Sexual health and intimacy for young adults

As a young adult you may be dating, in a relationship, or married. Cancer can make navigating romantic relationships complicated.

Dating when you have blood cancer

Dating can be intimidating no matter your situation. Remember, every date before your diagnosis probably did not go perfectly. You may have bad dates after your diagnosis as well. You may also meet incredible, new people.

If you feel well enough during treatment, you never have to stop dating. Due to side effects of treatment, you may not feel up for it. You may want to take time for yourself to heal. It is your choice. Do not feel pressured to date if you are not interested or not feeling up to it. However, do not let cancer stop you from dating if you feel like you are ready to meet new people.

Telling a date about your diagnosis

When and how you tell someone about your cancer diagnosis is your choice. Some people prefer to tell right away to clear the air and to see if the person will be supportive or not. Some people prefer to wait until they trust the person. Take some time to think about which is most comfortable for you.

If your date reacts negatively, it is not your fault. People have different histories with cancer. In some cases, you may be able teach this person what it means to be a person with a cancer diagnosis. In others, you may have to move on.

Existing relationships

If you are already in an established relationship, even a new one, your diagnosis may reveal positive and negative aspects of your relationship and your partner. Cancer can be difficult on everyone affected by the diagnosis.

People react to cancer differently. Your partner may be supportive and end up being your best caregiver. Your partner may have a difficult time coping. Either way, your relationship will probably change. If you hit a rough patch, it may be beneficial for you and your partner to do couples counseling. Look to your healthcare team, support group, or place of worship for resources and recommendations.

Cancer treatment often brings up fertility issues that will require you to discuss future plans about parenthood. If you think this person may be your life partner, you may want to make these decisions together.

Cancer treatment and surgery can affect sexual function in all people. You may need to both prepare for changes to your intimate relationship.

Sexuality and intimacy

Cancer treatment may affect your sexuality and the way you feel about your body. Potential sexual side effects of cancer treatment include:

• Erectile dysfunction
• Vaginal dryness
• Pain during intercourse
• Lack of desire
• Difficulty reaching climax

You may be self-conscious about physical changes to your body such as hair loss, weight changes, swelling, scars or the presence of a central line or port.

Fatigue, nausea, pain, or other side effects may interfere with your desire for sex.

Your doctor may even advise that you abstain from sex if your white blood cell or platelet counts are low.

Here are some of the most important things to keep in mind:

• Ask your doctor if it is safe for you to have sex.
• Speak to your healthcare team about sexual changes. There are treatments and therapies available to improve sexual side effects.
• Ask for a referral to a sex therapist.
• Be open with your partner about any changes, especially if something hurts or is uncomfortable.
• Always use protection to prevent unwanted pregnancy and sexually transmitted infections (STIs).
• For women, even if cancer treatment interrupted your menstrual cycle, you still may be able to conceive. During treatment, do not try to conceive. Pregnancy during cancer treatment can be dangerous for both mother and child.
• Always use condoms to protect against STIs even if you use another form of birth control.

The decision to have sex or be intimate with someone is completely your decision. It may not be safe, comfortable, or enjoyable for you to have sex during cancer treatment. If this is the case, rethink intimacy and find new ways for you and your partner to be intimate such as writing love notes, massages or light touching, or simply spending time alone together.

Intimacy during cancer treatment

Intimacy is closeness between people in personal relationships. Sex and intimacy are not mutually exclusive; one can exist without the other. Sex is not the only way to build or maintain intimate relationships. Additionally, physical intimacy is not always sexual. For example, hugging a friend is a form of intimacy. Trust, safety, communication and acceptance are the most important aspects of intimate relationships.

Ways to build intimacy without sex

• Write love notes or simple messages in an email, text message or on a sticky note to remind your partner how much you love and appreciate them.
• Set aside time to be alone together. Take your time. Appreciate and enjoy each other and the gift of being able to be fully open with one another.
• Lie naked together.
• Enjoy a meal together.
• Take a walk together.
• Read a book or watch a movie together and discuss it afterwards.
• Try a new activity together, such as a painting class.
• If you are comfortable, explore other types of physical intimacy: touching, kissing, cuddling, holding hands or massage.
• Ask your healthcare team for a referral to a therapist for couple’s counseling to help improve communication.

Communicating with your partner

Discussing experiences, feelings and concerns with your partner(s)—giving each other the chance to talk and listen—is an important part of maintaining or improving your quality of life. Your partner may have his or her own concerns, such as being afraid of hurting you during sex, feeling guilty or selfish for wanting to be intimate with you or not knowing how to talk about their feelings. You may also want to talk about seeking help from a professional, such as a couples counselor or sex therapist.

