Frequently asked questions about sex during and after cancer

Can sex during treatment be harmful to a patient or partner?

A few chemo drugs can be present in small amounts in semen. You may want to use condoms while you are getting chemo and for about 2 weeks afterward. Some types of

radiation treatment require special precautions for a certain amount of time, too. For instance, a man who is having “seed implants” (brachytherapy) for prostate cancer should check with his doctor about safety precautions, like using condoms, because sometimes the seeds can move.

Men who are getting chemo also should avoid causing pregnancy during and for some time after treatment because chemo may damage the DNA in sperm cells. This could lead to birth defects. Ask your doctor about birth control if your partner might get pregnant. You will also want to know when you can stop using birth control for this reason.

Although sexual activity is usually safe for your partner during your cancer treatment, some couples just stop having sex, without checking out their fears with the health care team. If you have been cleared medically to resume sex, but are still unsure, you may just need more time.

Be sure to let your partner know that you’ll want to have sex as soon as you feel better. Give your partner some ideas on helping you feel more sexual again, such as, “Let’s try being affectionate in a relaxed way,” or “I’d like to know that you still find me attractive.”

You may also need to reassure your partner that your cancer treatment does not make sex dangerous. Cancer can’t be caught from another person. If you have external radiation treatments, having sex with you does not expose your partner to radiation.

When should a person with cancer not have sex?

Ask your cancer care team if sex may be a problem at any time during or after your treatment. Here are some general guidelines:

When recovering from surgery, sex can cause bleeding or strain the cut (incision). Sex may also increase your chance of an infection. The time between surgery and when it’s safe for sex varies. It depends on the type of operation and how well you are healing. Your surgeon can tell you when it’s safe to try sex again.
Some types of cancer, like cancer of the bladder, may cause bleeding in the genital area or urinary tract. If this bleeding is worse after sex, talk with your doctor about it. You may need to wait until the bleeding has stopped and the area has healed.
During chemo, a person with an infusion catheter sometimes worries that sexual activity will harm it. As long as you take care not to rub against it, sex should not cause any problems.
When you’re being treated for cancer, there are often times when your immune system isn’t working as well as it should. At these times, it may be easier for you to get all kinds of infections. Again, ask your doctor if sexual contact puts you at too much risk for infection. Most doctors say that if you’re well enough to be out in public, you’re well enough to have sex. If you’re in the hospital because of weak immunity, ask your doctor’s advice on kissing, cuddling, or sexual touching.
There are things you can do to try to prevent urinary tract infections. Some of the bacteria that can start infections in the urinary tract or genital area may wash away if you urinate a few minutes after sex. You might even want to drink a glass of water before sex, so it will be easier to urinate afterward.
If you notice any sores, bumps, or warts on your partner’s genitals, or any unusual fluids or discharge, you should find out the cause and then decide if it’s safe to have sex.
You can greatly reduce your chances of getting a sexually transmitted disease (STD) if you wear a latex or plastic condom for oral, vaginal, or anal sex from start to finish each time you have sex.

Getting professional help

Many health care professionals, including doctors, have little training in sexuality issues. They may not be at ease even talking about sex, but they can still help you find someone who is. Many doctors also fail to mention the sexual side effects of cancer and medical treatments. If they do talk about it, they might not give you a clear picture of what to expect. But if you are concerned about how cancer or its treatment might affect (or has affected) your sex life, it’s important to bring it up and to get answers to your questions, even if it makes you uncomfortable.

If your cancer specialist can’t help you, you should be examined by a urologist (a medical doctor trained in diseases of the urinary tract and male genitals) with extra training in how to treat sexual problems. Many urologists perform surgery or prescribe medical treatments for erection problems. They also have the special equipment that may be needed to find the cause of an erection problem.

When the most likely cause of a sexual problem is a hormone imbalance, a medical doctor called an endocrinologist should be consulted. Endocrinologists are expert in the complex cycles and systems that control hormone levels. Usually your primary doctor is best able to decide if you need the special knowledge of an endocrinologist to solve your problem.

If your cancer specialist or family doctor is not able to help you, they should be able and willing to refer you for help. There are many different programs and specialists that can help you find the answers you need.

Sexual rehabilitation programs in cancer centers

A center that specializes in treating cancer may have experts on its staff that can assess and treat sexual problems. But these specialists may see only the patients who are being treated at their hospital. If you’re being treated at a cancer center, check to see what programs are offered.

