It might have been the last thing on your mind when you were first diagnosed with cancer, but if you've found the condition has affected your sex life, you need to know you're not alone. We ask an expert about the best ways to regain intimacy after treatment.
Research from Breast Cancer Care has found that eight in 10 women diagnosed with breast cancer say they are unhappy with their sex lives after undergoing treatment. 83% of those surveyed had been diagnosed over three years ago, suggesting that some women continue to struggle for a long time without support.
"Sex ground to a halt"
44-year-old Sharon Brooker from Peterborough is only too aware of the long-term effects of cancer treatment on someone's sex life. She was diagnosed with breast cancer in the summer of 2013, just a year after getting married. She had a lumpectomy, chemotherapy and radiotherapy to treat the disease. But in 2015, Brooker separated from her husband for a year and a half.
"Breast cancer completely changed the dynamic of our relationship to patient and carer," she reveals. "Physical changes like hair loss and scars meant I didn't think I was attractive anymore - I remember looking in the mirror and breaking down in tears as I didn't recognise myself. As a result, our sex life ground to a halt and two years after my diagnosis we separated."
Brooker says none of her healthcare team mentioned the impact breast cancer could have on her relationship or sex life. Almost five years later, she is still experiencing ongoing side effects of the treatment, such as irritation on her breast and vaginal dryness. But she has reconnected with her husband and communication between them has improved.
Samia al Qadhi, chief executive of Breast Cancer Care, says: "Far too many women have not been told about the impact breast cancer and its treatment can have on their sex lives, leaving them suffering in silence - it is crucial this taboo is broken. The NHS must ensure everyone diagnosed with breast cancer has the opportunity to talk about sex, intimacy and altered body image to help get the support they need."
Former nurse Samantha Evans, who co-founded sexual health and pleasure site Jo Divine, completely agrees. She points out that treatment for many different cancers, though particularly prostate, breast or gynaecological, can affect sex life, but there's not enough awareness of this issue.
She says: "Sex is not covered in training and many doctors feel uncomfortable talking about it, do not know what to recommend or do not think that their patient will be interested in sex after treatment, especially if they are older."
It doesn't have to be this way. Evans recommends both partners are included in the conversation about sex from diagnosis.
"It's important to include both partners, be they heterosexual or same-sex couples, in the discussion right from the start if they wish to. That way, they can fully understand the implications that cancer and its treatment may have upon their sexual relationship. Often this leads to better sexual satisfaction post-treatment too."
Techniques to try
Of course, not everyone with cancer will experience sexual problems. But if you are, talking to your partner or your healthcare team can help ease your worries. Evans stresses that it's important to realise that getting back to sex after treatment is a gradual process and cannot be rushed. However, that certainly doesn't mean you can't get your sex life back on track.
"Taking your time and going at your own pace will ensure higher success at returning to normal sexual activity."
It's not always easy to talk about sex, but communicating with your partner is so important. Evans recommends finding the right environment for both of you to speak openly about how you feel and what might work in the bedroom.
"Try discussing what has changed within your relationship, what feels pleasurable, what feels uncomfortable or painful, where you'd like to be touched. Explore new sexual positions, new ways to enjoy intimacy including: sex without penetration, oral sex, sex toys, mutual masturbation, cuddling, kissing and massage."
Use the right lubricant
Having vaginal dryness and irritation leading to painful intercourse is a common complaint in women who have had cancer, particularly those taking hormone treatments. Evans says it's important to use a good sexual lubricant, especially if you are unable to use topical vaginal oestrogen products.
However not all lubes are created equal, she points out.
"It's really important to be aware of the ingredients of your lubricant, as many contain glycerin and glycol, even some available on prescription. This can lead to thrush, a common problem post-cancer treatment. And it is, of course, essential that you only use products designed for vaginal use."
Try a toy
Sex toys are not just a great way to explore new sexual sensations but can also help sexual health issues too. Yes, really.
"Many women often find it takes longer to orgasm, or they struggle with decreased sexual sensation. Using a simple bullet vibrator on your clitoris during foreplay or penetrative sex is a great idea or for solo pleasure too," explains Evans.
Vibrators could even help with vaginal tightness that some women experience as a result of treatment.
"Using a slim vibrator or vaginal dilators can help stretch the tissues of the vagina and improve flexibility and circulation."
Switch it up and get moving
"Fatigue is a big issue for people with cancer, so if you feel physically drained in the evening, try having morning sex or sex during the day. Even quickie sex can be fun and may reduce your fatigue. And although it might sound strange, by slowly increasing the amount of physical activity you do, you may have more energy for sex," says Evans.
Taking regular exercise, if you're able to, can help both physical and psychological side effects of treatment, which in turn, improves body image and boosts your mood.
Let's talk about sex
Evans acknowledges that the Breast Cancer Care survey results are disappointing, but believes a positive change is occurring around this issue. Many doctors and nurses are taking notice and want to help.
She points out that the Royal College of GPs, in collaboration with Macmillan Cancer Support, has developed a toolkit for managing the consequences of cancer treatment, including the sexual impact upon relationships.
"Over the years I have noticed more healthcare professionals get interested in getting advice about sex for their patients. We need to make talking about sex the norm, not the exception, during and following cancer treatment. No one should have to give up on their sex life and relationship after cancer," she concludes.