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An intimate relationship involves the interaction between two (or more people) engaged with each other in more than just the social sense. There are many aspects to how a couple relate with each other in the context of their relationship. Examples may be whether the couple are involved in an intimate non-sexual relationship or a sexual relationship or whether the couple are same sex or opposite sex. A good relationship is often the foundation stone for a mutually satisfying sexual relationship.

Relationships are not always easy and often require compromise by both members of the partnership. Desire discrepancy is an example of differing sexual needs within a relationship which usually requires a negotiated compromise solution for the long term contentment of the two individuals. There are many factors, both positive and negative, involved in the attraction between two people so forming a relationship may not be easy or without stress.

All relationships benefit from good effective communication and commitment to making the relationship succeed. All relationships require ongoing maintenance and attention to succeed happily for 50 years. Couples also benefit from time alone. Children may pose extra stress on intimate relationships as time becomes limited, energy is depleted and differences of opinion on parenting techniques arise. It is also important for each member to have time out to pursue their own interests, but not to the detriment of the relationship.

Over time sexual needs may change in relationships so the importance of ongoing respect, affection and attention to each partner must always be emphasised. There are many self help books available which address the many issues that most couples may face at one time or another. Sometimes the problems prove too difficult to manage without outside help. Relationship or couples counselling may then be an appropriate

Men and women often lose interest in sex when they feel their lives are being threatened by illness. Loss of sexual function in the presence of a chronic medical condition may arise more from the treatment of the condition than the actual illness itself. In addition the level of sexual functioning present before the onset of the illness determines the eventual level of return of sexual function.

At first concern for survival is so great that sex is far down the list. Loss of desire may be a result of worry, fear, depression or anxiety. It may also be caused by physical problems such as nausea, pain, fatigue or hormone imbalance.

Sex and sexuality are important parts of everyday life. There is a difference between the two. Sex is thought of as an activity—something you do with a partner. Sexuality is more about the way people feel and is linked to your need for caring and closeness, playfulness and pleasure.

Feelings about sexuality affect our zest for living, our self-image, and our relationships with others. Yet patients rarely talk to their doctors about how they may feel as a sexual being or how the medical treatment may affect their sex lives. Many of us feel awkward talking about these matters even to a close sex partner. Many people with a chronic illness, including cancer, worry that their partner may be turned off by changes in their bodies. Or the partners worry that they may hurt the ill person during sex.

Good quality sex is possible in the face of medical conditions including diabetes, heart disease and cancer. This is true notwithstanding that many medications have a variety of side effects. Many people with chronic illnesses continue to have sex, and some have exceptionally good sex. Loving expression is possible almost regardless of what kind of physical condition you are in.

Serious illness, potent medication often known to inhibit sexual desire and exhaustion may be enough justification to stop having sex altogether. Yet, if you want to have sex you can deal with these situations and enjoy great lovemaking. You may have to change how and when you have sex, but all in all it can be worked out.

Many sexual problems that people have after cancer treatment will not last long. Pain with erection or ejaculation after pelvic surgery or radiation is likely to go away. The stress of treatment can also reduce hormone levels temporarily which may reduce desire or cause erection difficulties until hormone levels return to normal. As one feels more in control of one’s body, self-confidence returns and one’s sex life often improves.

Sexuality for the man with cancer

Some cancer treatments can cause lifelong change in a man’s sexual function. This may depend of the type of treatment that was required as well as the individual response and recovery. For example after a radical prostatectomy for prostate cancer where nerve sparing was possible, a reasonable sexual recovery may be possible.

Dealing with short-term problems: As men age or go through health problems, feelings of sexual excitement no longer lead to an instant erection. There are simple strategies that may help; perhaps you may just need more time or more stroking to get aroused. Perhaps you have not found the right kind of caressing. A hand held vibrator can provide intense stimulation. Sexual fantasy, looking at erotic stories or pictures may help. The more excited you are, the easier it is to reach orgasm. The first orgasm after cancer treatment may occur while asleep during a sexual dream. Sleep erections are not affected by mood or state of mind and may give an indication of the best erection your body can produce.

Sexuality for the woman with cancer

No matter what kind of cancer treatment you have you will still be able to feel pleasure from touching. Few treatments (other than those affecting the brain or spinal cord) damage the nerves and muscles involved in feeling pleasure from touch and reaching orgasm. For example women who have pain in their vagina due to pelvic surgery or radiotherapy or dryness due to menopausal symptoms or lack of oestrogen can often reach orgasm through stroking of their breasts and outer genitals. Sexual touching is often satisfying even if some aspects of sexuality have changed.

Many couples have a somewhat narrow view of what is normal in sex. If both partners cannot reach orgasm with penetrative sex they feel cheated. This may be a chance to learn new ways to give and receive sexual pleasure. Touching, stroking and cuddling can be pleasurable. Try touching yourself. You may need to practice having orgasms alone before going back to sex with a partner.

In some cases a woman may need to try different positions or types of genital touching.

Remember if you are in a sexual relationship and one of you has a problem it affects both of you. Dealing with the problem works best when your partner can be part of the solution. If sex becomes difficult, the physical expression of caring remains an important way of sharing closeness and can bring much pleasure.

Mandy Goldman
President
Cancer Counselling Professionals