Intimacy & Sexual Dysfunction with Cancer & Illness

I'm pleased to introduce Jen Fecher, Director of Educational Services at Reclaiming Intimacy, to share this important information about intimacy and sexual dysfunction for people with cancer and/or other forms of chronic illness. Jen has worked in the education field for over sixteen years, with most of that time focusing on adult sexual education, sexual dysfunction, & intimacy issues. A wife, mother, educator, entrepreneur, author, and a chronically ill human, Jen has first-hand perspective on the issues many people are facing.

Enter Jen:

Facing Intimacy & Sexual Dysfunction with Cancer & Illness

As if the diagnosis of cancer and immediate life and body changes were not enough, the realization that sexual dysfunction has now stolen their ability to resume their routine intimacy and sexual activity regimen is often the end-all for ‘returning to normal life.’

Sexual health is often left out of the care plan as simply staying alive becomes the main focus.

We often find ourselves asking, “is it really living if one is not encompassing every aspect of living a full, whole life?” Intimacy and sexuality are vital parts of the human existence, and life. Ignoring these needs, desires, or wants, only leads to patients hiding their true needs, or altering their needs because they are being told that intimacy or sexual acts will not be possible again.

This is a huge mistruth! There are many, many options for reclaiming one’s intimacy and sexual abilities & needs!

Intimacy and Sex is Possible Again

At Reclaiming Intimacy, we work to break the taboo of discussing intimacy and sexuality in the medical community, and strive to provide patients holistic options, therapies, and resources to help them to reconnect with themselves, their bodies, and within their relationships, while also acting as a resource for medical professionals.

Both men and women face varying issues with sexual dysfunction throughout their lives. Some of the most common female-centered issues are vaginal atrophy, vaginal pain, and extreme dryness. For males, those common issues are erectile dysfunction, loss of ability, and painful intercourse. Many people also face loss of libido, lack of desire, the inability to orgasm (or anorgasmia), incontinence, and relationship disconnect, and pain with intercourse or any sexual acts.

“Studies suggest that sexual dysfunction is one of the most common and distressing consequences of treatment, affecting between 50-90% of adult survivors, depending on type of treatment.” Dana-Farber Cancer Institute

Sexual Dysfunction

The basic definition of sexual dysfunction states that anything that hinders a person from reaching a level of pleasure from stimulation, or sexual stimulation, qualifies as ‘sexual dysfunction.’ There are many levels of sexual dysfunction.

Temporary Sexual Dysfunction

Some people face temporary bouts of dysfunction through natural changes in life like aging or natural body decline. This may mean that a man suffers from slight erectile dysfunction occasionally or has instances with sexual activity where he cannot achieve an erection, that is resolved by using an erection support ring. For a female, this could mean having occasional vaginal pain upon insertion, that is relieved or lessened by using lubrication.

Moderate Sexual Dysfunction

Moderate sexual dysfunction typically occurs sidelined to another issue, like medication. This type of dysfunction may cease once treatment has come to an end. For instance, someone who is taking medication for diabetes, cancer, blood pressure, heart disease, anxiety, or depression might see side effects that impact their sexual ability in various ways. These effects may continue until the medications are stopped and out of the bloodstream.

Severe or Complete Sexual Dysfunction

Severe complete sexual dysfunction often plagues those who have faced chemotherapy, radiation, or had a surgical intervention that involved the pelvis or genitalia. For many, this type of dysfunction is often considered to be on a more “permanent” basis, due to surgical intervention, medications, or a myriad of other reasons.

Regardless of the type of dysfunction one might be facing, there are a multitude of options in each category that can be investigated and tried before routing to yet another surgical option. There are numerous at-home therapies that can be done to help one to restore their lost sexual function. Pairing these holistic options with the invaluable information that physical therapists can give for pelvic floor therapy, is often the fastest route back to function and enjoying sexual activities once again.

“The prevalence of dyspareunia varies from 3 to 18% worldwide, and it can affect 10 to 28% of the population in a lifetime” (NCBI, 2022).

Pain with Sexual Activity

Another of the most reported issues for people in regard to sexual activity is pain. This type of pain, dyspareunia, can affect males and females and has no age requirement or limit. Although it is most predominated in females. This pain can also occur before, during, or after the act.

There are several different conditions, diseases, medical ailments, and cancers that have been linked to increased pain with any sexual activity. Some of those common physical causes could be:

• Vaginal atrophy for females
• Skin disorders
• Infections like a yeast or urinary tract infection
• Injury or trauma from childbirth
• Endometriosis
• Vaginismus
• Cystitis
• Irritable Bowel Syndrome
• Chemotherapy
• Radiation

Aside from the physical setbacks or pain triggers, there are also numerous life circumstances that can also cause, or worsen, overall pain with sexual activity.

• Stress
• Feelings: guilt, shame, fear
• Self-Image and Body Image issues
• Medications
• Relationship Disconnect
• History of abuse
• History of rape or sexual violence
• Conditions like cancer, arthritis, diabetes, and thyroid disorders

The symptoms of pelvic pain are often easy to distinguish, and it is best to keep a journal of when you are experiencing these issues and what acts were taking place. This journal can then be taken to your medical appointments to discuss with your doctor or physical therapist.

