Sexuality and cancer may not seem like an obvious combination. Yet a large number of people, especially women after breast cancer, have to deal with questions about their sexual health. Fortunately, help is available: Nienke Dekkinga, a sexual health counselor, helps make these topics easier to talk about. She provides training for patient organizations and gives lectures to healthcare professionals in oncology. Her message is powerful: it is possible to regain your desire for sex, even after a major oncological treatment journey. A few weeks ago, I attended an online masterclass with her, and I am happy to share this information with you in this (or these) blog post(s).

How do you make sexuality easier to talk about?

Sexuality is a topic we often prefer to avoid, especially when it comes to the impact of illnesses such as cancer. Often, we are not thinking about it at all and are simply in survival mode. 

The idea that sex is "taboo" after such a major experience makes it difficult for many people to talk about it – both with their partner and with healthcare professionals. And at that moment, it is not only the patient's fault. Healthcare professionals do not always know how to deal with this topic either. Yet, discussing sexuality is important for yourself and your relationship. 

It starts with open communication. How do you feel about your body? What works for you in bed now, and what no longer works? Sexuality is not only about physical acts, but also about how you feel in your body. If you have difficulty enjoying sex, this can have a profound effect on your self-image and your relationship. It is important to explore together with your partner what works and what does not. And, if necessary, to involve a healthcare professional. This could mean that your GP supports you with this, or that you start a conversation with a sexologist. 

How do you rediscover sexuality after breast cancer?

After breast cancer, you may have to get to know your body again and explore how to regain your sexual desire and pleasure. Treatments can cause many changes in your body: hormone therapies can dampen your desire for sex, chemotherapy can cause fatigue and nausea, and surgeries can cause physical changes that affect your sexual experience. Think, for example, of scars or changes in how your breasts feel.

A large-scale study in 2017 involving 3,000 women showed that 51% of women no longer experience sexual desire and 60% suffer from vaginal dryness. For 40%, penetration causes pain, and 26% have difficulty reaching orgasm. These figures can be quite shocking, but it is important to realize that there really is something that can be done about this! 

The impact of cancer on sexuality goes beyond the physical changes in your body. The psychological consequences are often just as profound. Many women who have completed their oncological treatments continue hormone therapies for years, which can further reduce their desire for sex. What used to be exciting may no longer work. Your sexual response cycle changes, and you will need to use patience and creativity to find pleasure in sex together again.

The sexual response cycle and how to get it going again

In the past, people thought that sexual desire came spontaneously, but the reality is often different. Especially after cancer treatments, you may have to work harder to build arousal. It starts with understanding the sexual response cycle. In both men and women, physical arousal is activated by sexual stimuli, such as an erection in men or an engorgement of the clitoris and vaginal lubrication in women, but after treatment, this process can become disrupted.
Many women, for example, find after breast cancer that their clitoris becomes less sensitive or that they have difficulty becoming aroused. If your body no longer responds automatically, extra stimulation can help. Lubricants (link) can, for example, help with vaginal dryness. Do not be afraid to discover new ways of becoming aroused.

Physical health and sexuality

Your physical health plays a major role in how you experience sexuality. Poor fitness, being overweight, and smoking can have negative effects on the blood vessels, which affects your sexual response. Improving your fitness through exercise and healthy eating can enhance your sexual experience. In addition, make sure you get enough rest and recovery, because this helps not only your physical well-being, but also your mental well-being.

Mental health and sex

Your mental state has just as much influence on your sexuality as your physical health. The way you look at sex, your "sexy state of mind," can make a difference. When you have negative associations with sex due to pain or a bad experience during the illness, this can block your desire. It is therefore important to communicate together with your partner about what feels good and to explore your thoughts and feelings about sex. With patience and an open attitude, you can find new ways to enjoy intimacy, even if sex does not always feel the same as it did before you were ill.

How do you find out what works for you?

What works for you varies from person to person. It is important to find out which stimuli arouse you. Perhaps stroking your skin is no longer as pleasant as it used to be, but you feel aroused by an erotic message or by sharing an intimate moment. For example, listen to an erotic podcast. Or share your erotic desires with your partner. This does not mean that you actually have to act out those erotic desires. But simply talking about it can help to create sexual arousal. Sometimes the experience of sexual stimuli can change due to treatment, so it may take some time before you discover what works for you.

Also important: do not be ashamed of using lubricant for vaginal dryness. Try giving or receiving an erotic massage. Sex does not always have to be the same as it was before the illness. New ways of intimacy can also bring satisfaction and pleasure. If penetration does not work for you right now, you are allowed to say so. Sexual pleasure is not only about penetrative sex.

Sex after cancer

Sex after cancer does not have to stop. Sex can feel different and it can take more effort to get your body in the mood again, but with patience, communication, and openness with each other as a couple, sex can become pleasurable again. The most important thing is to take the time to rediscover your body and desires and to work together with your partner on a pleasant sex life. As Nienke Dekkinga says, it is mainly about the question of how you can look at your sex life with satisfaction, and how you can achieve that together.