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Issues with Intimacy

124206709_8If you are the spouse or partner of someone who has head and neck cancer, intimacy will most likely become an issue in your relationship at some point. Physical and emotional side effects from cancer and cancer treatments can not only reduce the desire for intimacy, but they can make physical contact uncomfortable or painful for your partner. Surgical treatments, chemotherapy and radiation can all cause physical changes and side effects that make intimacy with your spouse or partner more challenging. While the challenges can feel overwhelming, they can also strengthen your relationship.

Because of the sensitive nature of this issue, both partners may be reluctant to talk about it, and your care team may not bring it up. However, it’s important to raise the issue with your care team, as they may be able to provide ways to manage sexual side effects in patients and provide guidance. In addition, counselors, therapists or cancer social workers can provide advice to help you find new ways to show your love for each other and reestablish intimacy when the time is right.

Above all, it’s important to try to communicate honestly with your partner and accept that while sexual intimacy as it was before cancer may no longer be possible, intimacy may be achieved in other ways such as cuddling, massage and other loving touches.

The emotional side of intimacy

You and your spouse or partner may each be dealing with your own fears, depression and anxiety differently. In one study of head and neck cancer patients and their partners, about 35 percent of cancer patients experienced serious psychological distress while 33-39 percent of their partners did.1 Manne S and Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psycho-Oncology.2010 September;19(9):941-954. In other words, the cancer can affect you emotionally just as much as it affects the patient. Emotional support goes both ways, not just toward the person with cancer. In fact, cancer patients and their partners usually identify each other as their most important source of support.1 Manne S and Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psycho-Oncology.2010 September;19(9):941-954. Both people will probably manage their stress and cope with their emotions best by sharing their worries and concerns with each other. A strong couple with good communication and coping strategies adapts more easily to cancer-related emotional challenges.1 Manne S and Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psycho-Oncology.2010 September;19(9):941-954.

About one-third of head and neck cancer survivors report having substantial problems with sexual interest or enjoyment, regardless of what type of cancer or treatment they had.2 Low C, Fullarton M, Parkinson E, O'Brien K, Jackson SR, Lowe D, Rogers SN. Issues of intimacy and sexual dysfunction following major head and neck cancer treatment. Oral Oncol. 2009 Oct;45(10):898-903. Open communication with your partner is the single most important key to maintaining a strong relationship and restoring intimacy. In order to feel understood and cared for, you will want to know that you can talk about anything with your partner and that your partner will be generally accepting and supportive in response. Your partner needs to feel the same about you.1 Manne S and Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psycho-Oncology.2010 September;19(9):941-954. Communication will not always be perfect. There will be moments of anger, fear, withdrawal and weakness on each side that will be hurtful to the other person. Just keep working on the relationship. Apologize when you’re wrong or hurtful, forgive your partner and do the best you can moving forward. Fighting cancer is probably going to be the most challenging thing you’ve ever done together.

The physical side of intimacy

Radiation and chemotherapy have a variety of side effects that can affect your ability to be physically intimate with your loved one. Some chemotherapy drugs cause skin rashes, painful sensitivity to light and gastrointestinal distress. Radiation can cause painful sores in the mouth. These treatments can also decrease sexual desire or the ability to become aroused or perform sexually. Many of these symptoms and side effects will fade after treatment is completed, but some may linger, such as lack of sexual desire or infertility. You will need to listen to your partner and respect his or her readiness or interest in physical intimacy. If problems persist after treatment and recovery, talk to your care team or therapist for advice. Sexual dysfunction is a major stressor for couples, sometimes for months or years after cancer treatment is completed.3 Surviving Cancer: Effects on intimacy. NIH Senior Health. http://nihseniorhealth.gov/lifeaftercancer/effectsonintimacy/01.html.

In addition, surgical treatments to remove tumors can bring permanent changes to your loved one’s head and neck that will require you to give up some kinds of intimacy you used to enjoy or invent new ways to express your love for each other. For example, the removal of part or all of your loved one’s tongue, lips or jaw could make kissing more difficult or less enjoyable for one or both of you. Reconstructive surgery may help, but there is still a chance that your partner will have numbness or weakness in that area that changes the way you kiss or sexually stimulate each other. If this is the case for your partner, you can have fun discovering new ways to arouse and satisfy each other.

Ways to strengthen your relationship

There are steps you and your partner or spouse can take that will help to preserve and strengthen your long-term relationship.

  • Communicate Well
    During this time, it’s extremely important to communicate and be honest with your partner. If you’re finding it difficult to communicate verbally, writing your feelings in journals and exchanging them can be a useful method. Set up a time each day for open communication and protect this practice throughout your treatment and recovery.
  • Accept That Your Relationship May Change
    You and your partner may have different ways of dealing with the challenge of cancer, so accepting that your relationship may evolve can help you prepare. Simple activities, such as going for walks in a park together, can strengthen your relationship.
  • Create New Ways to Be Intimate
    Cancer treatments can have physical and emotional side effects that can decrease desire and make physical intimacy more difficult.3 Surviving Cancer: Effects on intimacy. NIH Senior Health. http://nihseniorhealth.gov/lifeaftercancer/effectsonintimacy/01.html. Your partner’s confidence and body image may suffer, making him or her feel less attractive.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5. You may also struggle with seeing your partner the same way. Radiation or surgical treatments to the head and neck area can make it difficult to even kiss the one you love. While it may be uncomfortable to talk about, it’s a good idea to raise this issue with the cancer care team, as they will likely have a good understanding of your partner’s particular situation. It’s also important to listen to your partner’s needs and concerns. Waiting until your partner feels ready and then finding new ways to express affection, plus sharing other activities, can be beneficial.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5. Most couples adapt to physical changes and say they eventually forget about the changes and even stop thinking about them during intimacy. What seems strange or uncomfortable at first becomes your new normal. What matters most is your love for each other, and that will come through regardless.
  • Seek Counseling or Therapy Together
    Many patients and their partners find that attending regular couple’s counseling or sex therapy sessions help them to communicate well, develop coping strategies, overcome challenges and restore physical intimacy during and after cancer treatment and recovery.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5.
  • Plan a Vacation
    Figuring out ways to keep dreams alive can create strength during difficult periods. Planning a vacation or giving yourselves something to look forward to once your spouse or partner has completed treatment and is feeling better can be a great escape.
You find this connection with each other that you maybe didn’t have before, in a look or touch that you remember. That lets the other person know you are there, that you are a team.Bonnie S. (wife of a tonsil cancer survivor)

References

1 Manne S and Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psycho-Oncology.2010 September;19(9):941-954.

2 Low C, Fullarton M, Parkinson E, O'Brien K, Jackson SR, Lowe D, Rogers SN. Issues of intimacy and sexual dysfunction following major head and neck cancer treatment. Oral Oncol. 2009 Oct;45(10):898-903.

3 Surviving Cancer: Effects on intimacy. NIH Senior Health. http://nihseniorhealth.gov/lifeaftercancer/effectsonintimacy/01.html.

4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5.