Cancer, self image and sexuality

Each of us has a mental picture of how we look, our "self-image." Although we may not always like how we look, we're often used to our self-image and accept it. But cancer and its treatment can change how you look and feel about yourself. Know you aren't alone in how you feel. Many others have similar feelings.

Some body changes are short-term while others will last forever. Either way, your looks may be a big concern during or after treatment. Every person changes in different ways. Some changes will be noticeable to other people, but some only you will notice. Regardless, you may need time to adjust.

Some issues you may face include:

• Hair loss or skin changes
• Scars or changes in the way you look caused by surgery
• Weight changes
• Loss of limbs
• Loss of fertility, which means it can be hard to get pregnant or father a child

Even if others can't see them, your body changes may trouble you. Feelings of anger and grief about changes in your body are natural. Feeling bad about your body can also lower your sex drive. This loss may make you feel even worse.

Changes in the way you look can also be hard for your loved ones, which in turn, can be hard on you. For example, parents and grandparents often worry about how they look to a child or grandchild. They fear that changes in their appearance may scare the child or get in the way of their staying close.

Coping with body changes

How do you cope with body changes?

• Mourn your losses and know it's okay to feel sad, angry and frustrated. Your feelings are real, and you have a right to grieve.
• If your skin has changed from radiation, ask your doctor about ways you can care for it.
• If you're wearing a wig, you can take it to a hairdresser to have it shaped and styled.
• If you choose to wear a breast form (prosthesis), get help having it fitted. Also, check your health insurance to see what costs are covered.

Gundersen's American Cancer Society patient navigator may be able to provide you with helpful resources to deal with many of these changes, such as getting a wig and/or breast form.

Coping with these changes can be hard. But, over time, most people learn to adjust to them and move forward. If you need to, ask your doctor to suggest a counselor who you can talk with about your feelings.

Staying active

Many people find that staying active can help their self-image. Some things you can try are:

• Walking or running
• Swimming
• Playing a sport
• Taking an exercise class
• Weight training
• Stretching or yoga

You may find that being active helps you cope with changes. It can reduce your stress and help you relax. It may also help you to feel stronger and more in control of your body. Start slowly if you need to and take your time. Talk with your doctor about ways you can stay active.

Hobbies and volunteer work can also help improve your self-image and self-esteem. You may like to read, listen to music, do crossword or other kinds of puzzles, garden or landscape, or write a blog, just to name a few. Or you could volunteer at a church or a local agency, or become a mentor or tutor. You may find that you feel better about yourself when you get involved in helping others and doing things you enjoy.

Changes in your sex life

It's common for people to have problems with sex because of cancer and its treatment. When your treatment is over, you may feel like having sex again, but it may take some time. Sexual problems can last longer than other side effects of cancer treatment. It's important to seek help in learning how to adapt to these changes.

Until then, you and your spouse or partner may need to find ways other than sex to be intimate. This can include touching, holding, hugging and cuddling.

Treatment-related problems

Sexual problems are often caused by changes to your body. Depending on the cancer you had, you may have short-term or long-term problems with sex after treatment. These changes can result from chemotherapy, radiation, surgery and/or certain medicines. Sometimes emotional issues such as anxiety, depression, worry and stress may cause problems with sex.

Some common concerns include:

• Worries about intimacy after treatment. Some people may struggle with their body image after treatment. Even thinking about being seen without clothes may be stressful. People may worry that having sex will hurt or that they won't be able to perform or will feel less attractive. Pain, loss of interest, depression or cancer medicines can also affect sex drive.
• Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that also change your sex life. For example, some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis or cancer of the testes. Some treatments can also weaken a man's orgasm or make it dry. Less common problems include being unable to ejaculate or ejaculation going backward into the bladder. Alternately, after cancer treatment, some women find it harder, or even painful, to have sex.
• Having menopause symptoms. When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or experience other problems that can affect their desire to have sex.
• Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for some cancer survivors to conceive children. But keep in mind that:
  • Depending on your age, the type of treatment you received and the length of time since treatment, you may still be able to have children.
  • Families can come together in many ways. Some people choose adoption or surrogacy. Some people get involved in the lives of nieces or nephews or in child mentoring programs.
  • You can reach out to your healthcare team with questions or concerns, as well as to professionally led support groups offered at Gundersen.

Ask for help

Even though you may feel awkward, let your doctor or nurse know if you're having problems with intimacy or sex. There may be treatments or other ways you and your loved one can be intimate. Some people also find it helpful to talk with other couples.

Tell your partner how you feel

Talking to your loved one and sharing your feelings and concerns is also very important. Even for a couple that has been together a long time, it can be hard to stay connected. Let your partner know if you want to have sex or would rather just hug, kiss and cuddle.

Try to talk to your partner about any concerns you have about your sex life. Be open about your feelings as much as possible and try to avoid placing blame on you or your partner.

*Article adapted from the National Cancer Institute.