FAQ – Sexuality

That is a question that comes up very regularly, not just from people affected by cancer. It’s interesting that when it comes to the question of wanting sex, we assume that it should somehow just happen naturally, like hunger or thirst. But that is not the case! We don’t ask why we would rather eat a piece of chocolate than a carrot. Because whenever it comes to desiring something, we have to ask what is it that I desire? If, for example, you experienced pain during sex or the sex was just not enjoyable for whatever reason, or you perhaps aren’t getting along with your partner, understandably you don’t want to go through that again or be close to him/her. If you are worried about something or are just not yourself, feel under pressure because your partner desperately wants to have sex again, it is understandable that your body just doesn’t have the desire for it. That is why the question you should be asking yourself is what exactly would the sex worth wanting be like? What is it that you desire? Maybe not the same thing as your partner? Or not sex, but just being close to someone, touching, stroking, kissing without automatically having sex at the end of it? But it is often the case that we avoid physical contact in the first place because we know that it will end up as sex or certainly that sex would be expected but that’s not actually what we want. But maybe it would actually be the “harmless” physical closeness that we need and actually want. So listen to yourself, ask yourself what you really need and, most importantly, talk to your partner about what you both need and want. This is how you can slowly build up a kind of sexuality again that you can both enjoy and that you will then also feel like having. This is something that might sound easy but can in fact be difficult. Everybody is different, has different needs, fears, worries and also a different history. That’s why we’re here to take a look at that with you. A hormone deficiency can also lead to a decrease in your libido and should be discussed with your doctor.

It’s definitely not “normal” when you experience pain during sex because that would mean it’s always like that and you simply have to live with it. BUT it is unfortunately common, especially in the beginning when you are still discovering your sexuality or even later on when your vagina has changed and is dry or you haven’t had sexual intercourse for a long time, etc. For sure you should contact a gynecologist to exclude an underlying cause like an infection or irritation that could also explain having pain (“see also: “My vagina is dry. Is that normal? What can I do?”). After having excluded these causes, to ensure you don’t have any pain, the pelvis has to be able to relax in order to dilate the vagina and allow it to become moist. However, this is not always that easy! Especially if you are afraid of pain you have perhaps experienced before, or are worried about failing to please your partner, or anxious about how you will find sex after a long break or after chemotherapy, etc. In order to be able to enjoy sex in a relaxed way, you need trust in yourself and in your partner, and need to be able to indulge in it without worrying about anything. Again this is something easy to say, but more difficult to put into practice. Therefore, it is important to ask yourself, what do I need to be able to let go? It’s certainly important to be able to talk openly to your partner, about worries, fears, about what you like and what you don’t. Go at your own speed and don’t put yourself under too much pressure. You need time and patience to find out what you like and what you need. And there is no such thing as “normal”, just your very own way.

Your vagina might be dry because the floor of the pelvis is tense which results in a reduced flow of blood. The process of the vagina becoming wet is like sweating, the blood flow has to be strong so that secretions can be pressed through the vaginal wall. Your blood flow is increased by arousal, i.e. a perceived desire for sex. The movement of the pelvis also increases blood flow. But this needs varying lengths of time and sometimes you have the feeling you are ready for your partner’s penis but in fact that is just something your mind feels; the pelvis is in fact not ready for it yet. This is when it is important to pause and take your time until the pelvis is ready too. But if you are frightened of experiencing pain or you are unsure about how things will work and whether your partner will like it etc, your pelvis will tense up whether you want it to or not. And then the blood flow decreases and the vaginal entrance also narrows. Another reason can be a hormone deficiency that dries out the mucous membrane of the vagina, just like with dry skin. This is particularly the case if the ovaries do not produce any hormones, for example during or shortly after chemotherapy. Even hormone replacement therapy might still not be enough for the vagina. Therefore, it can sometimes be useful to strengthen the mucous membrane using a special cream or suppositories that are inserted into the vagina. Lubricants can also help to alleviate penetration. But even then, you still need the pelvic floor to be relaxed so that moistness can be increased again. This is why it is important to talk to your doctor about what could help and particularly what you need in your specific situation. The one thing that is certain is that there is a solution, which may vary from one person to the next! So pluck up the courage to talk about it and don’t give up!

Yes, of course it is possible to have sex during chemotherapy? But it is something you should discuss with your doctor. Small injuries to the mucous membranes or even the skin of the penis can occur during sex and this can, under certain circumstances, lead to inflammation or bleeding. But this is very different from one person to the next and is something that has to be discussed with your doctor. If you experience vaginal dryness, for example, it is important to see if a hormone cream helps and perhaps a lubricant as well to allow the penis to glide as smoothly as possible and avoid injury. Furthermore it is important that you use a condom, not only to reduce injury to the penis skin, but also to prevent your partner from coming into contact with the chemotherapy drugs in your blood and mucous membranes. Apart from that, it is also important to use birth control because you should avoid getting pregnant during chemotherapy and also in the six months following the end of cancer therapy.

