Oncology

The diagnosis of cancer and receiving corresponding treatments often including surgeries, radiotherapy, and chemotherapy, will profoundly affect one's sexuality, sexual identity, and sexual behaviour. Surgeries such as mastectomy (removal of breast), oophorectomy (removal of ovary or ovaries), vulvectomy (removal of vulva), hysterectomy (removal of the uterus), and orchidectomy (removal of one testicle or both) may have a significant impact on the person in ways such as:

• Losing interest in sex.
• Feeling less sexually aroused.
• Difficulties having/keeping erections.
• Having orgasms.
• Pain during sex.

Chemotherapy
With chemotherapy the effects are often both physical and psychological. Those of childbearing age should be advised to prevent pregnancies, as chemotherapy has a detrimental effect on the embryo's development. The preservation of sperm and testicular tissue may be advised. The medical team will discuss these options in more detail. Chemotherapy often brings about a lack of sex drive and reduced vaginal lubrication, possibly leading to pain during intercourse. Patients undergoing chemotherapy should also be advised to protect themselves against sexually transmitted infections, especially when their white cell count is low, with the constant use of condoms. Hair loss, weight gain or loss, feeling sick, dryness of the mouth, diarrhoea, constipation, tiredness, and loss of appetite have a detrimental effect on the sex life of the persons involved.

Radiotherapy
With radiotherapy there is often localised damage to nerves, muscles, veins, and arteries, which often affects the person's abilities to express their sexuality. Radiation often gives rise to erectile difficulties, vaginal dryness leading to painful intercourse, weight gain or weight loss, nausea, vomiting, constipation, diarrhoea, radiation burns, and extreme tiredness, which are all deterrents to a healthy sexual lifestyle.

Support
Fortunately, with the right advice and guidance from the oncology team, many people and partners adjust and feel satisfied with the kind of sexual relationships they have. This may mean adjusting to changes in ways of being sexual with one's partner. This may take time and some experimentation. It is very helpful to talk to one's partner and share feelings, fears, and wishes. In addition, coming to a consensus together on what can be done at the time is important to be able to relax and express one's feelings without fear. Erections, penetration, and orgasm may become secondary to mutual intimacy and emotional bonding.

Cancer care often leads to a change in body image, so one has to get to know one's body again and to accept oneself as is. Self-exploration may help, such as touching areas which were not previously considered sexy, like the eyelids, ears, and back. The sooner the altered body is confronted, the easier self-confidence and sexuality becomes. One's body could be appreciated in several non-sexual ways, such as mutual massage, having showers/baths together, and carrying out some sort of physical activity, such as a walk near the sea or at the countryside. Exercise increases blood flow to the body, including sexual organs. Wearing sexy underwear and clothes that deflect attention from the affected body areas may aid in feeling wanted again. Discovering new ways to feel sexually satisfied can become a more satisfying exercise in itself than the usual sexual routine. Communication with one's partner is crucial in adjusting to one's body changes. It is also important to accept positive compliments from one's partner in order to feel attractive again. If one feels exhausted one should try less energetic and more fulfilling sexual activities.

Enjoying one's sexuality does not interfere with treatment, make the cancer worse, or increase the risk of recurrence. It is important to increase one's opportunities for physical contact and closeness for a better well-being.