Relationships are hard under the best of circumstances. Cancer makes it harder

The Trouble with Intimacy

The following is an excerpt from The Big Ordeal: Understanding and Managing the Psychological Turmoil of Cancer, by Cynthia Hayes, in bookstores February 2021.

Many of us going through cancer treatment are so thankful to be alive we don’t think we have a right to expect a sex life too. But sex is a part of living. It feels good. Sex contributes to a sense of vitality. It releases hormones that create a warm glow long after the sex is over. And helps us maintain intimacy with our partners. But sex and cancer don’t always play together nicely. 

Research shows that 30 to 100 percent of cancer patients have some type of sexual difficulty1. And with good reason. As if the psychological stress and loss of sense of self that come with being deep into cancer treatment weren’t enough, there are some very real physical changes that interfere with sexuality for nearly all cancer patients, starting with fatigue. 

When you are saving every ounce of energy to get through the day, it can be hard to find the personal resources to initiate or respond to sexual activity. But it’s not just that we are tired. Fatigue and its corollary, inflammation, make it hard to feel sexy. Inflammation is caused by pro-inflammatory cytokines, chemical messengers that tell the brain how to deal with threats and encourage “sickness behavior.” And while that sickness behavior may drive us back to bed, it’s not with any pleasurable intent in mind… 

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  1. J. Carter et al., “Interventions to Address Sexual Problems in People
    with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline,” Journal of Clinical Oncology 36, no. 5 (February 10, 2018): 492–511, doi: 10.1200/ JCO.2017.75.8995; D. S. Dizon, S. Suzin, and S. McIlvenna, “Sexual Health as a Survivorship Issue for Female Cancer Survivors,” Oncologist 12 (2014): 202–10,

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