Sexual recovery after cancer treatment

asco-logo The couple that entered my office on a warm fall day seemed out of sorts. She looked nervous, and he looked irritated. Before he sat down I heard why he felt that way: “I don’t even know why we’re here.“

I explained briefly what my role is but this did not seem to clear up anything.

“I just want her to be fixed. I want her to be normal. Can you do that?”

I glanced over at the woman who was sitting in the chair. Her face was expressionless, but her eyes told a different story.  They were sad and a little bit scared, and I addressed her, trying with my posture to show her that she was my priority.

I listened to her story as I have listened to many other women with a similar tale to tell: breast cancer, mastectomy, radiation, chemotherapy, and now adjuvant endocrine therapy. Her whole body ached, she said, and her interest in sex was gone. He interjected at this point.

“How much longer can this go on?” The anger in his voice sucked the air out of the room, and I got up to turn down the heat, hoping for some fresh air.

He went on: “It’s not fair to me, ya know. I get frustrated. I try to touch her, and she pushes me away because her back hurts and her knees hurt. I want to make her feel good, but she pushes me away.”

“So you think that sex will make her feel better?” I ask quietly.

“Well, sure,” he replies, “Doesn’t it do that for everyone?”

I now had something to work with besides his anger and frustration.

We talked about how, for some men, sex can be a distraction from pain and hurt and a miserable day. How that works for some women but not all, and pushing him away is in part a response to her pain but also because she is not ready for sex yet.

“And it’s also why I avoid you at other times,” she added. “I don’t want you to get the wrong idea, so I keep my distance and don’t hug you anymore.”

The man looked at me as she said that. I could see the confusion on his face. So I decided to use a tactic I had never used with other couples in similar situations.

“Can you imagine for a moment what it might be like for you if you got cancer and could no longer have erections?” I asked.

He was silent for a few long minutes. I held my breath, not sure what he would say next.

“So do you mean that if I was the one with cancer, then I might be the one who started avoiding her?”

I nodded. I see this often, I explained to them. A cycle of avoidance is set up when one person isn’t ready for or doesn’t want sex, and it causes a chasm to grow, and many couples find it difficult to talk about it and so the distance between them continues to grow and they start to argue, and this causes further distance. The tactic I used was to personalize the situation for him in a way that I anticipated would resonate. I was not sure what his response would be, and it was possible that it could have increased his anger. But personalizing what is a hypothetical situation can work. I have used this technique when speaking to a stranger on the phone when making a reservation or trying to change something. Asking “What would you do if you were me?” forces the person I am talking to mentally put themselves into my situation, and it often has the benefit of turning a “no” into a “yes.”  This might not always work, but in the face of his frustration and lack of understanding of what his partner was going through, I thought it was worth a try.

As I talked, I saw his face soften and tears gathered in his eyes.

He reached over towards her to take her hand, and then he stopped himself.

“Is it OK if I hold your hand?” he asked.

She nodded, the tears running freely down her cheeks, and he took her hand in his.  “It feels like I’m broken,” she whispered, “And I know that you want me to be better but what if I can’t ever have sex? When you touch me, I’m scared that you want sex and I feel guilty …”

We talked a little bit more about the side effects of her treatment and how recovery can and does take time, and everyone is different. I explained how I could help guide them through what lies ahead in her sexual recovery and that they can come back and see me again whenever they want.

As they left, he took my hand in his large one. “You have no idea how much you helped me, Doc. Putting myself in her place. It made all the difference.”

Yes, it can.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

Image credit: Shutterstock.com

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