February is a month with a focus on love. If you've read any of my previous posts, you know I like to dream of the days when folks who have experienced cancer get more of the information and services they need and want, to have the best quality of life possible. While I hope for each of you that every month has lots of love, this month in keeping with the theme of February, my blog focuses on body image, sensuality, sexuality and LOVE.
L libido, loss
O observation, openness
V vaginal health, voicing your needs
E encouragement, exploration, empowerment
L (libido, loss)
Cancer changes lots of things in life and no matter what kind of cancer you experience there are changes to the body! Many experience a sense of betrayal by their body or a sense of being broken. A definite sense of loss. You may have significant physical changes from surgeries and visible scars, or you may have “unseen" changes due to radiation treatment or aggressive chemotherapy. Loss of libido is experienced by most and may be due to hormonal alterations, fatigue, pain and your mood state or physiological state. So, let's talk about it! Let's start the discussion and provide resources. Let’s acknowledge that when you don’t feel good about your body it is difficult to feel sensual and sexual. Libido or your sexual desire can be impacted by lots of things including some of your medications. For women, the libido is also intricately interwoven with her brain and her thinking. While for many, this is not anything to even think about during treatment, after treatment body image changes, loss of one’s sense of sensuality and sexuality can be huge.
O (observation, openness)
Many look at their bodies and experience a whole range of emotions. Can you acknowledge what you feel? How did you feel about your body before cancer? Negative body image is unfortunately very common in our culture as it seems we are often surrounded by bodies far more “perfect”. Now add scars, hormonal changes and weight gain or weight loss, as well as feeling traumatized by the changes cancer and cancer treatment bring! How might you move toward accepting and loving your body? What are your thoughts about beauty? Can you acknowledge your beauty?
Openness There is a lot of struggle and sometimes a lot of shame talking about sensuality and sexuality. For health care providers, there may be a sense of lack of time, lack of comfort and lack of knowledge in regards to sensuality and sexuality issues patients may experience. There are no clear guidelines as to what to say or do. I encourage you to be open with your patients. Let them know that cancer and the treatments can impact ones’ sense of their body image and sensuality as well as sexuality. That intimate relationships may require a new level of care and conversation. Many, if not most of your patients think these conversations are important. If your time, or comfort level or knowledge, or age or gender seem to get in the way of this conversation consider other resources available at your center or from the internet.
For people who have experienced cancer, and perhaps their partners, there is benefit to open communication about both the physical challenges (for example vaginal changes brought about by early menopause and chemotherapy, sexual performance changes after radiation or surgery) and openness to the idea that you may benefit from learning about sex and pleasure, and pleasuring all over again. While most would not want to return to those early awkward teenage days of changing bodies and navigating body responses and body responsiveness, there is benefit from starting from a place of not knowing but acknowledging you aspire to be a communicative lover. Remember when just kissing was quite the erotic experience? I am so thankful to the young adult cancer community for putting a bit more focus, demand and urgency on this topic and on greater openness in discussing sensuality and sexuality concerns. Big thanks go to Aniela McGuiness and Nora McMahon of @Cancergrad (cancergrad. org) to opening this discussion on their Facebook page this month and including a special edition for men (Feeling NUTS? Cancer from the Male Perspective, aballsysenseoftumor.com). I know every year at the Stupid Cancer Conference, Cancer Con (stupidcancer.org), the sessions on sexuality for the women and the men are packed. Fact is people of all ages enjoy their sexuality. Let’s give thanks to young cancer thrivers for really getting the discussion going!
V (vaginal health, voicing your needs)
There is so very much to say! How many of you let your patients know, or if you are a patient heard from your doctor, that during chemotherapy you might experience menopausal symptoms so let’s talk about what you might do? I have given many conference workshop sessions on sexuality and when talking with women always start with vaginal health. Hoping to create some ease, I would often start with a check in to see how many women were “educated” about the need to take care of their facial skin, you know moisturize??? Vaginal health is so important for all women! As women reach menopause they may be given information. Women who have experienced cancer often experience early menopause or surgically induced menopause. Let’s start the conversation proactively! The topic of vaginal health and vaginal changes include comfort with discussing the benefits of moisturization, lubrication, and for many due to structural changes to the vagina, dilation. Provide resources and educational materials about useful products and the differences for women who may have cancers that are okay to use hormone replacement or products and those that are cancers to avoid these products. Let folks know that they may notice increasing difficulties with time out from treatment. Many people may wait for their doctor to bring up these issues thinking they will if they are important. Or they may be reluctant to discuss these personal matters because of age differences or gender differences. I hope for the day when the discussion doesn’t start only because the woman is already experiencing pain with intercourse or pain due to vaginal atrophy and dryness, or the side effects of radiation and loss of sexual functioning present a devastating reality for a man. I hope for the day for all women and men who have been treated for cancer not to think they are alone with their worries about sensuality and sexuality.
E (encouragement, exploration, empowerment)
So much of what has been mentioned can be really difficult, and perhaps disappointing, and perhaps one more reminder of what cancer has done to your body, to your life. Encouragement is needed! Encouragement helps. Persistence and problem solving benefit from encouragement! I hope you can find it from your health care team and your cancer community. It might be a referral to a sex therapist, urogynecologist or a physical therapist that specializes in women’s health and rehabilitation. Exploring your sensuality may be through movement and dance, a specialized workshop, nature, new clothes, getting physically stronger, treating yourself for a very romantic date or taking time to remember and remind yourself that at your core you are a beautiful being. Exploration may include taking the time to learn what pleasures you or finding out about products that can enhance your sex life. Empowerment may include giving resources to the folks you see in your practice. Empowerment is knowing that it is 100% okay to ask and expect resources to address your needs for sensual and sexual healing.
Open your heart, fling your hopes high and set your dreams aloft. I am here to hold your hand.
- Maya Angelou
So, here’s where I need your help! I am going to follow a dream that I have been having for years and want your input. I would like to design a small, laminated card for oncology professionals to “start the conversation” and perhaps a checklist of common questions or concerns. Please send me your thoughts, your comments, what you want your doctor to ask, or if you are a health care professional what has been helpful in your practice. I would love for these cards to be available at oncology conferences and perhaps even for you to bring to your oncology team! I'm hoping to hand these out for free at an upcoming conference in May.
Thanks and gratitude for your insights and wisdom.