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Sexual Counseling

Many people with cancer may at some point worry about how the illness will affect their sexuality. Following an initial diagnosis, many people temporarily lose interest in sex as they focus on what the illness will mean for them. Feelings of anxiety and uncertainty may interfere with sexual desire. This usually occurs because survival is uppermost in a person's mind and sex may seem unimportant in the face of serious illness. Once treatment is completed, people usually experience a return of sexual desire, but this is often complicated by new doubts and worries. Cancer treatment often affects the way we see ourselves. Our image of ourselves as whole and healthy prior to a cancer diagnosis may now be different. While it is true that you are still the same person after treatment for cancer, your body image will be different. For some people, that change may result in sexual problems. Since sexuality is part of our self-image, our altered self-image may affect our sexuality.

For some people with tumors directly related to areas of the body associated with sexuality (uterine, ovarian, prostate), actual physical problems may result from treatment. Obviously, your doctor should tell you exactly what to expect and how sexual relations may be affected. For the most part, however, sexual problems following cancer treatment have more to do with emotional reactions to an altered self-image than anything else. Also, feelings of fatigue, uncertainty about the future, and depression will certainly affect sexual interest. Some people worry that cancer can be transmitted to their partner through sexual relations. There is absolutely no truth to this idea.

The problem with sexuality as it relates to cancer is the reluctance people may have in talking about it. Often embarrassed to bring it up, people may think their doctors will wonder how they could worry about sex in the face of such a serious illness. While sexuality may not be the first thing on a person's mind after hearing of the diagnosis, eventually the impact that cancer can have on sexuality may become a very real concern.

Health-care professionals sometimes assume that if people have a problem, they will ask about it. For this reason, they often don't ask people if they have questions about sex. This is unfortunate because it leaves the person with cancer with the burden of raising the subject. Sexual problems are real and are either based on actual changes in one's body as a result of treatment or in a change in the way people feel about their bodies. Whatever the reason, questions about your sexual life require answers.

HOW SEXUAL COUNSELING SERVICES CAN HELP

  1. Offer help with feelings of unattractiveness following surgery for breast cancer, colon cancer, or head and neck cancer, or any treatment that affects your feelings of sexual desirability.

  2. Offer help with actual physical problems associated with resuming sexual activity following cancer treatments, such as how to manage an ostomy during intercourse, problems of sexual arousal or lack of interest due to fatigue or problems in communication, and resuming sexual relations after surgery for prostate or bladder cancer.

  3. Provide information and guidance about your illness for your spouse or partner, who may be unsure about when or how to resume sexual relationships.

  4. Provide written materials about sexual problems and their solutions.

HOW DO YOU FIND THESE SERVICES?

  1. First, talk with your doctor about whether your treatments will have any effect on sexual activity. Sex can be difficult for many people to discuss. If your doctor does not bring up the subject and you are uncomfortable asking, ask a nurse or social worker to help you talk with your doctor. If your problem is a physical one related to treatment, your doctor can offer suggestions or refer you to another health-care team member (an enterostomal therapist for ostomy patients, for instance), if appropriate. If your problem is related more to how you feel about changes in sexual desirability, a cancer counselor may be helpful.

  2. If the hospital staff is unable to provide counseling, community agency programs can be helpful. Examples are Family Service agencies and the American Cancer Society's "I Can Cope" program.

  3. Your family doctor or member of the clergy might also be able to provide guidance.

HELPFUL HINTS

If sexual intimacy was an important part of your life before cancer, this does not have to change. If your ability to have intercourse does change temporarily, there are other ways to achieve sexual satisfaction.

Hospitals often provide free sexual counseling. Community agencies or private counselors charge a fee, which may be adjusted to a family's income. Sexual counseling is a specialty within the counseling professions. It is always best to ask for a referral from someone you trust rather than select a name at random from the phone book. Ask your doctor, nurse, or social worker.

Sexual intimacy is a fulfilling part of life, with or without cancer. Pursue your questions and concerns with your health-care team.

The American Cancer Society provides two excellent pamphlets: "Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner" and "Sexuality and Cancer: For the Man Who Has Cancer and His Partner." These pamphlets are available through your local ACS unit.





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