Woman Cancer Sex

Anne Katz

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000228113
• Topic: Personal Development
• Subtopic: Nursing

Winner of the 2023 SSTAR Consumer Book Award!

Woman Cancer Sex, Second Edition, is an accessible and comprehensive resource for women living with and surviving cancer as they navigate specific challenges related to sex and sexuality.

Women who have survived cancer remain sexual beings despite the challenges of cancer treatment, and they often have nowhere to go with their questions and concerns. This text interweaves stories from clinical practice with evidence-based tips and interventions for a range of physical and emotional side effects resulting from cancer and its treatment. Each chapter describes the experience of a woman with a particular kind of cancer and a variety of related problems, including loss of libido, physical pain, body image issues, depression, and struggles communicating with a partner and health care providers.

Written by a leading voice in the field of cancer and sexuality, this book offers essential guidance surrounding questions about sexual health for women diagnosed with cancer. It will also be of use to health care providers including social workers and sex and couple therapists.

PART I

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THE BASICS

1

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Why Sex Matters

For women in the 21st century, sex and sexuality are important aspects of our lives. We are all aware of ourselves as sexual beings, whether we express that with a partner or alone, frequently or infrequently, proudly or with conflicted feelings.

So what’s the difference between sexuality and sexual functioning? Sexuality has been defined as the way we experience and express ourselves as sexual beings. This begins in infancy and persists through old age, and it is influenced by the norms of our families, communities, and society as a whole. It includes our awareness of ourselves as female or male and is an essential part of who we are and how we interact with others, irrespective of whether we actually engage in sexual activity. Our sexuality persists even when we’re faced with challenges; it’s not based in our breasts or genitalia but rather in our hearts, minds, and souls. We may feel pleasurable sensations in our genitals, but we experience those sensations in our heads and hearts, too. Part of our sexuality embraces how we seek out pleasure and our connectedness with our partner, as well as how we experience erotic thoughts and feelings. Our sexual orientation, or who we choose to be sexual with, is an intrinsic part of sexuality. For some of us, procreation or reproduction is the expression of our sexuality. All of this occurs in the context of our religious, cultural, and ethnic beliefs and practices. Many of us have strong feelings about what’s right and wrong, acceptable or not acceptable about sexuality, sexual expression, and sexual activity. This, too, is influenced by our family of origin, our education as children, teens, and adults, and the experiences we’ve had as we have matured.

On the other hand, sexual functioning describes what we do as sexual beings. There is a whole language around these two words. Most people have their own language for sexual functioning and may use euphemisms to describe what they do. For example, many couples talk about their “intimate life,” which comprises their sexual activity as well as the feelings of connectedness. Or they may use that phrase because they’re embarrassed to say the words “sexual activity” or “sexual intercourse.” Many people refer to “making love,” which may be, to them, a more acceptable way of saying that they engage in sexual activity. The words “sexual activity” have different meanings; for some people they mean having intercourse, while for others it may mean masturbation, alone or with a partner, or oral sex without penetration.

The importance that we as individuals and couples place on sexual functioning tends to ebb and flow throughout our lives. At the beginning of a relationship, sex is often of high importance, and most of us can recall with fondness those first few months of a new relationship where every kiss, touch, and even glance made our pulse race. But when raising a young family, many women find that sex takes a back seat to the myriad other roles and responsibilities they have. When sexual desire for the members of a couple are at different levels, this can cause stress in a relationship. Menopause also presents changes to sexuality and sexual functioning at a time when a woman’s partner may be experiencing his or her own changes. Acute or chronic illness poses another challenge, and some couples choose to ignore their sexual needs and desires in the face of health challenges for fear of causing damage or pain to their partner.

Cancer and Sexuality

Some people may think that these two words—sexuality and cancer—don’t go together. This is probably because they haven’t experienced cancer or because they have an image of sexuality as being related to the more sensationalistic images we see in the media. If sexuality is the expression of ourselves as human beings, then it’s important to consider that cancer and its treatments don’t take away the experience of being a sexual person. Cancer may change the way we see ourselves as sexual beings, but not necessarily in a negative way. Today, the success or failure of cancer treatments is not judged solely on the basis of cure but also on how it affects quality of life for the individual. Cancer can have a profound effect on all aspects of quality of life, and these include physical, psychological, and social dimensions.

The physical location of the cancer can profoundly affect how a woman sees herself as a sexual being. Gynecological cancer affects a woman’s reproductive organs, which are also her sexual organs. Breast cancer affects a part of the body that represents femininity to many women, and alterations to the structure of the breast can profoundly affect her self- and body image. Other cancers may seem less likely to affect sexual functioning, but because the heart, mind, and soul as well as the body play a part in sex, any cancer experience can affect how women perceive themselves and how they express their sexuality and sexual feelings.