Sexual medicine clinics

In recent years, medical schools and even private practice groups have begun treating sexual problems and/or promote sexual health. Such clinics provide psychological and medical exams through many different types of health care providers. Some clinics require both sexual partners to take part, but you may be seen alone if you’re not in a committed relationship.

Sex therapists and counselors

Sex therapy is a brief type of psychotherapy or counseling (about 10 or 20 sessions) focused on solving a sexual problem. Sex therapists believe that sexual skills are learned and that bad habits can be corrected by learning different sexual techniques. In between meetings with the therapist, a couple (or sometimes just one partner) is given homework assignments. The homework includes exercises to help you communicate and enjoy touching more. They can also help reduce anxiety that often interferes with good sex.

Sex therapists may practice in a clinic or alone. Most states have no laws regulating the title “sex therapist,” so people with no formal training can call themselves sex therapists. But a sex therapist should be a mental health professional (a psychiatrist, psychologist, social worker, or psychiatric clinical nurse specialist or nurse practitioner) with special training in treating sexual problems with sex therapy. Some counselors may provide sexual counseling if a licensed professional supervises them.

It’s not always easy to find a well-trained sex therapist. It’s even harder if you live far from a city.

Professional societies can often give you information about their members in your area who have special training in sex therapy. These are good places to start:

American Association of Sex Educators, Counselors, and Therapists (AASECT)
www.aasect.org

National Association of Social Workers (NASW)
www.helpstartshere.org

You can also get a listing of professionals in your area by contacting your state’s psychological association or a state association for licensed marriage and family therapists.

Other kinds of counseling

Sex therapy is not the only kind of counseling that can help a person with cancer. Psychotherapy can help you feel better about the changes in your body, help you and your partner communicate more clearly, and give you skills to better cope with the cancer and cancer treatment.

The stress of being diagnosed and treated for cancer can worsen problems that already existed in your relationship. Poor or strained communication with your partner can be discouraging and frustrating. In this case, couples counseling may be helpful if your partner is willing to work with you. Individual therapy can also help you decide how to best deal with the problem.

Finding a well-qualified mental health professional is important. These are some of the different types of mental health professionals out there:

Psychiatrist: This is a medical doctor (an MD or DO) with a specialty in psychiatry. They should also be certified by the American Board of Psychiatry and Neurology.
Psychologist: Most who are practicing alone have a doctorate in psychology (PhD or PsyD) or in education (EdD). Psychologists do not have medical degrees and don’t write prescriptions. Psychologists with a master’s degree are most often supervised by one with a doctorate. In most states a psychologist must be licensed. Those who practice usually have degrees in clinical or counseling psychology.
Social worker: A social worker usually has master’s degree in social work (MSW). Licensing laws vary from state to state. Some states have a category for licensed psychotherapists called “marriage and family counselors.” They usually have a master’s degree in psychology or a related field, plus training in counseling.
Psychiatric clinical nurse specialists or psychiatric nurse practitioners: These nurses have a master’s degree in psychiatric nursing. They are licensed professionally, although their ability to prescribe medicines varies from state to state.

The cost of counseling varies with the professional’s training and experience, and health insurance companies reimburse at different rates. You may want to check with your insurance company to find out if it will pay (and how much it will cover) for counseling or therapy.

One way to get quality treatment for a lower fee is to find a nearby medical school with a psychiatry clinic. You can also go to a university that trains clinical psychologists and has a psychology clinic. You might be seen by a student in advanced training, but they will be supervised by a senior professional.

What to avoid

Sexual problems are common and upsetting, and men often seek help for them by going to someone who’s not really a health care provider or by trying unproven remedies or cures. Television, magazines, radio, and the Internet abound with ads for “natural” treatments that promise to give you better erections and longer sexual endurance. These heavily marketed herbs, creams, pills, and supplements have not been studied, and there’s no proof that they work: not herbal potency pills like “poppers” or “Spanish fly,” oysters, splints around the outside of the penis to stiffen it, muscle exercises that claim to make a man’s penis bigger, hypnotism by someone not trained as a mental health professional, or visits to an independent “sexual surrogate.” These treatments are not proven to work, and some of them might even be harmful. Talk to someone on your cancer care team about any treatment you’re thinking about trying before you try it.

Thursday, December 7, 2017

Questions Men Have About Cancer, Sex, and Getting Professional Help