Thousands of people in America every year confront a life-threatening illness and survive. What follows for them is a physical and emotional roller coaster of treatment and coping.
Often, the most difficult adjustment involves sexual activities. An important first step back to a rewarding sexual relationship involves the patient’s communication with his or her partner, doctors and nurses, said Mark Wolever, PhD, a clinical psychologist associated with the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, NC.
And that’s not always easy: Because Americans often have trouble discussing sexual issues, or perhaps because patients feel they should be happy just to be alive, they often don’t seek out professionals who could help them overcome their concerns and rediscover their wholeness.
“The people who are most successful are those who have a purpose in their life, whether it’s their job, their family or their spirituality,” Wolever said. They see the disease as a part of who they are. They don’t let it consume them.”
Bostwick’s Challenging Journey
Barry Bostwick, an actor who stars as Mayor Randall Winston on the ABC-TV sitcom, “Spin City,” began a journey that brought him head-on with such challenges in June 1997, when he was diagnosed with prostate cancer. He told TV Guide magazine that his initial reaction was a shocked “feeling of unreality” followed by a very difficult question: “What are my options?”
He chose a radical prostectomy, which involves the surgical removal of the prostate and surrounding lymph and seminal-fluid glands. Post-surgical tests brought good news: the cancer had not spread.
Nonetheless, dealing with the physical and psychological effects of the diagnosis and treatment, including sterility and partial loss of sexual function, has not been easy for Bostwick. In fact, “the most difficult hurdle was the sexual part,” said his wife, Sherri Ellen Bostwick. “But this has brought us closer together.”
Bostwick was told to expect a loss of about 20 percent of his sexual function following surgery. He believes that time, and his loving and supportive partner, will help him develop new ways to be intimate.
“Shock, anger and denial are oftentimes the early knee-jerk reactions to diagnosis,” Wolever said. “And, I might add, these are reasonable responses. For perhaps the first time, a person has to face his or her mortality.”
Anxiety, stress and uncertainty can accompany the next phase, which includes endless batteries of tests to determine the extent of the problem and sorting through information about the various-and sometimes conflicting- treatment options. Once a plan of action is established, Wolever said, patients become more oriented on the physical, focusing their energies on treatment and recovery.
Following treatment, “the biggest obstacle is the acceptance of what has taken place and a degree of uncertainty that goes along with it,” Wolever said. Each step of the way, physical, emotional and psychological issues can interfere with a patient’s ability to live fully, including having an active sex life.
For example, Wolever said, women who have been diagnosed with breast cancer often express a “fear of mutilation” early in the process. “As folks learn about the various procedures, they see some of their worst fears may not come to fruition,” he said.
Developing A Positive Self-Image
A woman’s body image and self-esteem, as well as frank discussions with a reconstructive surgeon early on, can help her develop a more positive approach to treatment. It also helps to have a partner who they are confident will remain with them no matter the results, Wolever said.
The same holds true for men who may feel as they are “less than a man” following removal a prostate, or people with AIDS who some may feel they are “damaged goods” or a threat their partner.
Likewise, persons who have suffered heart attacks are often fearful of resuming activities, including sex, because they think (often incorrectly) that exertion will bring on another attack and kill them.
The Y-ME National Breast Cancer Organization encourages this thinking in its publication For Single Women With Breast Cancer: “Some of your apprehensions about dating and sex may begin with feelings about your body – including any feelings you may have of anger and disgust. Reclaim your body by recognizing that having breast cancer is just a part of who you are. You are a lot more than breast cancer, and you are a lot more than the breast or breasts you may have lost.”
Sometimes, though, a person can become clinically depressed and in need of counseling and/or medication. Depression can cause a person to feel hopeless and unable to appreciate pleasurable activities, which can result in a diminished libido.
Also, the very treatments that help keep a person alive can cause physical impediments to a healthy sex life. Help is often available for these problems if a patient is open to discussing them with his or her physician.
For example, some blood pressure medications prescribed for heart disease can induce impotence in men. And while new triple-drug therapies are helping many people with AIDS, one patient wrote to POZ magazine that “the pharmacopoeia of pills that has leased health and hope to many … can sometimes wreak havoc with lovemaking.”
In these cases, testosterone supplements sometimes can help re-ignite sexual desire, said Mary Romeyn, MD, a San Francisco AIDS specialist. Testosterone is prescribed for persons with AIDS who are deficient in the hormone primarily to increase lean muscle mass and offset the effects of wasting. But it also has the additional effect of improving sex drive in many patients.
Women who undergo radiation treatment for breast cancer often find their breasts are sore – a condition that is usually temporary. If they had one or both breasts removed or reconstructed, Y-ME suggests that they “may have to adjust to the loss of the role the breast(s) or nipple(s) had in sexual arousal or response.”
Also, Y-ME notes that premature menopause caused by chemotherapy or hormonal therapy brings the same changes that come with menopause, including loss of desire and vaginal pain. Ointments and lubricants can moisten the vaginal lining and reduce discomfort while testosterone could help improve sexual desire for women who are deficient in the hormone.
Life Is Different … Not Bad
A key factor in re-igniting a sex life following a potentially fatal illness is recognizing that while life is different, it doesn’t have to be bad. Until full sexual drive returns, touching, cuddling, massaging and even talking can be rich experiences. Of course, even if an individual is lacking in desire, he or she can always help satisfy their partner by helping them masturbate, for example, as long as they don’t feel pressured.
“You have to be receptive to the idea that sexual pleasure can take many shapes,” Wolever said. “It doesn’t necessarily have to be reached through orgasm.” The bottom line is to acknowledge the situation and keep the pilot light burning so the flame can re-ignite when the time is right.
Romeyn put it this way: “If you cant get your penis to work, there are still plenty of other ways to make love. We all need loving and touching, and you don’t need a member that stands on command in order to have a rich and powerful sex life.”
Actor Barry Bostwick will call on the love and support of his wife to overcome his bout with illness.
After an illness, acknowledge the situation but keep the flame burning to re-ignite your sex life.