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Prioritizing Your Sexual Health During Cancer

Waiting to feel like "yourself" isn't a solution; take charge of your need to be intimate.

“A woman’s health is her capital.”

– Harriet Beecher Stowe

Sexuality and intimacy are important factors for quality of life and discussing sexual health should become a routine part of conversations you have with your cancer care team before, during, and especially after cancer treatment. During the tumultuous early days and weeks after your diagnosis, your mind may not have been able to focus on anything except your cancer. You may have very few sexual feelings because many people are more concerned about the future than about having sex. In some cases, surgery or treatment is scheduled very quickly after a diagnosis. In other cases you may receive neoadjuvant chemotherapy prior to surgery.

“Bodies are not only biological phenomena but also complex social creations onto which meanings have been variously composed and imposed according to time and space.” Katrina Karkazis, Fixing Sex: Intersex, Medical Authority, and Lived Experience

While you address how you feel about sex and intimacy and before you do something about it, there are some things to remember while you are ON treatment regarding sexual activity.

Your comfort levels matter. Sexual activity is fine during treatment if you feel comfortable with it. Cancer treatment can affect your desire for intimacy, arousal, desire and satisfaction. It can also be incredibly tiring and stressful and you may not feel up to sexual activity in the same ways as you did before treatment. You may or may not want sexual intercourse but hugging, caressing, holding hands, and massages may feel good and serve as a stepping stone towards building back your sexual desire. It may be hard but open and honest communication with your partner is key. If you had surgery involving the pelvic area you may need to allow extra time for healing before having sex that involves vaginal or rectal penetration (with penis, fingers or vibrators).

Take sensible precautions. If you are being treated for oral cancer, be careful during oral sex. If you have mouth sores, avoid oral sex. Do not have vaginal intercourse if you have open sores on the genitals or in the vagina. Do not have anal sex if you have sores in the rectal area, rectal bleeding, or tears in the rectal tissue.

Take extra care while on chemotherapy. Chemotherapy can be excreted in saliva and vaginal secretions for 48-72 hours after a treatment. You should use a condom for oral sex or intercourse (vaginal or anal) during this period to prevent your partner from being exposed to chemotherapy. (this includes IV and oral chemotherapy). Be sure to ask your oncologist if the chemotherapy you are getting affects getting or being pregnant. It is important to use a safe and dependable form of birth control to prevent pregnancy while or even after treatment has ended for a specified period of time. Saliva can contain chemotherapy for 48-72 hours after treatment, you should avoid open-mouth kissing during this time as this can expose your partner to chemotherapy.

Ask about your blood work. If you have a low white blood cell count or low platelet count (platelets below 50,000), you will need to pause for a while from vaginal, anal, or oral sex till your blood counts normalize or are safe. This is because there is an increased risk of infection or bleeding when your counts are low.

Be aware of fertility-related issues during treatment. Fertility is directly affected by surgery that involves removal of the reproductive organs. Certain types of chemotherapy and radiation to the abdomen and pelvis also affect your fertility. How cancer treatment affects your fertility depends on many things, including the type of treatment you receive, your age, your other health issues and your current fertility status. You may be temporarily infertile due to treatment or there might be issues resulting in permanent infertility.

Your cancer care team will usually advise you to abstain or use a reliable form of birth control while you are receiving cancer treatment. You also shouldn’t try to conceive within six months of finishing chemotherapy because it may increase the chances of miscarriage or having a baby with a genetic complication. Trying to figure out when it is appropriate to conceive (become pregnant) is a discussion that you must have with your cancer care team because it can be impacted by the type and stage of cancer you have. You will need sufficient time to rule out any chance of early recurrence and recover from the effects of treatment before you may truly feel comfortable getting pregnant.

Considering how treatment options have improved and the high survival rate of patients with cancer it is important that you advocate for your sexual health and make it a part of your conversations on a routine basis. The next blog will discuss products and solutions that can make a significant contribution to improving your approach to intimacy, desire and sexual health.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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