Watch for these symptoms and check in with your doctor if you are experiencing them.

• Pain in the vagina, penis, urethra, or bladder
• During penetration, or the act of insertion
• During or after intercourse
• Deep within the pelvis during or after intercourse
• Pain that begins after a pain-free round of intercourse
• Pain that only arises with specific partners, or under certain circumstances
• With use of tampons or menstruation cups
• Pain that is accompanied by any burning, itching, or aching
• Pain with stabbing sensations

Diagnosing pain in the pelvis or with sexual acts is not very complex, or rough. With a basic check-up with history, your doctor can help you to determine what might be the cause, or worsening trigger, for your pain. An internal exam may be done for both men and women to better help your doctor determine exact pinpoints of pain. Other tests that may be performed are an ultrasound, bacteria cultures to check for infection, urine test, allergy test, or a referral to a counselor to help to work through any mental blocks or traumas that may be happening.

Other Types of Pain During Sexual Activities

• Positional Pain. This is a pain that can be triggered by being in a sexual position that causes pain or strain to certain parts of the body. There are hundreds of positions that could be attempted with sexual acts, so finding the positions that suit you best is always important. If you are struggling with positioning during your sexual acts, look in to finding a positioner (a piece of furniture designed to ease the stress on the body during sexual acts) and trying it out.

• Inflammation in the Abdomen. For those people who are struggling with GI issues, abdominal or intestinal inflammation, or generalized swelling, this can make intimate acts especially tricky and complicated. Certain positions and deep penetration may be a hard NO for these patients, and their partners should be made aware of their needs before any acts begin.

Options for Treatment with Pain during Sexual Acts

There are numerous options for those struggling with pain. Depending on your situation, one of these options may be addressed by your doctor:

• Sensory massage. By doing regular, gentle massage around the areas that bring pain, this can help to slowly reduce the impact of touch, and thusly the pain that accompanies that type of touch. One can also use items to help the body learn and get use to different types of sensations. This could be feathers, cold metal, soft cotton, Velcro, or anything with a specific texture.
• Dilator therapy. This therapy is done using dilators with lubrication to help to open tightened vaginal walls and muscles, while helping to restore natural function. There are numerous types of dilators on the market and finding the best set for your needs is a must. Sexual wellness experts, gynecologists, and physical therapists are often the best resource for finding the best device for use.
• Pump therapy. Males practicing pump therapy are working towards rebuilding their natural erection potential and function. By using penis pumps to help draw blood in to the penis shaft, over time and regular use helps the cells to remember who they are, and how they are supposed to tightly hold blood to help create that hard erection. For males who have had radiation to their pelvic region, they face a long, tough battle in reawakening those damaged nerves to reach a partial erection. There are also numerous devices to help these men be able to have penetrative sex acts even when they cannot achieve or maintain an erection.
• Pelvic Floor Therapy. For men or women, this therapy is invaluable in helping to restore sexual function, leaving the body aches and pains behind. An at-home solution you can use alongside pelvic floor PT is Overcome Pelvic Pain. 

Things to Consider and Remember

There are many things to consider if you or your partner is struggling with sexual dysfunction issues or pain with those attempted sexual acts.

• Consider pelvic floor therapy if you are struggling with sexual dysfunction, pain in or around the body (especially around the abdomen, back, and midsection), or if you are having issues with incontinence. Reach out to a Doctor of Physical Therapy to ensure the best possible care and treatment plan. Pelvic floor therapy is a wonderful therapy to know and practice regularly throughout your life.
• Before jumping in to any prescription or surgical interventions to help resolve or better your sexual dysfunction issues, first look in to all of your holistic options. These holistic options involve using medical devices designed to help restore this lost function. Reclaiming Intimacy offers these medical devices, and more, that have the potential to be covered by your medical insurance plan. Many people are able to utilize these therapies with simple devices to fully restore their normal sexual function and abilities.
• Consider Sex Therapy. When matched with an AASECT-certified therapist or counselor, they can help you to better understand yourself, and how intimacy best works for your needs. They can also help you to work through any mental blocks that might be hindering your ability to enjoy pleasure as a whole.
• Remember that physical therapy can help you to learn how to relax tight, stiff muscles even in the pelvic region. Need an at-home solution? Consider Dr. Bri's online course, Overcome Pelvic Pain. 

If you or your partner are struggling with sexual dysfunction, pain with intercourse or sexual acts, or are just generally seeking assistance or options for overcoming these issues, do not hesitate to reach out to Reclaiming Intimacy, your physical therapist, or your doctor for more guidance and direction. 

 Article Summary: Intimacy and sexual wellness are vital parts of living a whole, full life. Human need dictates that we all need these things to thrive and feel happy. Unfortunately, sexual dysfunction is often at the forefront for stealing people’s sexual ability and general desire for intimacy when it comes to cancer, survivorship, and for those facing long-term illness. Learn your options to overcome sexual dysfunction and pain with intimacy issues by empowering yourself with information from Reclaiming Intimacy!