The American Association of Sexuality Educators, Counselors and Therapists can help you find a therapist, or you can ask your doctor for a referral.

You may not be interested in sex. Until your treatment is completed, and you feel better, you and your partner may need to find new ways to be intimate.

If you do wish to continue having sex, ask your treatment team if it is safe to do so.

Ways to prepare for sex

• Take a warm shower or bath to help relax your body. You can invite your partner to join you, if you like.
• Take a nap before sex to help you feel less tired.
• If needed, take nausea or pain medication 30 minutes before sex.
• Set the mood. For example, light candles and play music.
• Use lubricants for comfort.
• Water-based and silicone-based lubricants are safe to use with condoms and dental dams. Silicone-based lubricants are a good option for anal sex, as they dry out less quickly than water-based lubricants. Oil-based lubricants are also an option; however, they can make latex condoms and dental dams less effective.
• Start slowly with other forms of physical touch such as kissing, massaging, or touching.
• Remember that climax or orgasm is not required for sex to be enjoyable. Try not to put pressure on yourself or your partner. Seek to enjoy the moment.
• Tell your partner what feels good to you.
• If you and your partner are both comfortable, you can try using sexual enhancement aids, such as a vibrator.

Consent

“Consent” is an agreement to engage in sexual activity. Open and ongoing communication is an important part of safe and enjoyable sexual experiences. Tell your partner what you enjoy and what your boundaries are. The choice to have sex or engage in sexual play is always yours. Even if you were sexually active before your cancer diagnosis, only continue or resume having sex if you are physically and emotionally ready. Consent to one sexual activity is not consent to all sexual activities. Consent to sexual activities in the past is not consent in the present. Consent can be withdrawn at any time, even during sexual activity. Physical response, such as vaginal lubrication or penile erection, is not consent. Consent cannot be given under fear or intimidation. Consent cannot be given by someone who is underage, under the influence of drugs or alcohol, asleep or unconscious. If you have experienced sexual assault, call the National Sexual Assault Hotline at (800) 656-HOPE (4673).

Sex and safety during cancer treatment

Disclosing sexual history and/or sexual orientation

When discussing sexual health, your healthcare team may ask about your sexual history. This information can help members of your healthcare team give you the best care. Some sexual activities may call for different types of care to keep you safe and comfortable.

You should never be ashamed or denied medical care because of your sexual history, gender, or orientation. You deserve to receive care from healthcare professionals who will respect and address all your medical needs. If you are not comfortable with a healthcare professional, find another one who will support you. Try asking a healthcare professional you do trust for a referral.

If you are a member of the LGBTQIA+ community, you can find healthcare providers who understand your needs by visiting the LGBTQ+ Healthcare Directory or OutCare to search their directories.

Preventing pregnancy

Getting pregnant during cancer treatment can be unsafe for both the pregnant person and the fetus. It is important to always use a form of birth control.

Treatment may cause changes to the menstrual cycle, including early menopause. Even if the menstrual cycle stops during treatment, you may still be able to become pregnant, so it is best to continue to use birth control.

Birth control methods include:

• Abstinence
• Condoms
• Condoms also provide protection against sexually transmitted infections (STIs.)
• Oral birth control
• Intrauterine device (IUD)
• Implant
• Shot
• Vaginal ring
• Patch
• Spermicide (with or without a diaphragm)
• Non-hormonal vaginal bio adhesive gel

Talk to your doctor about which option is best for you. Get instructions for using your method of birth control. Follow the instructions exactly.

Preventing sexually transmitted Infections (STIs)

Sexually transmitted infections (STIs), also called “sexually transmitted diseases (STDs),” are infections that can be spread through sexual contact, including oral, anal, or vaginal sex and genital touching.

Condoms or other barrier protection, such as dental dams, during vaginal, anal, or oral sex help to protect you and your partner from STIs.

Some STIs can be cured with treatment. Others can be managed with treatment. Early diagnosis and treatment of many STIs is important to decrease the risk of more serious medical issues developing and to prevent spreading the disease to others. If your white blood cell counts are low, you may be more at risk for infection, including STIs.

Other considerations during cancer treatment

Chemotherapy and other drugs can be present in bodily fluids such as saliva, semen and vaginal fluids for up to 48 to72 hours depending on the drug. The risk of exposure to chemotherapy or other drugs during sexual activity are not clear. Ask your treatment team if you should take any precautions or avoid sexual activities for some time after treatment to protect your partner from exposure.

If you are receiving external beam radiation therapy, you will not expose your partner to radiation.