start at the physician who, while he or she may not bring it up in the first place, can tell you a lot about what to expect and about solutions.  What will be the effect of treatments and the disease? How long will it last?  What can be done to alleviate problems or what alternatives may be available?  If your oncologist cannot help, than perhaps meet with a primary doc, gynecologist, urologist or other specialist. Get answers.

Now I know that we normally only communicate about sex by awkward signals and signs (i.e. the glass of wine on the end table, that special perfume or a risqué show on TV), but in this area you may actually have to talk.  What are you feeling, physically and emotionally?  What are your needs?  If you cannot have an orgasm as you would in the past, what would feel good now?  Even though one partner may be injured, it is ok, at least for now, to satisfy the other.  Just sharing feelings about what has been lost, can go a long way.

A very elderly couple, whom I have the honor of treating, was in the office not long ago. He is wheelchair bound, occasionally confused and on complex medications for cancer. I see them often. In the course of our visit, they shared that after an absence of months, they had intercourse and he achieved climax. This was obviously an experience of great joy, intimacy and peace. They felt more normal. They had taken care of each other’s needs and connected to a normal life that was so important. I was touched that they shared this wonderful experience with me.

Thus, the biological, psychological, the human math:

Cancer = fear, pain and death.

Sex = life, joy, sharing, wonder, laughter, rest, empowerment, softness, wellness, excitement, vitality, connection, involvement, stimulation, giving, taking, scent, supporting, communicating, growth, experimentation, learning, art and love.

Touch, today.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.