In the first instalment of our new blog series exploring sex and cancer, we speak to psychosexual therapist Dr Eleanor Holloway about the expectations and realities of sex after diagnosis and treatment.
We all know about the ‘new normal’ that comes after a cancer diagnosis. So if we can readjust our expectations about work, friendships, and our energy levels after cancer, why do we put pressure on ourselves when it comes to sex? Many young adults who shared their thoughts in our anonymous survey wanted to know when they could expect their sex lives to return to normal after cancer treatment – so we decided to ask an expert.
What is ‘normal’?
Sex is just like any other aspect of life: it helps to reflect on what you want before you make a plan to go out and get it. If you want to ‘get back to normal’, you need to define ‘normal’.
“Does that question mean ‘how long will it take my sex life to look exactly like it did before I had a diagnosis of cancer?’ asks Dr Holloway. “If it does, how long ago was that? What did your sex life look like then?”
It’s important to be honest with yourself about the reality of your sex life before cancer. Was it really all that great? It may well have been amazing – but it’s also quite possible that not all your sexual encounters ended with a mind-blowing orgasm. There might not have been many orgasms at all.
When you think about the sex life you had before, are you thinking about the months before you were diagnosed with cancer, or perhaps a different time in your life: before you had children, or a long-term relationship, or a stressful job? Getting ‘back to normal’ might not be as straightforward as you think.
Our attitudes towards sex are shaped by the world around us. Dr Holloway suggests examining those external factors a little more closely, too:
“Does ‘normal’ mean how my sex life looked before cancer, or what I imagine it ‘should’ or ‘could’ have looked like, according to some set of criteria that I’ve been sold by society?”
Great expectations
We are constantly bombarded with messages about how our sex lives ‘should’ look. We often assume that we know what everyone else is doing – and can be self-critical if we aren’t measuring up to these invisible (fictional!) standards. For example, we might assume that ‘good sex’ means frequent sex, or that ‘real sex’ has to involve penetration. As young adults, we might believe that we should desire sex all the time – but the idea that the younger you are, the more sex you have is also a societal expectation rather than a fact.
Worried that you aren’t having enough sex, or that you aren’t doing it ‘right’? Dr Holloway can provide some reassurance:
“Very few people know what everyone else’s sex life looks like. Those who do, work in sexual health – because we ask the questions.”
There might be a big gap between what we think we should be doing in the bedroom, and what we actually want to do. Porn plays a huge role in how we understand sex.
“People judge their own sex lives against complete fantasy situations, just due to exposure,” says Dr Holloway. “We don’t see each other having real sex, and we don’t talk about real sex enough.” She points out that we have a tendency to mistake screen sex for reality – in porn or romantic films – even though we wouldn’t compare ourselves to film stars in other respects.
“We understand that James Bond is a constructed fantasy, and that we aren’t going to have the same experiences when we go on holiday. Yet we watch porn and think in some way that it applies to us. We think ‘my sex life could look like that’. No, it could not!”
Take some time to consider how the world around you has affected your thoughts and feelings about sex, and then start to pose questions about the type of sex life you want.
“For example, is it better to have mediocre sex every day or really good sex once a week?” Dr Holloway asks. “Would I prefer a really intimate physical experience with my partner, where we feel connected and relaxed, or a guarantee that full-on ‘sex’ will happen?”
Why have things changed?
Once you have a clearer idea of the sex life you are working towards, it’s time to take a step back and look at the way things are now. How did you get to this point? Be prepared that there might not be a straightforward answer:
“I frequently find that people have a problem in their lives, and that has an impact on their sex life. They then look at their sex life and say that the issues are all due to this one event. If I ask my patients about [their sex lives] before and after the event, there’s an awful lot else going on – but it’s easier to pin it to one thing.”
Dr Holloway explains that it’s important to explore all factors that may be causing a barrier to sex. People encounter difficulties in their sex lives for all sorts of reasons, and a triggering ‘event’ could be anything from a change in contraception, to a termination, or a bereavement. Having children – whether that’s through birth, fostering, or adoption – has a profound effect on intimacy. Getting a cancer diagnosis in your 20s, 30s, or 40s might be the first ‘event’ to affect your sex life, and as an unplanned and unwanted interruption it can have a huge impact.
Ill health can create a make-or-break situation for your relationship, but it also brings dormant issues to the fore.
“If you had a relationship problem or an issue with your self-confidence before you were diagnosed with cancer, odds are that being diagnosed with cancer may shine a light on the pre-existing issues,” says Dr Holloway.
Think back to your sex life before cancer. Why has it really changed?
Physical or psychological?
It can help to reflect on the physical and psychological effects that cancer can have. Your treatment may have placed physical limitations on your sex life. For example, you may have had a mastectomy or an orchidectomy, or had internal organs removed. You might have entered menopause. Sometimes there are obvious physical factors that can affect your sex life – but you may also be struggling with fears or emotional concerns that you haven’t been able to address.
“‘When am I going to get back to normal?’ invites the assumption that going backwards, to what things were like, is the most preferable situation,” Dr Holloway tells us. “And I would not make that assumption at all! You’ve had cancer treatment and it may be literally, physically impossible for you to go back to how it was before. Going backwards may not lead you to a better place. It’s much better to think about going forwards to what you want.”
Your sex life will have to adapt – and actually, the perfect sex life might be an adaptable one. After all, nobody stays the same forever.
Dr Eleanor Holloway is a Psychosexual Therapist, Senior Accreditation with College of Sexual and Relationship Therapists, and Speciality Doctor in Sexual Health and Psychosexual Therapist at Oxford University Hospitals NHS Foundation Trust.
Look out for more blog posts in our special sex series. Coming soon: one young adult cancer patient tells us why she didn’t talk to her oncologists about sex, and we ask medical professionals for tips on talking to our own doctors.