The Stages of Illness

As with all other illnesses, cancer has its own unique stages. Sexuality and sexual functioning are affected at every stage of the cancer journey. The time surrounding diagnosis is usually one of crisis. When multiple tests are being done to diagnose a particular cancer, a woman may find that she’s too stressed to enjoy sexual thoughts or sexual activity, yet other women may find that sexual activity is a distraction and a way to connect with themselves and their partner in a pleasurable way and put aside fears and uncertainties. When the cancer diagnosis is made, life is forever changed and a woman must now learn a whole new way of being as she works with the health care team to develop a plan of care and treatment. For many, a diagnosis of cancer initially presents a very real threat to life, and thoughts of death are very real. Many women find that even thinking about sex seems contradictory. Others find solace and comfort in the arms of their partner. Touch and sensation may take on new meaning in the face of this threat to life.

Cancer treatments can have significant effects on sexual feelings and expression. The most common treatments for cancer—surgery, radiation, chemotherapy, and hormonal manipulation, as well as the newer immune modulators—all have the potential to affect how the body works. These impacts may be temporary or long lasting, or for some, permanent. They can affect nerves, blood vessels, muscles, skin, bones, and levels of hormones. But the mind, too, can be affected, and the psychological and emotional impact of the treatments may persist for many months or even years. Some women put sex on the back burner and, over time, might not revisit themselves as sexual beings. Other women mourn the changes in their life and try to stay connected to their partner and their own bodies through whatever means they can find, depending on their health and the severity of side effects of treatment.

When treatment is over, the “chronic” phase of cancer begins. Many women find that over time the body heals and returns to something resembling normalcy. But this can be a time of great uncertainty, when altered sensations can cause panic that the cancer is back. Some women will experience a recurrence of the cancer and once again there is a crisis as expectations or hopes are crushed and a transition to quality versus quantity of life may need to be made.

But thanks to dramatic advances in cancer detection and treatment, more and more people are surviving cancer. According to the National Cancer Institute, in the United States in 2016 there were 15.5 million survivors of cancer. This number will grow to an estimated 20.3 million in 2026 (https://www.cancer.gov/about-cancer/understanding/statistics).

Many myths are associated with cancer survival, including that once treatment is over, a woman is expected to go back to life as it was before and should also return to her pre-cancer sense of self, including sexual functioning. The reality is that some women return to their previous levels of sexual functioning and others don’t. Some find that the alterations they needed to make during treatment or recovery from treatment have opened up a new world of sexual expression, and they incorporate these changes as permanent features of an expanded or different sex life. For other women, the cessation of sexual activity during acute treatment is never addressed and they don’t attempt to return to their previous activities. This may be a relief for some women—perhaps sex wasn’t important to them or was not enjoyable, and the cancer was a welcome excuse to avoid it. Others don’t know that help is available to assist them in finding solutions to problems they encounter with treatment and/or recovery. Some women are never even asked by their health care providers if they have any questions or need help deal with changes in their sexual functioning. If you’ve experienced sexual problems during or after cancer, you’re not alone. Almost half of all cancer survivors report ongoing problems with sexual functioning; these problems are physical, emotional or psychological, and social.

What Can You Expect From This Book?

I’m a passionate believer that everyone who experiences cancer deserves to have any problems with sexual functioning addressed and resolved in the best way possible. Every day I counsel individual women or couples experiencing problems. This book explains the changes that many women with cancer experience and offers practical advice on how to handle these changes. Each chapter describes the experience of a woman with a particular kind of cancer. But the story in the chapter isn’t applicable only to women with that kind of cancer. Even if you’ve experienced a different kind of cancer, you’ll find yourself relating to that woman’s feelings and experiences with a variety of problems, including loss of libido, physical pain during and after treatment, and struggles communicating with a partner. Please read all the chapters in this book even if you think some don’t apply directly to you, because included in each woman’s story is information that applies to all different kinds of cancers. And ask your partner to read it too. Why is this important? Because some universal experiences for those with cancer are not different by type of cancer. For instance, fatigue is a universal response to many treatments, and body image is something that many women are concerned about and that is almost always affected by cancer.

This book has three parts. The first deals with sexual functioning and describes how things work, so that you’ll be able to better understand the terms commonly used in talking about sexuality and sexual functioning. The second part highlights the different feelings—physical and emotional—that women with cancer may encounter. These include changes in body image, loss of sexual desire, alterations in arousal, changes in orgasmic response, pain, and the emotional responses to these changes. There’s also a chapter on how to communicate with a potential partner about a sensitive and often emotionally laden topic. Issues facing lesbians with cancer are addressed, as well as the interaction between fertility and sexuality, and women of all ages are included. The third part of the book presents specific strategies for women with cancer, including medication and over-the-counter products used to treat sexual problems, communication strategies and exercises, and additional resources for where to find help. Because the partners of women with cancer experience their own individual issues, there’s also a chapter in this section for the partner of the woman with cancer.

