Why is sexual dysfunction so much higher in people who have cancer?

17 March, 2023
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“I just want to be close to my wife again.”

“Cancer has taken so much, I don’t even feel like this is my body.”

“Sex is the last thing on my mind – my libido is totally gone – but my partner feels like I’m ignoring them on purpose.”

Sexual intimacy can be complex even in the healthiest of relationships. Following cancer treatment, however, it can feel like a labyrinth of challenges. Up to 90% of people experience some type of sexual dysfunction post-cancer¹ compared to around 30-40% in the general population².

Sexual dysfunction is the term used to describe an interruption during any phase of the sexual response cycle – desire, arousal, orgasm, and resolution². Types of sexual dysfunction are generally classified into four areas: Lack of desire or interest, trouble getting aroused, trouble reaching orgasm, or pain during sexual activity.

Why is sexual dysfunction so much higher in people who have been diagnosed with cancer?

Cancer is incredibly impactful because it is truly a biopsychosocial problem. This means that the effect of cancer and cancer treatment is made up of an accumulation of biological, psychological, and social factors. In other words, cancer has the potential to alter many aspects of one’s well-being, not just physical health.

Sexual functioning is also biopsychosocial. Our bodies, minds, and relationships often all have to be cooperating together for a healthy and satisfying sexual connection. Cancer and cancer treatment can interrupt all of these elements.

Here’s a breakdown of common biopsychosocial issues that can affect sexual functioning as a result of cancer:

Biological:

People who have undergone treatment for cancer face numerous alterations to their bodies that can interfere with sexual functioning.

Cancer treatments often cause a number of impairing physical symptoms, like nausea, fatigue, and pain.
Some cancer treatments and surgeries, such as androgen suppression therapy or prostate cancer or oophorectomy for breast and gynecological cancers, substantially reduce sex hormones like estrogen and testosterone. Sex hormones play a huge role in sexual desire, arousal, and ability to achieve orgasm. Reduced estrogen can cause decreased lubrication and vaginal atrophy, causing pain during intercourse.
People may experience significant changes in their body, like the loss of their breasts or scarring, that can contribute to concerns about body image or result in loss of sensation.

Psychological:

It’s draining to manage intense emotions; this can make it hard to be interested in or present during sexual intimacy.

The diagnosis itself can cause troubling emotions, including anxiety and depression.
Feeling unwell from treatment impacts mood. The side effects of many treatments for cancer can mimic symptoms of depression, such as loss of energy and interest in activities. Even medications that are meant to be helpful, like steroids used to help prevent allergic reactions and reduce side effects from chemotherapy, can cause negative mood symptoms like agitation and restlessness.
A cancer diagnosis can effect how you think. People diagnosed with cancer face thoughts about dying, changes in how they feel about themselves and their bodies, and a tremendous amount of uncertainty. Ruminating and negative thinking are understandable consequences of a cancer diagnosis, and can influence how someone feels emotionally.
Having cancer is an extremely vulnerable experience. Bodies are poked, prodded, cut, and scanned to adequately treat the disease. This can be traumatizing itself, or could potentially retraumatize those who have experienced assaults on their bodies in their past. It is a normal reaction to withdraw from physical contact in the wake of this experience.

Social/interpersonal:

Difficult circumstances can test relationships, particularly a challenge as all-encompassing as cancer can be. Even if you have previously had a healthy sex life, cancer can introduce new barriers.

It is not uncommon for people in intimate relationships to have trouble communicating during cancer treatment. It can be hard for the person who is not undergoing treatment to truly understand their loved one’s perspective. This may lead to misunderstandings or assumptions that can interrupt intimacy.
There is a lot of change to adapt to. Surgical changes such as a mastectomy or ostomy are new variables to account for. Changes in frequency of sex may create conflict or may simply introduce a barrier that had not previously existed in the relationship. Understandably, people can get stuck in how things “used to be,” making it tough to consider ways to adapt or navigate new challenges to sexual intimacy.
Cultural or religious beliefs may make it difficult to talk about sexual intimacy so concerns can be addressed as a team.

