Q. Can cancer be sexually transmitted?
No, not directly. However, certain viruses that can lead to a few specific cancers can be sexually transmitted. The most common example, by far, is the human papillomavirus infection (HPV). HPV is one of the most common sexually transmitted viruses in the United States, and it causes nearly all cases of cervical cancer. Another example is the HIV virus, which can also be spread through sexual intercourse and can make patients more susceptible to other cancers, most notably lymphoma.
Thus, it is very important for everyone to always practice safe sex. If you have been diagnosed with or are recovering from cancer, and especially if you are receiving chemotherapy or other kinds of immunosuppressive treatments, your immune system may be weakened, increasing your vulnerability to infections of all types. Safe sex means using condoms (or dental dams) with all partners and, ideally, maintaining a monogamous relationship. Using barrier contraceptives, such as condoms, is also important during chemotherapy because some drugs may be excreted in seminal fluid and unintentionally enter your partner's body. Furthermore, initiating a pregnancy during treatment may expose the fetus to chemotherapy drugs in early pregnancy.
Q. Will I be able to become pregnant if I've had cancer?
That depends on many things. The first is physical: do you still have your ovaries and/or uterus? If you still have your uterus but not your ovaries, then you could become pregnant through a donor egg (or your own previously donated egg) using in vitro fertilization (IVF). If you still have your ovaries but not your uterus, you can't become pregnant yourself, but you can donate an egg for IVF and have a surrogate mother carry the pregnancy.
Even if you retain your ovaries, you still may have stopped menstruating as a result of the chemotherapy, hormone therapy, or radiotherapy used to treat your cancer and prevent its return. Nonetheless, it is possible that your periods will return, particularly if you're young. There is also evidence that pregnancy occurring after the first couple of years of surveillance beyond treatment of breast cancer is a safe and reasonable option for many women.
If you have just been diagnosed with cancer, it is important that you discuss your desire for children with your health care professional before you begin treatment. In some instances, doctors may be able to harvest your eggs, freeze them, and then implant them for later use. It may also be possible to modify your treatment somewhat to protect your fertility. Men may want to bank their sperm for future use.
Q. What are some other ways to share intimacies if I'm too tired or emotionally drained to have intercourse?
When dealing with cancer, what many people need most is intimacy—and that can have very little to do with sex. Simply lying in someone's arms, holding a loved one or friend, or receiving a massage or foot rub, can be incredibly intimate. Ask your partner to find a poem that expresses how he or she feels about you and read it aloud, or share some favorite food or music. Just being together, and knowing that your partner accepts and loves you—cancer and all—can provide an intimacy that far exceeds that of intercourse. All kinds of intimate touch can be extremely satisfying and there are many books that further describe a variety of fulfilling sexual activities other than intercourse.
Q: It's been two years since I finished treatment for my cancer and I'm still cancer free. I know I should be grateful, but I feel I've lost something very valuable—my sex life. I just don't seem to be interested any more and I feel guilty for worrying about it. Should I just adjust to a life without sex?
Although your loss is real and your question legitimate, there are many things to consider before deciding to adjust to a "life without sex." To begin, there is nothing to feel guilty about. Going through cancer treatment can be very difficult for anyone, and losing interest in sex is not your fault.
Second, know that these kinds of questions and issues are very common, and you are not alone. As one medical article noted: "Intimacy is often a casualty in the battle against cancer." It's a huge problem, with studies finding that as many as half of all women breast cancer survivors and 70 percent of all prostate cancer survivors experience sexual challenges, as well as 25 percent of Hodgkin's disease or testicular cancer survivors.
Sometimes, unlike the nausea, hair loss, fatigue, and other side effects of cancer treatment, sexual problems don't resolve when the treatment ends. However, in many cases they do. It's important to know and understand that sexual dysfunction, diminished libido, and decreased intimacy often have multiple causes and characteristics.
Sometimes they have a physiological cause and are permanent. Sometimes the cause is physiological but the effect is temporary. Sometimes the cause is primarily psychological and can be treated with medications and/or counseling. In some cases, sexual dysfunction can have both physiological and psychological components. Sorting through the causes and possible treatments is greatly facilitated by expert medical and/or psychological advice.
For some people, sexuality is an important aspect of who they are. For many, it is a significant part of the quality of their lives. For others, love and intimacy is more important to them than sexuality. Whatever is true for you, talk with your health care provider about your questions and concerns.
Quite often there are medications and even exercises that can help. Additionally, it can be very helpful to talk with a mental health professional trained in sexual issues. Many people with cancer discover that they are able to discuss sex more openly and find new intimacy with their partners. Don't resign yourself to a life without sexual intimacy until you've explored all your options.
Q: Ever since my cancer treatment ended, I've been having pain "down there." Yet the longer I go without having intercourse, the more I fear it. What can I do?
First, talk to your health care professional about the pain you are experiencing and its likely causes. If it's due to dryness from estrogen deficiency, there are numerous options that can help restore the health of the vaginal tissue. Additionally, there are gels or creams that can help prevent pain, at least for a short time.
To alleviate your fear of having intercourse, consider trying some gentle manual stimulation first. The pain may also have other causes, such as surgery or radiation, which can affect the vaginal canal and its overall tone, causing pain during intercourse. Carefully using a vaginal dilator, which works by slowly stretching the skin in your vaginal area, can help open the vagina further. This device can also help if you haven't had intercourse for a while and are afraid to try because you fear it might hurt. You can get a prescription for a dilator from your health care professional.
Q: Can you recommend some resources on cancer and sexuality?
Yes. The American Cancer Society (www.cancer.org) provides excellent information about sexuality after cancer on its website. There are also several books that address the issue, including:
Couples Confronting Cancer: Keeping Your Relationship Strong. Joy L. Fincannon and Katherine V. Bruss. Atlanta: American Cancer Society, 2003.
Men, Women, and Prostate Cancer: A Medical and Psychological Guide for Women and the Men They Love. Barbara R. Wainrib and Sandra Haber. New York: New Harbinger Publications, 2000.
Sexuality and Fertility After Cancer. Leslie R. Schover, MD. New York: John Wiley & Sons, Inc., 1997.
If you're looking for a sexual health therapist, try the American Association of Sex Educators, Counselors and Therapists (AASECT) at 804-752-0026, www.aasect.org.