Sexual health matters. Why is it so hard to talk about?

Cancer affects every part of your life, so it shouldn’t be surprising that it can also affect your sex life. But many people just aren’t comfortable talking about it.

Sure, sex can be an awkward topic. And if you’re living with cancer, questions about sexual health might seem less important than other aspects of your treatment. You might think it’s your doctor’s job to start the conversation. Or you might simply feel too embarrassed to bring it up. 

But know this: other people living with cancer likely have the same questions about sexual health that you do. It may be helpful to begin the conversation and be honest about your needs.

“When I see patients, I encourage them to advocate for themselves and try to ask for services,” Ashely Arkema, a nurse practitioner who focuses on gynecologic health and sexual dysfunction, said on a Memorial Sloan Kettering Cancer Center podcast. “I think the important thing is to know that these are really common issues and you’re definitely not alone if you’re feeling this way.” 

This article explores some of the common ways cancer may affect your sex life, both physically and emotionally. And it shares Microsteps that can be taken to start the conversation about sexual health with your healthcare team and loved ones, including sexual partners.

Physical Health 

Cancer may affect your body in ways that affect your sex life and overall sexual health. Some common experiences include:

• Pain during sex
• Physical changes, such as difficulty getting or keeping an erection
• Loss of sensation
• Menopausal symptoms including hot flashes and vaginal dryness
• Fertility issues

Physical changes, and their impact on sexual health, will vary by cancer type. Certain cancers, such as colorectal, prostate, cervical, ovarian, and others in the pelvic area, may be more likely to cause sexual challenges. And certain treatments, such as chemotherapy and radiation therapy, can have sexual side effects, such as damaging reproductive organs or affecting them in ways that make sex painful.

Emotional Health

How you feel about yourself and your body can play a big role in your sexual health. Many people living with cancer experience changes to their sense of identity [link to “Does cancer change who you are? Reflections on identity.”]. Some struggle with body image and self-esteem.

Some emotional challenges may be connected to physical changes. For example, if you’ve experienced weight changes, hair loss, or scarring from treatment, you may feel less attractive or less confident. If you experience fatigue, you may feel worried or insecure that you cannot perform sexually like you did before your diagnosis [link to “How cancer-related fatigue can affect relationships].

Feelings of vulnerability and isolation are common, and some people choose to avoid sex altogether.

That’s to say, any emotional challenges you may be facing around sexual health are real, and completely normal. They might be hard to talk about, but if you’re experiencing them, you’re not alone.

Microsteps to guide conversations about sexual health

Here are some Microsteps that can be taken to help you advocate for your sexual health and talk about your needs in a way that’s comfortable for you. As always, speak with your care team for the guidance and recommendations that are best for you.

Writing down questions for your doctor or care team about sexual health before your next appointment.

If you have questions or concerns, don’t wait for them to bring it up to you. It may help you feel more prepared if you write down your concerns in advance. Common questions may include: How will treatment affect my sexual desire? What can I do to manage side effects like vaginal dryness or trouble getting and keeping an erection? You may also consider asking about safe sex practices during treatment, such as contraception guidance.

Asking for a specialist referral to discuss your sexual health questions.

If you need more specific guidance than your doctor can give, consider asking for a referral to a specialist in men’s or women’s sexual health. Having a healthcare provider of the same gender might make you feel more comfortable and open to discussing these topics, but this is a personal choice. 

Planning a conversation with your partner in advance.

Before having the actual conversation, consider letting your partner know that you’d like to discuss sex and intimacy. Try to avoid late-night, spur-of-the-moment conversations, which may make your partner feel less comfortable.

Having a conversation with your partner in a neutral space — that’s not the bedroom. 

Consider that you both may have feelings and sensitivities about the topic, especially if you’ve avoided discussing it so far. Try to have the conversation on a walk or in a private setting, not in a public place or in the bedroom.

When talking about sensitive topics around sexual health, using “I” language in conversation with your partner.

Try beginning statements with “I” instead of “you.” This can reduce the chance of hostility in difficult conversations.

For example, instead of “You need to stop avoiding this conversation,” you might say, “I understand why you might feel uncomfortable talking about this, but it’s important to me that we get on the same page.” 

Visiting an intimate store with your partner.

The salespeople may be able to point you toward accessories that may make sex feel more comfortable for you. It may also spark conversations about what could make sex better for you both moving forward. Online shops are also an option. 

Developed with Thrive Global