Sexual health involves much more than sexual intercourse. It also encompasses the way an individual expresses herself sexually through her behaviour, mannerisms and relationships.¹

Most people who have had cancer experience issues with sexuality and intimacy. Some cancer treatments may directly impact the body physically—whether through physical appearance such as hair loss, or other side effects like nerve damage, changes in hormone levels or limitations with using certain body parts.¹ Others will shift the degree of sexual desire a woman experiences compared to before treatment. Many symptoms are temporary as the body repairs and recovers, yet some will be lasting.

It is important cancer patients and their families and caregivers understand the implications of treatment for a woman’s sexual health throughout cancer treatment and beyond.

Cancer treatments including surgery, chemotherapy, radiation therapy and hormone therapy all have different side effects, some that are temporary and others more permanent. Many of these side effects can impact your sexuality by affecting:

• Your feelings – often you will experience fear, anxiety, anger, sadness
• Your body’s production of hormones which are required for sexual response
• Your physical ability to receive and give sexual pleasure
• Your body image – often feeling less confident and a low self-esteem

Everyone is different and will experience unique sexual problems. Common problems, particularly following cancer treatment, can include:

• Onset of menopause after chemotherapy —temporary or permanent
• Hormonal changes
• Memory loss or thinking changes (e.g. brain fog or “chemo fog”)
• Hair loss, scarring, weight loss or gain
• Emotional outbursts (e.g. shock, disbelief, panic attacks)
• Nausea, anxiety, depression or other side effects arising from drug treatment
• Relationship difficulties—family, romantic partners or with children
• Trouble dealing with fluctuating emotions (e.g. anger, grief, sadness, anxiety, fear or shame)
• Fatigue
• Change in or lack of appetite
• Incontinence including bowel or bladder issues
• Skin breakouts, rashes or other skin-related disorders
• Body and self-esteem issues due to physical changes from particular operations, such as a mastectomy
• Loss of desire, interest and ability to actively engage in sexual activities or receive sexual pleasure
• Pelvic pain or other pain during intercourse
• Infertility
• Vaginal related symptoms such as dryness or reduced vaginal size

There are many practical measures you may like to consider during and following cancer treatment to improve your sexual health.

These include:

• Managing fatigue through resting often, saving energy for the most important things and trying to be intimate at different times of the day
• Speaking to your doctor about the impact that your mental health, hormone levels and medications can have on your sexual function and libido
• Communicating with your partner about the impact that cancer treatment has had on your desire for sexual intimacy
• Exploring different ways to increase your libido and help you and your partner reach satisfaction, such as quick and gentle sessions, stimulating yourself, trying more comfortable sexual positions, changing the venue, and creating a more sensual experience through skin-to-skin touch, massage, dressing sensually, and setting the scene with soft lights and music
• Using a personal lubricant with a water or silicone base
• Planning sexual activity for when your pain is lowest, ensuring to take your pain medication shortly before sexual intercourse, and trying different positions. If you continue to experience pain, you may like to consider seeing a specialist who can advise on the use of vaginal dilators and pelvic floor exercises to reduce pain
• Applying a non-hormonal, over-the-counter vaginal moisturiser to help restore lubrication
• Asking your doctor about vaginal oestrogen therapy to restore your oestrogen levels

Whether your loved one has undergone treatment or is scheduled to start soon, it’s important to familiarise yourself with the follow-on effects that cancer treatment may have. While each case will vary depending on the type of cancer and treatment approach, supporting your loved one is paramount to the recovery process.

Often when we don’t understand what our loved one is going through, we can make meaning out of their actions, behaviour or attitude post-treatment. We know that being the caregiver, regardless of relationship status, brings about a unique set of challenges. That’s why we encourage you to equip yourself with the facts so that you can nurture, support and navigate this period effectively.

Some ways you can offer support to your loved one after cancer treatment include:

• Romantic partners: discuss how the surgery may impact the sexual nature of the relationship and general day-to-day interactions
• Bring as much positivity to the relationship as you can
• Encourage your loved one to share their feelings and emotions—before, during and after treatment, emotion intensity increases and can linger from hours to weeks, to months. Be present and listen intently. Allow them to share their experience without needing to change their perception or state of mind at that moment. This will allow them to express rather than repress emotions, which can lead to emotional turmoil and stress
• Offer emotional and/or physical support when needed
• Respect their personal and physical space
• Respect their sexual boundaries, which are likely to have shifted
• Encourage laughter
• Take a break: engage in light physical activity where appropriate, or get out into nature
• Surround yourself with a support network whether that’s friends, a counsellor or community counselling group. Proactively dealing with your role as caregiver and its challenges positively impact the relationship with your loved one
• Consider complementary therapies like yoga, or spiritual practices relevant to your respective beliefs/faith.