Coping with the sexuality effects of tr…


Coping with the sexuality effects of treatment: An interview with a social worker

Oct. 23, 2017 | by Dr. Both Sides

Sexuality is something we have to talk about in cancer care. It’s become clear that cultural and gender barriers mean women are not getting the help they need to address this silent problem, which affects up to 85 per cent of them both during and after cancer treatment.

So I decided to connect specialists on a Q & A blog with questions you always wanted to ask, but barriers have prevented the conversation.

Wellbeing in sexuality is important when it comes to confidence, going back to work, relationship stress, caregiver fatigue, depression, anxiety and more.

This is why I’m here.

We know that most patients will experience some change in their body image and sexual function because of their cancer treatments, but only 10 per cent of patients will raise sexual concerns with their Health Care Provider.

Only two per cent of Health Care Providers regularly speak to patients about sexuality - even though 96 per cent believe it is part of their job.

Patients and partners can experience feelings of isolation, anxiety, depression, inadequacy, distress, poorer quality of life, or a sense of emotional distance from their partner if sexual intimacy within the couple’s relationship diminishes after cancer treatments.

The sexuality effects of cancer treatment and beyond in women are today’s topic in this Q & A with Lisa Roelfsema, MSW, RSW, social worker at Trillium Health Partners with the Mississauga Halton/Central West Regional Cancer Centre.


1. How can we deal with these barriers? Does a column like this help those who are less likely to voice their concerns or embarrassed at their cancer visits?

It may help to deal with these barriers by knowing that you are not alone.

Most women struggle with the changes that cancer brings to their body image and their sexual function. A column like this helps to validate that you are not alone.

If your health care provider does not bring it up at your visit, it does not mean that it’s not an important part of your care.

Sexuality is an important part of who we are as women and we have a right to ask questions about what we can do to have wellness in this area.


2. What percentage of patients experience distress from their change in body image and sexuality?

What we know is that almost all patients will experience some changes in how they feel about their bodies and how they function sexually.

For most women, they have very little interest or desire after cancer treatments.

A lot of women are put into early menopause and experience sudden and intense side effects.


3. What are some of the suggestions you have to re-establish self-confidence and closer relationships during cancer treatment and beyond?

Going through cancer treatments is challenging and we can sometimes find ourselves overwhelmed by our thoughts:

“Am I ever going to feel normal again?”

“Will my partner still find me attractive or desirable?”

“If I don’t have a partner, will someone want me with the changes that cancer brought?

One step toward creating change for yourself involves being aware of your thoughts and asking yourself whether your thoughts are helpful, or if you could consider a different thought that might be more helpful.

For example it might be more helpful to think, “I may not feel like I did before, but there’s a lot of me that hasn’t changed and I could still find ways to enjoy the body that I have.”

The good news is that feeling confident about yourself as woman or sexual partner is something that starts with you. There are things that you can do to put yourself in a mindful place of enjoying intimacy.

What makes you feel confident or sexy?

Is it wearing something that only you and your partner will see?

Do you put your make up on in a particular way?

Wear a particular perfume or play certain music in anticipation of creating intimacy with your partner or just yourself?

Consider attending a Look Good Feel Better Workshop to connect with other women, learn makeup techniques and build confidence in yourself.


4. Is it common after cancer treatments to avoid contact by your partner?  Do some partners have a problem accepting the changes?

If you are in a relationship, you may have a partner who understands that you will need some time before you’re ready to resume sexual pleasure.

Because the person who has had the cancer is experiencing so many changes, they sometimes begin to think that their partner may not find them as desirable as they did in the past.

As more time passes, it sometimes is hard for couples to figure out when or how to reconnect. For most of us, how we enjoy sexual pleasure isn’t something we talk about, we just do what we enjoy.

After cancer treatments, not only are you dealing with the changes that cancer brings, you also have to find words to talk about something that you haven’t really talked about before.

For a lot of women, it seems to be harder for them to accept the changes and easier for their partners.


5. Do all these problems require a counsellor?  What can the patient do to help themselves through this difficult time?

According to the PLISSIT model (see image), only a small per cent of people experiencing problems with their sexual function and intimacy after cancer treatments will require Intensive Therapy or a higher level of intervention.

Most people will benefit from being given permission to discuss their concerns, receiving limited information or education and being provided with specific suggestions for their problems.

You can help yourself by giving yourself permission to bring up your concerns or asking your questions.

Join a support group either in person or online and ask your questions. There is a very high probability that someone else will have the same concerns.

Keep in mind that most patients have very little desire for sex after cancer treatments, but sometimes our appetite grows as we eat.

When it comes to eating, you may not feel hungry for food but when you see and eat food, you may realize that you were hungrier than you thought.

Our sexual appetites are similar in that we often don’t start with interest or desire. However, if we’ve had some good experiences in the past and we leave ourselves open for enjoying pleasure, we may find ourselves willing to start engaging or to respond to our partner.

As we do so, we may find that our appetites build, we may be more interested than we thought and we may have some good intimacy and pleasure as a result.

Talk to your health care team at the cancer centre or your family doctor.

Access trusted online resources like the Canadian Cancer Society, the deSouza Institute for online support groups or Wellspring, which offer a number of programs to promote wellness and healing after cancer treatments.


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Dr. Both Sides

Dr. Both Sides Connects

At 47, I was diagnosed with simultaneous bilateral invasive breast cancers. My world as a busy mum and doctor was in a tailspin as I underwent bilateral mastecomies, reconstruction, node sampling then axillary dissection, chemo then hysterectomy after significant BRCA mutation results. I then helped family members through BRCA testing and the difficult decisions. I am so grateful to be back at work, able to help people through the emotional side that comes with cancer - from Both Sides.