Today, most women who receive a cancer diagnosis will go on to survive and, in time, the memory of cancer and its treatments grows less acute. Sexuality is a part of life, and women deserve to continue to express themselves as sexual beings in loving relationships. This book gives you the information and tools you need to reclaim your sex life after the challenges of cancer.

2

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HOW DO THINGS WORK?

In order to talk about sex, we need to know about the parts and processes by which sex happens. We know quite a bit about the female and male reproductive organs. And we know how they work, but even there we are learning as new research describes details that we were not aware of before. Do we know how diseases like cancer affect sexuality? Yes, in part we do, but there is still lots to learn. Let’s start at the beginning with the female sexual organs.

Sexual Anatomy

Women have breasts, and below the waist, the genitalia. The breasts grow and develop during the years of puberty. They are described as secondary sex characteristics. The breasts are mostly fat and a special tissue called mammary glands. The mammary glands produce milk after a baby is born, and the fat gives breasts their size and shape. Each breast has a nipple on it that is surrounded by a colored area of skin called the areola. The nipples and areolae have many nerve endings that are very sensitive and play a role in sexual arousal.

A woman’s genitalia have external and internal parts. Warning: there are a lot of Latin names for these parts! On the outside is the pubic mound, or mons. It is a fatty pad that lies over the pubic bone and after puberty is covered in hair. Starting from the rear of the mons are two fleshy folds of skin (called the labia majora) that run back to the entrance to the vagina. These are usually also covered in hair. They lie over the inner lips (the labia minora). The inner lips surround the opening of the urethra (which carries urine from the bladder) and the entrance to the vagina, called the vaginal introitus. This whole area also has a lot of nerve endings and a rich blood supply, and during sexual arousal the whole area will swell and grow darker in color.

Where the inner labia meet in the front, just below the mons, is the clitoris. This organ has the highest number of nerves in the human body, even more than the number of nerves supplying the male penis. It used to be thought that the clitoris was a small organ, about the size of a pea. Many medical textbooks still show it that way. But we now know that the clitoris has a large part of itself, described as “wings,” hidden under the skin of the labia, so there is clitoral tissue as far back as the entrance to the vagina on each side. Just a small part of the clitoris is visible on the outside and it is partly covered by a hood.

The entrance to the vagina, or introitus, lies between the urethra in the front and the anus behind. The vagina is a tube about three to five inches in length. The walls of the vagina are covered in mucosal tissue that is also richly supplied with blood, but not many nerve endings are in the walls of the vagina. This is probably a good thing when you think about a 9-pound baby coming through the vagina! There are more nerves in the lower third of the vagina near the entrance. In the normal resting state, the walls of the vagina touch each other. The walls of the vagina have many folds, and a fluid is secreted by the mucosal cells to keep the vagina moist.

The cervix lies at the top of the vagina and is the entrance to the uterus. The cervix makes a fluid that lubricates the vagina. On either side of the cervix are two large groupings of nerves and blood vessels that supply the sexual organs. The uterus is a muscular organ, roughly the size and shape of a pear. The uterine tubes (also called the Fallopian tubes) extend from each the side of the uterus toward the ovaries. The ovaries produce eggs (ova) and the sex hormones estrogen, progesterone, and testosterone.

Hormonal Influences

Two areas in the brain, the hypothalamus and pituitary gland, control the secretion of hormones by the ovaries. These hormones (estrogens, progesterone, and testosterone) are important for various aspects of female sexuality and sexual functioning. Another hormone, prolactin, has an effect on libido, and yet another hormone, oxytocin, known as the hormone of attachment, is secreted in response to physical touch as well as after orgasm. Women have higher levels of estrogen and progesterone than men and lower levels of testosterone. Estrogen is involved in the maturation of sexual organs, the development of the breasts and body hair, and in the regulation of the menstrual cycle. Estrogen is also called the hormone of arousal because it increases the secretion of lubrication in the vagina.

The Sexual Response Cycle

The brain is often described as the biggest sex organ in part because of the role that the brain plays in sexual thoughts and fantasies, sexual desire, and the interpretation of sensations. Our modern understanding of human sexuality comes originally from the work of Masters and Johnson in the 1960s (Masters & Johnson, 1966). They developed a model of human sexual functioning comprising four parts. These stages (excitement, plateau, orgasm, and resolution) were described as the same for men and women and were thought to occur in a linear fashion with one stage following the other. These stages are essentially made ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Introduction
• Part I. The Basics
• Part II. How Cancer Affects Sexuality
• Part III. Resources
• Appendix 1: Mindfulness-Based Exercises
• Appendix 2: Sensate Focus Exercises
• Index