Open to any cancer survivor who has completed treatment (not including ongoing hormonal or immunotherapy). Each virtual session will include a guest speaker and Q&A session, immediately followed by an optional 45-minute support group discussion. https://www.summitmedicalgroup.com/event/what-now-cancer-survivorship-speaker-series/

1. Intimate Relationships After Cancer
Presented by:
Susan Angelicola, MSN, APN
Women’s Health Nurse Practitioner
Department of OB/GYN

2. “No matter what one’s gender
identity or sexual orientation we
all have the basic needs of
expression of our sexuality, the
need for love and bonding.”

3. What is sexuality?
• Human sexuality is the way people experience
and express themselves sexually.
• This involves biological, erotic, physical,
emotional, social, or spiritual feelings and
behaviors.
 It is not as simple as how often we have sex or who we choose
to have sex with…

4. Sexuality encompasses nearly every
aspect of our being, from attitudes and
values, to feelings and experiences. It is
influenced by the individual, family,
culture, religion/spirituality, laws,
professions, institutions, science, and
politics.
~It is not limited to the act of sex~

5. What is intimacy?
• Knowing
 A truly intimate relationship lets both people know one another on the deepest
level
• Acceptance
 Neither person feels the need to change the other or to change themselves in
fundamental ways
• Appreciation of differences
 Discovery of differences and appreciation for each other’s uniqueness
• Safety
 True intimacy happens when both people feel safe enough to be vulnerable
• Compassionate problem solving
 Issues are confronted by both people with love, compassion and a willingness to
engage with whatever problems have come up

6. Intimacy and sexuality are different for every
person and every couple.
• Age
• Stage of life
• Relationship status
• Individual differences and preferences
• Sexual orientation
• Health

7. As a result, each individual and
couple comes to the journey of
cancer and cancer survivorship
differently…

8. The desire to have optimal quality of
life is the one thing that is not
different.
Intimacy and sexuality are integral
components to quality of life, even
during the lived experience of cancer
and beyond.

9. Statistics
• Cessation or decreased frequency of
sex and intimacy was reported by 59%
of women and 79% of men
• Reasons include the long-lasting impact
of treatments, exhaustion and
repositioning the partner who has
survived cancer as a patient, not a
sexual partner.

10. Upon diagnosis,
there are immediate life changes.
• Diagnosis itself including visits, testing, imaging and
planning
• Communication with friends and loved ones about
cancer
• Surgery or other operative intervention
• Treatments

11. Long Term Changes
that Continue into Survivorship
• Physical alterations
• Body image
• Long term effects of treatment
• Change of roles

12. Physical Alterations & Body Image
• Scars, changes to skin and/or hair
• Loss of weight/frailty
• Acceptance of new appearance
 Concern about still being viewed as a sexual being
• Partner’s acceptance of new appearance
 Concern about hurting your loved one during
sexual activity

13. Physical Changes to Sexual Functioning
• Vaginal atrophy and GSM
• Erectile dysfunction
• Treatments
• Surgical or treatment induced menopause and
related side effects

14. Long Term Effects of Treatment
• Fatigue
• Appointments and time spent maintaining
well being
• Living with fear of recurrence
 Anxiety and depression
 Feelings of isolation or inadequacy

15. The New Normal of Sexuality
and Intimacy
• Renegotiation of both was reported by
only 19% of women and 14% of men
 Non coital sexual practices
 New ways to express sexuality
 New ways to please one another
 Maintaining physical closeness without the
pressure of coitus

16. This renegotiation is important!
• Couples who decrease or discontinue sexual
relations will often decrease expressions of
non-sexual intimacy
• Non-sexual intimacy can help break this
potential cycle that may add to adjustment
problems
 Non-sexual intimacy includes verbal expression of
affection and love, physical expressions of
affection, sharing emotions and communication

18. Positive Affects
• Increased emotional closeness
• Expansion of physical pleasure
• Appreciation for the relationship
• Exploring the new normal together as a
team

19. Communication is Key

20. Communication
• Within relationship
• With health care providers
• In support groups or with others who
share the same lived experience

21. Barriers to Communication
• Helplessness/frustration
 Sex hurts, afraid to try, why bother?
• Embarrassment
 Not knowing where to begin, how to bring it up
• Misinformation
 Cancer is contagious, sex will make the cancer
come back

22. Aides to Communication
• Active listening
 “are you bothered by this change in our
sexuality/intimacy?”
• Define concerns and barriers
 “what are your concerns or frustrations?”
• Discuss needs
 “let’s think of ways together to improve our
intimacy”

23. References
• American Sexual Health Association
• University of Louisville, CHS
• Hawkins, et al., (2009). Changes in sexuality and intimacy after the
diagnosis and treatment of cancer. Cancer Nursing, 32, 4, 271-80.
• Taylor, C. (2005). Spousal intimacy after cancer. Gynecologic
Oncology, 99, S217-18.
• https://www.yumpu.com/en/document/read/3935039/intimacy-sexuality-
and-relationship-issues-after-cancer