11 Things Nobody Tells You About Sex After Kidney Cancer
When we talk about kidney cancer, we don’t always talk about how treatment for it creates challenges around sexual health. The thing is, many physicians aren’t trained to address the sexual side effects and may feel awkward discussing the sensitive subject with their patients, says Sharon Bober, Ph.D., a psychologist and director of Dana Farber’s Sexual Health Program in Boston. “Within the world of kidney cancer, this isn’t something that gets talked about a lot,” Dr. Bober says. But it’s important to be proactive so you can reclaim your sex life after kidney cancer. From foreplay to frequency, here are 11 things to know.
You Can Resume Sex…Really
Kidney cancer patients aren’t always sure when to resume intimacy, says Leslie Heron, A.R.N.P, a nurse practitioner with the Fred Hutchinson Cancer Research Center’s survivorship program in Seattle. Health care providers usually make clear to their patients when sexual contact should be limited. They may not always be as diligent at letting patients know when they can begin having sex again.
“We’re very quick to say, ‘Your white blood count is low, you’re at risk for infection, so no open-mouth kissing or sexual activity,’” Heron says. Patients with a low platelet count may also be advised to avoid sexual activity. “But we don’t do a very good job of then saying, ‘Hey, your white blood count is good again. Go for it!’”
It’s OK to Have a Ton of Questions
Sexual-health issues following cancer are the norm, says Heron. In fact, an estimated 60% to 80% of all patients who've gone through cancer treatment (of all types) report having some side effects relating to intimacy and sexuality, according to the American Cancer Society.
Since sexual-health questions come up before, during, and after kidney cancer treatment, patients should be empowered to bring up the subject with their health care providers anytime, says Lisa Egan, P.A., a physician assistant with Oregon Health and Science University (OHSU) Knight Cancer Institute. And if your doctor isn't able to give you the support and info you need, ask for a referral.
You Might Have More Than One Sexual Health Issue at a Time
While some people are faced with one main challenge regarding sexual function, more often there are a variety of sexual-health issues that arise during or after treatment for kidney cancer. “It’s rare that sexual dysfunction is driven by just one element,” says Dr. Bober. “Our sexual function is generally at the intersection between biology, psychology, and interpersonal relations. When someone goes through cancer treatment, we often see disruption in more than one domain.”
Guys, Your “Hydraulic System” Could Fail
Treatment or removal of a kidney can impact many systems and tissues in the body. For instance, reduced kidney function can lead to high blood pressure, Heron says. However, blood-pressure medications are also known to cause erectile dysfunction for some men. Here's why: “You can think of [men’s sexual physiology] as a hydraulic system,” she explains. “If there isn’t enough blood pressure, then the hydraulics don’t work.”
When sexual dysfunction occurs for either men or women it can impact their sense of self and their ability to feel connected to their partner, Dr. Bober says. There are prescriptions available to help treat erectile dysfunction, but an Rx is not necessarily a silver bullet. Oftentimes counseling is also needed to help resolve sexual dysfunction, Dr. Bober says.
Ladies, You Might Have Trouble Getting Aroused
For women, vaginal dryness is often a problem after kidney treatment. If vaginal tissues aren’t moist or if they lose their stretchiness, a woman’s ability to be aroused before or during sex can be impacted, says Heron. In particular, chemotherapy can dry out skin and tissues, including those around and in the genitals, she says.
“We talk about how chemo dries out your mouth, and how this puts you at risk for cavities,” Heron says. “Those same mechanics can dry out the vaginal canal.” Egan strongly recommends addressing these physical effects with your gynecologist, who may be able to recommend vaginal lubricants, long-lasting vaginal moisturizers, and vaginal estrogen products that can help, she says.
Cancer Treatment Could Kick-start Menopause
Chemotherapy may induce menopause or increase menopausal symptoms due to sudden estrogen deprivation, which is different from the gradual hormonal changes that women usually experience in natural menopause, Dr. Bober says. The symptoms of chemotherapy-induced menopause can be more severe, particularly in causing vaginal dryness. The sudden onset and severity of menopausal symptoms requires extra care.
It’s Common to Feel Disconnected From Your Partner
Egan says that many of her patients are still reeling from their cancer diagnosis as they undergo treatment. The news often impacts patients’ feelings of safety and their sexual identity, says Egan. Another blow to sexual intimacy: when one partner takes on a caregiving role that's largely focused on helping the patient through treatment. Of course you want to be there and do everything you can. But it's important to recognize that “this changes the dynamic of the relationship,” often disrupting the intimate bond the couple enjoyed before, Egan says. But it doesn't have to stay that way.
A Consultation With a Sex Therapist is a Game Changer
“Consulting a therapist or psychological counselor who is experienced in helping couples or individuals with intimacy is often a good idea,” says Dr. Bober. Sometimes talk therapy can unravel the issues that may be impacting your ability to get close or feel connected with a partner, Egan says. The American Association of Sexuality Educators, Counselors and Therapists (AASECT) can help you find sex therapists or sexuality educators in your area.
Keep on Talking (and Talking)
Heron suggests couples begin rebuilding intimacy by having an open, honest discussion about their relationship. If talking face-to-face about the topic provokes anxiety, try writing a letter. The key is to let your partner know that you would like to rekindle intimacy, even in small ways, such as holding hands or kissing goodnight. Egan gives “homework assignments” to cancer survivors and their partners with the goal of regaining feelings of safety and connectedness. She asks them to spend a month hugging, holding hands, and kissing, without attempting sexual intimacy. She urges couples to remember what it’s like to be physically close without “any pressure to proceed,” she says.
Have Fun Outside the Bedroom
Another step toward intimacy is to revisit activities that you’ve enjoyed doing together, Heron says. During kidney cancer treatment, you and your partner were likely preoccupied with appointments, treatments, and medications. Now it’s time to resume old pastimes you can do together— hikes or walks, house projects, travel, and the like. “Remember that you like each other,” she says. “It sounds simple, but it’s easy to forget. It’s like, ‘Oh, hey, there you are.’” Sharing experiences can rebuild a sense of closeness and break down barriers.
Take Things One Day (or Night) at a Time
Once you feel more connected to your partner, reintroduce what you’ve enjoyed together sexually. It’s important to manage expectations, however, as your sex life may not click into place overnight. And that’s OK! “Allow each time to be its own time,” Heron suggests. “Maybe on Thursday things didn’t work so well but think about what you can try that’s different next time. Maybe you can allow more time for foreplay and add a water-based lubricant to make things easier. Or try that Cialis the doctor prescribed for erectile dysfunction." And most of all remember this: A dormant sex life doesn’t have to be the price you pay for cancer treatment.