A diagnosis of cancer may reveal tensions that have existed in a relationship for a long time. Often, the relationship was not satisfying before cancer entered the couples’ world. Many women who were interviewed or participated in our focus groups showed an emotional strength that surprised even them. Some women did not recognize they were changing until they did something that surprised them, such as dismissing an unsupportive partner. During her course of chemotherapy, Elizabeth told her partner, “You haven’t been supportive since I was diagnosed. What do I need you for now?” With that pronouncement, she showed him the door.
A feeling of mortality changes the sick partner’s perspective. A well-functioning couple rewrites the old rules, to allow the ill partner to explore opportunities outside the boundaries of life before cancer, opportunities that she feels were left unexplored before because of the trade-offs couples always make.
Edith is a breast cancer survivor who told her executive husband that she felt he did not support her enough. She then outlined what had to be done to get their marriage back on track. Edith's cancer experience prompted her to express key issues that had developed over many years of living together. She saw it as an opportunity to improve the relationship. Her husband agreed, and they made changes to their relationship to meet both parties’ needs.
"I’m Still Sexy!” or “Am I Still Sexy?”
Betty’s husband often tells her she is sexy. To which she replies, “I’m glad you think so.” But to her, his comment is just a confirmation of how she feels: “I don’t have the perfect body - but it’s the only one I’ve got, and it gives me and my husband a lot of pleasure. Am I still sexy? You bet! You don’t have to be a Victoria’s Secret model to be smokin’!”
Christine was asked what makes her feel sexy. She answered by explaining how her boyfriend evaluates her appearance each morning. “When he says that I look sexy, that’s one of my sexy days.” When asked a question about her subjective experience, about her knowledge of how she feels, she replies from a position as the object of her boyfriend’s judgment. That is, she sees herself as sexy if she is the object of male desire.
A confident woman in a sexually equal relationship enjoys better health, longevity, better bonding with her partner, and less stress. The benefits are even greater if she doesn’t rely only on her partner for affirmation that she is sexy, but relies on her own sense of attractiveness.
After cancer is treated or cured, a woman has an opportunity to reflect on what she has done up to that point in her life, dreams that have been realized, dreams that have been forgotten or pushed to the side, choices that have been made, and her degree of fulfillment. Her relationship with her partner is part of these thoughts, and sex is a key ingredient of the relationship.
Intimacy and sexuality sit at the tip of an iceberg with a massive foundation. The base consists of knowing and feeling good about oneself, living in a loving environment, having a sense of humor, and introducing a creative flavor to her activities and sex. Many women with cancer see themselves on a path to self-renewal, moving forward toward a new and better version of themselves.
We have found women who truly discovered themselves only after they went through cancer treatment. After a life-changing event, some people live much as they did before. Some make small adjustments, and some make dramatic changes. Every woman decides for herself how far she wants to go in making changes.
Many women have demonstrated a unifying philosophy that speaks of revitalization in the New Woman phase of their lives. Denise speaks of the support she received during her breast cancer experience. Filled with emotion and appreciation, and endowed with a capacity for going beyond her former executive self, she started the SOS breast cancer support program for women in a number of cities in central Maryland. With the same ingenuity and dedication she had applied to her responsibilities as an executive, she developed a successful program for women with breast cancer. Like Denise, a large percentage of women with cancer demonstrate their capacity for self-renewal.
If you are in a relationship, the self-renewal may extend to your partner. The changes brought about by cancer prompt many couples to reinvigorate their relationship and their sex life. This process takes time and is both scary and exciting. Something may have been lost: the familiar way you have made love for months, years, or even decades. Yet something very precious may be gained: greater closeness and intimacy, a rediscovery of each other, and a deeply satisfying sexual relationship.
Chapter 2
Cancer and Female Sexual Function
In light of the changes induced by cancer therapy, many women are not sure whether their sexual difficulties are due to the procedures they have had or to something else. Understanding the normal sexual response cycle, the possible changes caused by cancer therapy, and common female sexual disorders, can help in renewing their intimacy.
The Woman’s Sexual Response Cycle
During our numerous individual and group interviews, many women indicated their lack of knowledge concerning the woman’s sexual response cycle. They did not know what was happening or should happen during a sexual encounter.
In talking about sexual problems, many women said that they missed having any desire for sex since their chemotherapy. A number of women also said that they had never had an orgasm, or were not sure whether they had ever had an orgasm. And now they fear that the cancer treatment will prevent them from ever having one. They are concerned and anxious about having cancer, and the fear of adverse consequences relative to their sexuality makes them even more apprehensive.
Ever since the work of Masters and Johnson, researchers have talked about sexual activity as consisting of four sequential phases. Desire, arousal, orgasm, and satisfaction (sometimes called resolution) are considered to constitute the female sexual response cycle.
Many women worry that when they do not feel sexual desire, they will not be a good sexual partner and will not experience personal pleasure. They believe that desire is the window to having and enjoying sex. However, in 2000, Dr. Rosemary Basson showed that arousal can come before desire or afterwards. In other words, arousal can prompt desire.
Results of studies show that for many women, the genitalia respond to sexual stimuli, even though their minds seem to be “stuck in neutral.” This explains why a woman with cancer may feel no desire, yet her body is responding.
It may alleviate some women’s anxiety on this issue to know that the mind and the body can play different tunes where sexuality is concerned. Good loving takes time, because the woman needs to be brought to a point of sexual receptivity and arousal. As a woman gets older, or experiences sexual effects of cancer treatment, she may need more foreplay to come to a point where she desires sex and is aroused. Many of the physiological effects of arousal, such as feeling warm and sensing some stirring in the genitals, are the same sensations a woman has during desire.
As she goes through the normal sexual cycle, a woman experiences physical changes in her breasts and genitals. During the arousal phase, and sometimes when she feels desire, her nipples are likely to swell, and she may feel some wetness and enlargement of the vagina, preparing her for intercourse. Her heart rate increases because more blood is pumping to certain areas of her body, especially her pelvic area. She may feel flushed as more blood is pumping to her face.
During the height of the arousal phase and before orgasm, a woman reaches a plateau. According to Masters and Johnson, the feelings that occur during excitement and arousal reach their peak in the plateau phase. The woman feels more sensitivity in her genital area. Her heart rate increases and the clitoris becomes engorged, ready for further stimulation so that she can reach orgasm.
Orgasm is the culmination of excitement. At this time, the woman often experiences contractions of the muscles in the pelvic area, especially the vaginal and rectal sphincter areas. Her muscles go into a recurring series of contractions, sometimes leading to a spasm in other muscles in her body.
The last phase, now named satisfaction, is the release. This is complete