Sex After Cancer

With a therapist or on their own, partners can try “sensate focus exercises” that involve them in exploratory touching without the pressure to achieve a goal like orgasm. Pelvic floor exercises, vibrators, techniques for dealing with scar tissue and restricted range of motion, dilators as well as lubricants: Dr. Guntupalli and Ms. Karinch tackle these specifics to encourage survivors to redefine sex after cancer as a sensual source of delight in a range of activities.

To illustrate this point, they tell the story of Allis, a 49-year-old ovarian cancer patient who undergoes “a total pelvic exenteration” (the surgical removal of the bladder, urethra, rectum, anus, vagina and cervix). She awakens with a permanent colostomy and a urinary diversion. She must wear two bags to collect feces and urine. To her dismay, gone are her cute thongs, replaced by granny panties. She buys an ostomy belt (to protect and hide the bags) as well as a black negligee.

But she sobs when her husband’s embraces bring home the realization that there is “no way to have normal sex.” After he reassures her that they can be creative, they begin getting ideas by visiting what she calls “naughty stores” and then exploring every possible way to enjoy themselves together.

Not facing such extreme physiological impairments, the youngest member of my support group nevertheless found herself “less easily aroused and less orgasmic.” Her explanation of how she cultivated “the art of desire” strikes me as illuminating for women and also for men.

She uses exercise to appreciate her body’s tremendous resilience; acknowledges that she is anatomically, psychologically and hormonally changed; experiments with solo sex and also extended foreplay with her partner; and samples the shared stimulation of movies, concerts and travels to create a sense of closeness. Since her marital bed had been her sick bed, she refurbished the bedroom with sensory stimulants. It now promotes joy in her partner’s life and in hers as well.

When Eros disappears, books and conversations can help couples prepare to welcome the god’s return. As the poet Marianne Moore once put it, in an entirely different context, “Whatever the problem, we must elude the sense of being trapped — even if all one can say to one’s self is, ‘if not now, later.’” For many people, better later than never.

Yet this is not the case for everyone, I realized when my contemporary and fellow academic Nancy K. Miller responded to my request for input on the issue of sex after cancer. In her 70s, she has, like me, managed the disease for years. With precisely the exasperation I associate with the intimacy I crave, she shot back, “You expect me to remember sex?” My laughter was a total turn on, as I bathed in the bliss of cherishing my friend’s candor.

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