April 17, 2000
Sexuality and Cancer
Mary K. Hughes, MS, RN
When you are diagnosed with cancer, the focus of your treatment is on getting rid of the cancer. As your treatments progress, you begin to deal with quality of life issues. The impact of cancer or its treatments on quality of life is immeasurable. Often, sexuality is an overlooked quality of life issue. The health care professional assumes that if sexuality were important to the patient, you would bring it up, while the patient thinks if it is important, the health care professional would mention it. Consequently, while other quality of life issues are discussed, sexuality is not.
Sexuality is an important quality of life issue and includes how you feel about yourself as a man or a woman as well as how you relate to others. It is more than gender or sexual intercourse and, most importantly, cannot be destroyed. Regardless of your age, you are a sexual being.
Because the health care team focuses on living with cancer, sometimes sexuality is overlooked. It is also a difficult topic for most people to discuss regardless of being a health care professional or a lay person. By acknowledging the importance of sexuality in a person's life, the health care professional can help you deal with sexual changes that result from cancer treatment or the cancer itself.
It is important to be aware of the phases of sexual activity in order to give the physician or nurse accurate information about sexual changes that you may be experiencing. The first phase is desire or libido, while the second phase is arousal. During the arousal phase, the penis fills with blood and lengthens and widens and gets erect. For women, the vagina lubricates. The third phase is orgasm or climax: the height of sexual pleasure. And the final phase is the resolution phase where the genitals return to their unexcited state. Included in this phase is the refractory period in which the penis is unable to be get rigid. For young men, this might be a matter of minutes, while in older men or men who have an illness, it may be a matter of days. When there is a change in any phase, it can be considered a sexual dysfunction, even though the other phases are intact.
There can be a variety of influences on sexuality including physical, psychological and social changes. When you are experiencing side effects such as fatigue, pain, nausea, insomnia, or constipation, you are not going to be very focused on sexual activity. Likewise, depression or anxiety can also interfere with sexuality. Not being able to work or care for yourself or having financial difficulties can also detract from sexual thoughts.
Certain medications have side effects that can interfere with sexuality. Most people are aware of the sexual side effects of certain anti-hypertensives, as well as nicotine, and alcohol. But while taking chemotherapy, people often notice a decreased sexual desire and for men an inability to get an erection. Medications for nausea, anxiety, sleep, pain or seizures may also cause decreased libido and erectile dysfunction. It is important to know that this might happen so that you can ask your physician if a change in medicine might improve sexual functioning.
People do not communicate with each other about sexuality; consequently, couples often stop having sexual intercourse without any discussion. This can be very confusing for the partner who is well and interested in sexual activities, but reluctant to talk with the person with cancer for fear of making him/her feel worse. When sexual intercourse stops, other forms of intimacy also change. People don't hug and kiss as much as they did before for fear of arousing each other and not being able to have sexual intercourse. Sometimes the person with cancer is ashamed of this change in sexual functioning and hesitant to talk with someone else about it.
Planning for sexual activities may become important so that you can take medicine for pain or other symptoms 30 minutes before that you can be prepared for this activity. Sometimes people find that even though they may not have a sexual desire, when they engage in sexual activity, they are arouseable and able to enjoy it. Vaginal lubricants are helpful in dealing with vaginal dryness experienced by so many menopausal women.
Men with erectile dysfunction may be helped by sildenifil (Viagra), alprostadil (MUSE) penile suppositories, vacuum devices, penile injections or penile implants. All of these have to be prescribed by a physician. Using different sexual positions may be necessary, depending on the sexual dysfunction. Some couples find it helpful to read books, such as The Joy of Sex, that give them ideas about alternative ways of sexually pleasing each other. The American Cancer Society publishes an excellent booklet, Sexuality and Cancer which can explain facts about cancer and sexuality.
Knowing that cancer can affect sexuality can give you permission to ask your health care provider about sexual changes that you have noticed. This will help you to have a better quality of life. After all, you are the one who decides what is a good quality of life and if sexuality is important to you, it is up to you to bring this to the health care provider's attention.
Mary K. Hughes, MS, RN
The University of Texas MD Anderson Cancer Center
Department of Neuro-Oncology
Clinical Nurse Specialist
1515 Holcombe- 100
Houston, TX 77030