Sexual wellbeing

Resuming sexual activity after cancer treatment

Sexuality and intimacy after a cancer diagnosis may be different, but this does not mean it will be better or worse. Your preferred sexual positions may become less comfortable temporarily or change over time. While talking about these changes can be hard, the challenges of cancer can also strengthen a relationship, and lead to new ways to express intimacy.

Should I see a Psychosexual Counsellor?

Counselling can have many benefits for you, including improved life satisfaction, solutions to problems, relationship improvement, improved health, and significant reduction in feelings of distress.

At times it is likely that you will have some uncomfortable feelings. This is not unusual and can mean that change is happening for you.

Sexual difficulties following a cancer diagnosis and treatment are common. Men or women who are otherwise healthy may experience issues such as low sexual self-esteem and changes to emotional intimacy, with vaginal dryness and painful intercourse for women, and erectile difficulties for men. While it is normal for individuals and those within relationships to experience the changes of sexuality and sexual activity related to desire and frequency of sexual activity and intimacy, this can be further impacted by cancer and corresponding treatments.

Counselling provides a safe, confidential, and supportive environment for you to talk about your sexual wellbeing. There are no physical examinations, no nudity, and no touch. Sex therapy is a ‘talk therapy’ which offers practical information and strategies in managing any sexual and relationship changes. Counselling can support you to:

• Enhance your sexuality and intimacy for you as an individual or for you in your relationship.
• Help understand related changes to your body image and sexual self-esteem following a cancer diagnosis and treatment.
• Maintain healthy sexual functioning and sex life, address sexual difficulties and awkwardness with connecting sexually.
• Redevelop a healthy sex-life balance.

An Accredited Psychosexual Counsellor can also link you to other allied health services as needed, to provide a holistic approach to support you, and your partner.

Fertility

Some cancer treatments can cause infertility (difficulty conceiving a baby), which can be temporary or permanent. When individuals learn that they may be permanently infertile, they often feel a great sense of loss. Those who did not get a chance to think about their fertility until treatment was over say the emotions can be especially strong. As well as talking with your partner, it may help to talk with a counsellor, sexual therapist, oncologist, urologist, or oncology nurse.

Information regarding fertility after treatment for men:

• Some men are able to conceive naturally, although may be advised to wait a certain period after treatment before fathering a child.
• Techniques include intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI).
• Some men use donor sperm to conceive a child.

Information regarding fertility after treatment for women:

•  A woman with eggs and a uterus may be able to conceive naturally.
• If a woman cannot use her own eggs, she may use donor eggs or embryos. A woman may also consider choosing a surrogate to carry her embryo or a donor embryo.

Coping strategies

• • Gather information.
  • Find support from friends and family.
  • Explore peer support.
  • Consider counselling.

Cancer Council’s Fertility and Cancer booklet below provides information about how cancer and associated treatments may impact fertility.

Menopause

Early menopause (or premature ovarian insufficiency or POI) is the term for menopause that occurs before the age of 40. When menopause starts suddenly, the symptoms are usually more severe than natural menopause because your body hasn’t had time to get used to the gradual loss of hormones. Premature menopause may also cause bones to weaken (known as osteoporosis or osteopenia). The loss of menstruation and fertility earlier than you expected may affect your sense of identity, or make you feel older than your age or friends. You may feel less feminine or worry that you are less attractive.

Coping with menopause

Cancer treatments can cause symptoms such as hot flushes, changes in menstrual cycle, troublesome vaginal symptoms, and changes in sexual libido. For younger women, these symptoms are often a shock, as they may be many years away from undergoing natural menopause. For some women diagnosed with cancer, pre-existing Hormone Therapy (HT) is stopped. Those women who were taking HT to manage their menopause before their cancer diagnosis may also feel their menopausal symptoms coming back and need assistance to manage these.

You can speak to your doctor about any concerns and may be referred to specialised services for ongoing advice at King Edward Memorial Hospital, including:

• • • Menopause after Cancer Clinic
    • Pelvic Pain Clinic

Male symptoms

Men can experience changes in sexuality, including menopausal changes after commencing androgen deprivation therapy. These symptoms may be hot flushes and sexual side effects such as decrease in libido and erectile dysfunction.

Managing these symptoms is important for your general wellbeing, as is finding a doctor, nurse, or counsellor you are comfortable discussing sexual issues with.

LGBTQI

During and after treatment for cancer, it is common to feel a range of strong emotions including anger, fear, anxiety, sadness, grief, and resentment. You may feel anxious about coming out to health professionals, fear being discriminated against because of your sexual orientation, gender, or intersex variation, or worry about how cancer and its treatment will affect your identity or relationships.

Recognition, acceptance, and respect of your sexuality is a crucial part of comprehensive cancer care. Your clinical team should openly discuss your sexual health and wellbeing to support you throughout your cancer experience.

Cancer Council’s LGBTQI+ People and Cancer booklet below can help you navigate practical, physical, and emotional issues, and offer direction to find inclusive cancer care.

The Genders, Bodies and Relationships Passport developed by LGBTQI+ Health Australia is a tool to support clear communication between intersex, trans and gender diverse individuals, and health and social care services. The passport provides important information about a person’s gender/s, body, and relationships in a single location.

QLife provides anonymous and free LGBTIQ+ peer support and referral for individuals in Australia wanting to talk about sexuality, identity, gender, bodies, feelings, or relationships.

Cancer, disability and sexuality

Coping with cancer can be difficult. When you have a disability, it can be even more challenging. If you live with a disability, speak to your health care provider for a referral to a clinical psychosexual therapist or psychologist who has experience working with individuals living with a disability.

A referral to SECCA (Sexuality Education Counselling and Consulting Agency) via your NDIS plan, can include counselling to talk about your concerns and offer strategies to support your sexuality after cancer.

Important links

• • Cancer Council WA publications
    • Sexuality, Intimacy and Cancer Booklet
    • Fertility and Cancer Booklet
  • Cancer Council WA CD on Sexuality and Cancer – COMING SOON
  • Breast Cancer Network Australia: Information for same sex partners
  • Pelvic Pain Society of Australia
  • Prostate Cancer Foundation of Australia website
  • Society of Australian Sexologists website
  • LGBTQI QLife
  • Jean Hailes for Womens Health
  • Breast Cancer Network Australia (BCNA) menopause booklet

The expert content on this page has been informed by Helena Green, Relationship and Sexuality Counsellor, Clinical Psychosexual Therapist, Clinical Sexologist. Helena specialises in supporting couples and individuals to overcome sexual and relationship difficulties and enhance and maintain sexuality and intimacy across all life stages.