This is a huge issue and something I can’t hope to do justice to in a blog.
It’s complex, too: it’s not just about overcoming any physical side effects but going back to thinking of your body as something that gives you pleasure as well as life. Add fear of rejection if your body isn’t the same, particularly if you’ve battled breast cancer.
If you’ve had cancer, I would highly recommend Woman Cancer Sex by Anne Katz (she does Men Cancer Sex also). The joy of the internet is you will generally find a book, website and/or support group for whatever your particular illness or surgery was.
Here’s some general advice which will help you to become sexual again after any sort of illness or surgery.
Find out all you can about the sexual side effects of your treatment
This can be easier said than done because it’s a rare specialist or surgeon who will voluntarily bring up the topic of sex. Most assume you’ve got bigger fish to fry and it will be the last thing on your agenda (quite right, at the time), others don’t want to invade your privacy. If they seem uncomfortable talking about sex with you, ask them to recommend a colleague who isn’t. Keep asking until you get answers.
You need to know: when it’s OK to start having sex, what you can do to get back in shape for sex, what the sexual side effects of any medication or surgery are likely to be.
Ask for pain medication if you need it and time it so it kicks while you’re having sex.
Sexual side effects. These nearly always include pain on penetration, lubrication issues, difficulties having an orgasm and erection issues for men. For both of you, it’s likely you’ll be more tired and have less energy than before which translates to a loss in desire. This means you have to think about sex and plan around these things. Turn planning sex, anticipating what’s going to happen, into part of the fun.
Talk honestly to your partner about how you’re feeling
Hopefully, they were with you in the appointment when you asked about the side effects. If they weren’t, fill them in. Talk openly about how you feel about sex now – and let them know when you’re ready to reconnect. Lots of partners won’t initiate for fear of pushing you too soon. They’re also worried your body has already been through so much, you might not want to do anything physical. Talk through any fears and let them reassure you. Give lots of feedback when you do start having sex again.
Practical solutions that work
Don’t think: That’s clearly the end of sex for us because I can’t do X.
Do think: What’s the best way to solve this? How can we get around this problem?
If fatigue is a problem, have low effort sex where your partner takes over and you lie back and enjoy. Time it for the time of the day when you feel most energised.
If penetration hurts, don’t do it. Sex isn’t just about intercourse. Oral sex is still enjoyable. So is stroking, touching and using clitoral vibrators that are used externally.
If your vagina is dry, use lube and talk to your doctor about an estrogen ring or testosterone patch to regain vaginal elasticity.
If your vagina is too tight, dilator therapy can help. This involves inserting very slim dildos inside the vagina, increasing the size as you get more comfortable.
If it takes longer to be aroused, spend more time on foreplay. Schedule sex so you can prepare and arouse yourself beforehand,
Sex toys do most of the work for you both: use them. Vibration can also help break up scar tissue and increase blood flow.
Rediscover what now works and what doesn’t. What did it for you before, might not do it now. Try the Sensate Focus Program (Px) for a sensual, explorative way to touch each other’s body.
If you’re nervous, try having an orgasm solo before having one with your partner.
Think sensual rather than sexual. Sleep in the nude. Massage each other. Have a bath together.
A happy ending
This is an inspiring story of sex after illness, told me to by a 51-year-old woman who’d had a whole host of different surgeries (including surgical menopause and removal of an ovarian tumour).
I felt ravaged – emotionally and physically – after it was all over. And I looked like Frankenstein with dozens of staples all over my stomach. I’ve been with my husband for years and we’ve always had regular sex but we didn’t have sex for six months. When I was able to have sex again, we both thought, well, we might as well wipe the slate clean and start fresh. We turned it around into a positive thing and started dating again, like we’d never had sex before.
“We went away for the weekend with the idea that we’d finally do it but then didn’t on the first night because we both felt too much pressure. We did it the next day instead, with little fanfare, when we woke up, like we used to. I was terrified the man who’d always fancied me wouldn’t now, with my scarred, ravaged body. But it was wonderful. All is fine and it’s even better than it was before.