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Treatment of Sexual Problems in People With Cancer

    Although research is beginning to clarify the frequency and types of sexual problems people with cancer experience, few treatment programs for sexual dysfunction in cancer patients have been designed or tested. Programs that integrate medical and psychological modalities aimed at the treatment of sexual dysfunction in those who have had cancer are warranted. Additionally, these programs must be cost-effective and accessible to people with cancer.

    Many patients are fearful or anxious of their first sexual experience after treatment and can often begin a pattern of sexual avoidance. If the patient is concerned about sending mixed signals to his or her partner, this can lead to avoidance of general intimacy and touch. The partner may also contribute to the generalized avoidance of intimacy through his or her reluctance to initiate any behavior that may be perceived as pressure to be more intimate or may contribute to any potential physical discomfort from greater expression of physical intimacy. Providers need to reassure patients and their significant others that even when intercourse is difficult or impossible, their sex lives are not over. The couple can give and receive pleasure and satisfaction by expressing their love and intimacy with their hands, mouths, tongues, and lips. Providers should encourage the couple to express affection in alternative ways (e.g., hugging, kissing, nongenital touching) until they feel ready to resume sexual activity. The couple should be encouraged to communicate honest feelings, concerns, and preferences.

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    If a man cannot attain an erection firm enough for penetration, and/or if intercourse is painful for a woman, some couples may be willing to find alternative ways to bring each other to orgasm and express sexual intimacy. Sensate focus exercises of noncoital pleasuring,[1,2] based on principles of sensuous massage, give couples an experience of sexual expression that allows them to be physically close and intimate without pressure and anxiety that can be associated with anticipation of intercourse. The structure and ground rules of sensate focus can help bypass performance anxiety (self-consciousness and self-evaluation) and enable the couple to lose themselves in the current experience of pleasurable touch. These exercises also help the couple communicate about potentially problematic or emotionally sensitive areas of the body. Providers should determine a couple's openness to modification of their sexual technique.

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