Dr. Anne Katz is the author of 15 books for healthcare providers and healthcare consumers on the topics of illness and sexuality, as well as cancer survivorship. Her book, the second edition of Woman Cancer Sex, was published in late 2020.

Given her experience, we welcomed her to our Sex Plus Symposium to share how some of the most common cancers impact sexuality. Today, we’ll explore the issues affecting women diagnosed with cancer and some of the non-pharmaceutical interventions they can use to improve sexuality. 

Impact of Cancer on Sexuality

Sexuality is important to all humans – whether it be sexual activity with a partner or alone. It encompasses our body image, thoughts, beliefs, longing and fantasies. But cancer treatments can dramatically alter this for people. 

Despite 80% of people reporting problems, according to Dr. Katz, sexuality isn’t often a topic of conversation when someone discusses a cancer diagnosis. At times, patients are unwilling to discuss sexual challenges with their oncologist because they don’t want to seem ungrateful or critical of the person providing an often life-lengthening treatment. Others are reluctant to discuss their sexual issues because of shame. 

Cancer treatment can create a loss of identity, feelings of unattractiveness, and a disconnect with femininity. 

Challenges for Patients with Cancer 

The most basic challenge to a woman’s sexuality is the very real side effects of cancer-treating medications. Nausea or fatigue are hard to battle when making a sexual connection. And often women continue to work and parent during treatment, adding to the loss of energy.

Beyond the physical illness, there are a lot of mental roadblocks to sexuality during and after cancer treatment. When dealing with the fear of a cancer diagnosis, many people lose sexual interest. Sex takes a backseat to existential questions like, “Am I going to die?” 

Women also experience difficulty with body image. For those undergoing chemotherapy, hair loss is common. This obviously includes hair on a patient’s head, but also includes eyebrows, eyelashes and pubic hair. Some women struggle to feel sexual when they feel unattractive. The loss of culturally feminine attributes can make it difficult to feel beautiful.  

Body image is further challenged when cancers involve physical changes such as breast reconstruction or an ostomy. 

Those with breast cancer have options, but “very often, the reconstructed breast is not the same shape as [a person’s] natural breast, and this really does compound these feelings of a loss of femininity,” Dr. Katz said. Beyond the physical look of a woman’s breasts, post-treatment, she may also lose the sexual pleasure from nipple sensation. 

In the chaos and trauma of a cancer diagnosis, women are asked to make decisions that will impact their future sexuality. At the time, some women think it doesn’t matter – they simply want to survive – but after surgery, the loss of sexual response becomes apparent. 

Sexuality is also impacted by the hormonal changes from cancer treatment. Vulva and vaginal dryness can lead to very painful sex — another limiter to sexual pleasure. 

Finally, women can experience a disconnect with their sexuality as a result of the trauma of the cancer treatment itself. Having radiation means exposing parts of a person’s body generally not seen by the public. Dr. Katz said, “they dissociate in order to get through this experience; it’s the kind of dissociation that we see in women with sexual assault.” 

Improving Sexuality for Cancer Patients

While all of these challenges do impact women during and after cancer treatment, sexuality is not impossible. 

Hormonal changes are common with cancer treatment — especially for gynecological cancers. While estrogen may be limited overall, local estrogen can help replenish the tissues of the vulva and vagina. 

For women who have pain with sexual touch or an attempt at penetration, the body will naturally tighten the muscles of the pelvic floor. Dr. Katz recommends using silicone graduated dilators to gradually reopen the vaginal opening, as well as pelvic floor therapy with a licensed provider. 

Another vital element of treatment is mindfulness-based cognitive behavioral therapy. 

Dr. Katz says patients shouldn’t immediately put penetrative sex on the table after undergoing cancer treatment.  

The focus on pleasure rather than a specific act relieves a lot of pressure and guilt a person might be feeling about their body and sexuality during cancer treatment. 

Positions or acts which were pleasureful before treatment may not be any longer or a woman may be uncomfortable with her naked body. Dr. Katz says these should not limit pleasure. Consider a new cover-up and try new positions to increase comfort during sex. To be sexually healthy, you have to be aware of body sensations. 

Seeking Sexual Therapy  

A cancer diagnosis doesn’t have to be the end of a person’s sexuality. In part two of Dr. Katz’s session, we’ll explore how cancer treatment affects men’s sexual pleasure.

At Kimberly Keiser and Associates, we are trained to help individuals experience healthy and natural sexuality in any situation. 

Contact us today to set an appointment.