Clearly, cancer and cancer treatment can significantly impact sexual intimacy. It can be a lonely and frustrating experience, particularly when experiencing the many other difficulties that occur alongside a cancer diagnosis. You are not alone – remember, up to 90% of people with cancer face problems with their sexual functioning – and there are more options available to help than you may realize. Consider these suggestions if you are struggling with sex following treatment for cancer.

Reflect

It may first be helpful to ask yourself, “What has changed?,” so you can clearly define the problem. Are you noticing changes in your mind, your body, your relationship, or all three? What messages are you telling yourself about sex, about your body, or possibly about your relationship that may be contributing to interruption in intimacy? Are there unresolved emotions or unspoken assumptions to tackle? Are you facing any medical symptoms that you haven’t spoken with your treatment team about? These questions will inform what the next best step may be.

Befriend yourself

Our minds are really good at telling us unhelpful and even downright cruel and untrue things about ourselves. Monitor that self-critic. Experiment with outlining evidence that doesn’t support whatever this unkind person in your head is telling you. Check out the strategies I outline in this post for ideas.

If you’re finding it hard to work through this on your own, consider speaking to a therapist that has a background in cancer care, body image, or sexual health, like myself.

Talk about it

I know, I know – WAY easier said than done. It can be uncomfortable or painful to discuss concerns about sex. However, it may be necessary in order to find your way back to sexual intimacy. If you’re struggling to talk about sex in your relationship, check out the American Association of Sexuality Educators, Counselors, and Therapists directory to find a certified sexual health practitioner.

Get creative

Is it possible to explore alternative ways to be intimate than you have in the past? What about expanding your definition of intimacy? It may be that sexual intimacy needs to look a bit different than it did pre-cancer. Explore other types of sensual touch, consider using toys, or experiment with positioning. Try not to take things too seriously – play can be an important part of intimacy and can relieve some of the pressure of navigating new territory.

If you’re not sure where to start, there are some great sex education resources available online. Lovehoney, a sex toy company, hosts a series of educational videos on YouTube on anything from how to make intimacy a priority to discussing different types of sex toys.

Practice Presence

If you’re worried about sex, you probably aren’t paying much attention to what how your body feels. It can be impossible to feel interested or engaged in sex when we’re in our heads. Mindfulness practice can be one method of learning how to shift out of your mind and into your body. Check out my mindfulness courses here.

Find your team

The field of specialists in sexual medicine is growing and oncology providers are becoming more adept helping people with cancer manage the quality-of-life impacts of their treatment. If your oncology team doesn’t seem to be addressing your concerns, consider seeking out a specialist. Many large cancer centers have sexual health or sexual medicine clinics exclusively for people coping with cancer, so do a bit a research to see what you may have access to. Pelvic floor therapists, menopause specialists, urologists, endocrinologists, and even psychiatrists may also be able to help you address your symptoms.

Above all, practice compassion toward yourself for what you have been through. As Emily Nagoski states beautifully in her best-selling book “Come As You Are: The Surprising New Science That Will Transform Your Sex Life”:

“Remind yourself that the day you were born, your body was a cause for celebration, for love without condition, and that’s just as true today as it was then.”

If you’re a health professional and would like to know more about helping people with cancer manage sexual functioning, pre-enroll in my upcoming on-demand course available May 15^th!

References

Bond, C. B., Jensen, P. T., Groenvold, M., & Johnsen, A. T. (2019). Prevalence and possible predictors of sexual dysfunction and self-reported needs related to the sexual life of advanced cancer patients. Acta Oncologica, 58(5), 769-775.

Sexual dysfunction & disorders: Treatment, symptoms & diagnosis. Cleveland Clinic. (2020, October 27). Retrieved March 16, 2023, from https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction.