Navigating intimacy and sexual health after a cancer diagnosis

A cancer diagnosis is life-changing on many levels. It ushers in a whirlwind of questions, appointments and uncertainty, along with physical and emotional changes.

While it’s common to hear about side effects like fatigue, hair loss or nausea, what to expect with sexual health often remains unspoken. For people with cancer and their partners, this silence can lead to misunderstandings and isolation.

But intimacy and sexual health are essential parts of your overall well-being, and they deserve space in the conversation, too.

Joseph Mitrovich, PsyD, a clinical psychologist with MultiCare Cancer Institute, says it’s not uncommon to hear from patients who’ve experienced a disconnect in their intimate relationships while navigating their cancer diagnosis and treatment.

“Even though sexual health issues can be more prevalent with certain diagnoses, like breast cancer for women or prostate cancer for men, these challenges can occur with any type of cancer,” Dr. Mitrovich says.

Cancer’s physical impact on sexual health

Cancer treatment often changes how a person sees and feels about their body. Weight loss, surgical scars, hair loss, mastectomies, having an ostomy bag or other physical changes can affect self-image, confidence and connection with a partner, which can become obstacles to intimacy.

Symptoms women may experience include pain with penetration, vaginal dryness or early menopause, while men may face erectile dysfunction or loss of ejaculation.

Depending on the type of cancer, both men and women may experience pelvic floor pain, bowel and urinary dysfunction, as well as lymphedema (swelling caused by the buildup of lymph fluid) that can cause pain and discomfort.

Any of these symptoms — as well as body image issues — can cause arousal difficulties, loss of libido and low sexual self-esteem.

The communication barrier and its impact on intimacy

One of the biggest obstacles to intimacy after a cancer diagnosis is lack of communication between partners.

Often, one person may avoid intimacy altogether without explaining why, while the other is left feeling rejected or confused. Some may be uncertain about what is physically possible during or after treatment.

Either partner may internalize assumptions that become barriers to intimacy.

“I’ve had patients tell me things like, ‘I don’t feel attractive anymore’ or ‘My partner wouldn’t want to be with me because it’s gross that I have an ostomy bag,’” Dr. Mitrovich explains.

“Using evidence-based approaches like cognitive behavioral therapy, patients examine their beliefs about how their body has changed and how these beliefs affect their feelings and behaviors,” he says. “Often, they discover their assumptions don’t align with how their partner actually feels.”

Having an open, honest and nonjudgmental conversation with your partner or including them in a discussion with a counselor, if they’re open to it, can be powerful ways to break down this barrier.

“Many are surprised to hear that their partner had no idea they felt that way and still very much find them attractive,” Dr. Mitrovich adds.

Being intentional about intimacy can help

Before diagnosis, sex and intimacy may have felt more spontaneous or effortless. When dealing with illness and treatment side effects, however, it’s important to be deliberate with intimacy.

“I encourage couples to take an intentional approach to reconnecting,” Dr. Mitrovich says. “We talk about taking the focus off intercourse and discuss other types of intimacy. Maybe it starts with cuddling or holding hands.”

Rather than abandoning intimacy because it doesn’t look like it used to, treat it as a process of rediscovery. This broader approach to intimacy recognizes there’s an emotional component in addition to physical intimacy.

“Someone with cancer may feel pressure to appear stoic for their partner — they may put on a brave face and say they’re doing OK because they know their partner is worrying about them,” Dr. Mitrovich explains.

Meanwhile, the partner isn’t sure how to help and goes into cheerleader mode, offering upbeat encouragement.

“Although it’s well-intentioned, this is sometimes not consistent with what the patient is experiencing and feeling,” Dr. Mitrovich says. “When you have each side in those positions, an emotional disconnect takes place, which can affect sexual health and intimacy.”

Building on emotional intimacy by being transparent and authentic — sharing fears, hopes and vulnerabilities — can help pave the way to physical intimacy.

“When a couple starts feeling more emotionally connected, there’s a closeness that starts to be felt again that facilitates the physical aspect,” Dr. Mitrovich adds.

Medical resources for the physical challenges of cancer

Beyond emotional and communication work, medical interventions can address specific physical difficulties.

“Many patients don’t realize that medical solutions exist for their specific concerns, or they may be too embarrassed to ask,” Dr. Mitrovich says.

Men with erectile dysfunction, for instance, may benefit from medications or devices like a penile pump. Women experiencing vaginal dryness or pain may find relief through lubricants, dilators or pelvic floor physical therapy.

In addition, medications, injections or nerve blocks can help with pain, and certified lymphedema therapists can assist with symptom management.

Normalizing the conversation about intimacy after cancer

Sexual health and intimacy issues are deeply personal but also incredibly common, normal responses to cancer and its treatment. If you’re navigating these issues, know you’re not alone and help is available.

Start by discussing your concerns with your oncology team; they can refer you to specialists who can address your particular needs. While the conversation may feel awkward at first, remember that your team wants to support you and your quality of life.