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Guide to Intimacy and Relationships

Cancer brings profound changes that can challenge any relationship. This is particularly true with head and neck cancer because treatments are often aggressive and may be disfiguring.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. While the challenges can feel overwhelming, they can also strengthen your relationship with your spouse or an intimate partner.

Keep in mind that you and your partner will each be dealing with your own fears, depression and anxiety, and you will experience your emotions 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 your partner, who may also be your primary caregiver, just as much as it does you. 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 and your care team 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. There is also a tendency for couples coping with cancer to engage in “protective buffering.” This is when one or both partners hide their concerns and negative feelings and avoid arguments in an attempt to not upset the other. Protective buffering tends to weaken rather than strengthen the relationship and raise both partners’ levels of distress.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. 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.

Physical limits on intimacy

Radiation and chemotherapy have a variety of side effects that can affect your ability to be physically intimate with your spouse or partner. 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 your sexual desire or your 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 communicate openly and honestly with your partner about your 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 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 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 you 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 you, you and your partner 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
      Though you and your partner may have different ways of dealing with the challenge of cancer, accepting that your relationship may evolve can help you prepare. Simple activities, such as going for walks 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 self-confidence and body image may suffer, making you 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. Radiation or surgical treatments to your head and neck area can make it difficult to even kiss the ones you love. While it may be uncomfortable to talk about, it’s a good idea to raise this issue with your care team, as they will likely have a good understanding of your particular situation. It’s also important to be open and honest with your partner. Waiting until you feel 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 yourself something to look forward to once you’ve completed treatment and started feeling better can be a great escape.

Dating or moving on

If you are single or find yourself to be newly single during your cancer journey, forming new relationships and dating can be a bigger challenge than they once were. This is particularly true if you have visible scarring or disfigurement as a result of your cancer treatment.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5. In such cases, it is impossible to begin a new relationship without making your cancer experience an early and central part of the process. You may find that you are afraid to begin new relationships because you are self-conscious about your appearance or do not wish to burden someone with your health concerns. You may also dread having to talk about body changes, infertility or other intimacy issues if the relationship progresses.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5. However, you should not give up the possibility of a new relationship because of these concerns. You are still you, and you have much to offer to new people in your life.

Here are some pointers for meeting new people:

      • Begin the process of meeting new people by simply getting out and finding or resuming activities that you enjoy.
      • Try not to use your cancer as an excuse to avoid interacting with others.
      • Let friendships form without further expectations.
      • Practice what you will say to people if and when the conversation turns to your scars or cancer.
      • When you do go on dates, just focus on having a social life that you enjoy.
      • Not every date has to be perfect or lead to a deeper relationship.
      • Try not to be too upset if a date doesn’t work out; remind yourself that this can happen with or without cancer.4 Body changes and intimacy. National Cancer Institute at the National Institutes of Health. http://www.cancer.gov/cancertopics/coping/life-after-treatment/page5.

The right person will see past your scars and be interested in who you are as a person. Every couple has challenges. If you have found a person with whom you can build a real relationship, he or she will be willing to work to overcome your particular challenges with you and vice versa.

Our intimacy was more about our tenderness together: our hugging, kissing, holding hands. 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.