Hester Hill Schnipper Photo courtesy of Beth Israel Deaconess Medical Center

LET’S BE FRANK: A cancer diagnosis and treatment are never sexual aids. Almost everyone going through cancer experiences diminished libido and physical responsiveness and decreased enjoyment of sexual activity. When you are scared, sad, feeling ill and less than your most attractive self, it is very difficult to feel sexy.

As is always the case, communication about sex is vital. You and your partner may fear that talking about it (or the lack of it) will make it worse, but silence is the greater danger. The sick partner probably feels guilty, not desirable in his or her current physical state, and perhaps worried that showing reluctance may encourage infidelity. The well partner likely is afraid of causing discomfort or pain, and is sad, and somewhat frustrated. You both love each other and wish that this part of your relationship could be better.

In addition to the emotional issues, there may be physical reasons that sex is problematic. Remember that cancer may be coinciding with normal aging, and that some of these changes in your body and sexuality would be happening anyway. Surgery, radiation therapy, chemotherapy and other medications have side effects. Depression and anti-depressants lower libido. Men may experience difficulties with arousal and maintaining erections; women may have problems with arousal, response and lubrication. Sex may be uncomfortable or even painful.

Here are some suggestions:

1) It is most important that you and your partner find a way to talk without shame or blame. You may find it helpful to identify a neutral, caring and well-informed person who can help you do this. If your doctor is not well-educated on this topic or seems uncomfortable with sexual issues, ask for a referral to an oncology social worker or another therapist with expertise. Your doctor can still help with questions about sexually related side effects of medications, surgery or other treatments.

2) If a woman is experiencing discomfort with intercourse, there are many products that can be helpful with lubrication. Position also matters: Those in which the woman can control the depth and rhythm (for instance, with the woman on top, or side-to-side) may help.

3) Remember that many medications are available to help men with erectile dysfunction. They usually work well.

4) Your body has been changed by cancer treatment. You may need to relearn what gives you pleasure. Experiment at your own pace.

5) Some women may want to invest in beautiful lingerie to wear to bed if they feel self-conscious about scars or other cancer changes. Naked is not necessary.

6) Try to move the focus away from intercourse and orgasms to intimacy. Think of other ways to feel close and loving: Shower together, exchange back or foot rubs, snuggle while you watch a movie or simply go to sleep holding hands.

Hester Hill Schnipper, a licensed independent clinical social worker, is a breast cancer survivor who served as the manager of oncology social work at Beth Israel Deaconess Medical Center in Boston.