To have an erection, you need a certain genital maturity (even though young children can actually have an erection). This is mainly controlled by the release of testosterone and often happens spontaneously during puberty. So a frequent morning erection is a natural reaction of your body. However, when testosterone levels drop during chemotherapy and sometimes afterwards, these spontaneous erections may not occur as frequently and may in fact stop altogether. It is different, however, if you want an erection because you want to have sex. So even if you feel aroused, in other words you want to be intimate and more with a partner, your penis might see things differently. An erection is a reflex which happens automatically with intimate touching and / or thoughts, but it can be suppressed and effectively controlled. So if your head takes over and decides that it is not currently a good idea to have sex, you may not have an erection at all or it may disappear again suddenly. This is not something you are conscious of: it often tends to happen subconsciously, When, for example, you are worried about “not getting it up again” or are putting yourself under pressure as you feel it is time you had sex again, etc., you lose the tension in your pelvis, the blood flows out of the erectile tissue again and the penis becomes flaccid or floppy. So an erection is also a matter of the mind. But not entirely. How long an erection can be maintained varies from person to person. This is also influenced by how well you are feeling in general, whether you are tired or feeling under the weather, or perhaps struggling with pain, etc. Therefore, it is important to consider what reason your mind might have for not wanting to have sex and what you possibly need to feel ready to have sex again. If you had a very active sex life before you were ill and you found it very easy to have an erection and keep it going, you have to accept that a lot has happened to you. The whole of your body has changed and first has to recover and find itself again. And that is something that needs time and patience! So don’t overdo it, don’t put yourself under too much pressure. Take things easy and try to find your way back to intimacy gently, slowly, by enjoying touching at first without building up pressure that this automatically means you have to have sex. There is no medication that will make you have an erection, it has to happen “spontaneously” and can then be prolonged if necessary. So if the main problem is that your erection fades quickly, there are medicines you can take to help slow that down. But all medicines can have side effects, so it is important to discuss the risk to you with your doctor beforehand.

This is also a very frequent question that is equally difficult to answer. Because there is no simple answer and the answer to the question is different for each individual because we all have our own different history, wishes, fears and experiences. In general, it is not easy to open up to someone and show yourself naked because we are effectively dropping our shield and are potentially running the risk of being rejected. This is why it is all the more important to first try to accept yourself, be at peace with yourself and all the changes that you did not want and perhaps are not terribly attractive. Easy to say and yet so difficult to put into practice. But we are the way we are, none of us are perfect, that is true of everyone, also for your partner who could well have similar worries. And somehow it is so difficult to accept changes or scars that weren’t there before. That is totally normal and takes time! And take that time and don’t put yourself under pressure because you have the feeling you should finally get round to giving your partner more than just touching. It is often the case that your partner is frightened of disappointing you or hurting you, and may perhaps even avoid intimacy because he/she doesn’t want to ask too much of you. That doesn’t mean that he/she doesn’t like you or doesn’t find you attractive, but that they want to protect you. That is why it is just as important to talk to your partner about why you are scared, your partner too, and what you both need to feel comfortable. And because it’s not easy, we are here to help you on your path and support you. Pluck up the courage to talk about it, even if you find it difficult. Because there is one thing certain: You are not alone and your worries are not stupid or a luxury, but are important and should be listened to and taken seriously.

First of all, the point in time at which we feel ready to discover and share our sexuality varies from one person to the next. There is no such thing as “normal”, no “too early” and no “too late”! You might even decide that sex is just not your thing and that you would rather go through life without any physical contact. And that is perfectly all right, as long as you feel happy with that! Everybody has their own speed, needs and desires, and that is a good thing! That is why it is always difficult to compare yourself to others, and nevertheless you still feel pressure because we want to be like the others, we want to be normal and be aware that people like us…. The question is at what price and is it worth paying? If you are scared, doesn’t that mean that there is also a reason why you are not ready yet? So much has changed, you have been through so much and you were preoccupied with so many other important issues in a time in which everyone else could perhaps approach life in a more carefree manner. Therefore, others may have been on a different path, with different hurdles and experiences: they simply cannot be compared to your journey. And that is why it is not possible to suddenly turn off onto this path; there is no shortcut, you have to go your way, which, with a few detours, might lead you there again, maybe faster, maybe slower. But don’t forget, it all takes time and so it’s obvious that a shortcut is not only scary but also means that you are missing all the experience that helped the others get to where they are now. Give yourself the time you need, listen to your body and mind, and what you need and want. Then you will find your own way, which might be a bit longer and a bit bumpier, but it doesn’t have to be less appealing in the end.

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