Individual Psychotherapy, Couples Counseling + Sex Therapy

Breast Cancer, Sexuality & Intimacy – Part III Let’s Keep Talking About Sex…

images-2So many people have been socialized that sex is dirty, bad, or at the very least not to be talked about. This becomes a bit of a challenge for couples, especially when there is a cancer diagnosis and treatment, because things change. Sex and intimacy are affected. Bodies changes, desires change, what feels good or not so good might change. There may need to be more planning involved and less spontaneity than there used to be.

Without discussion about sex and intimacy, couples can get lost and distant from one another. Generally speaking, males can feel that the distance and lack of spontaneous desire on the female partners’ part may be because she is no longer interested in him. Females may indeed have less spontaneous desire for sex due to issues related to cancer treatment, or possibly due to the aging process or the fact that there is often less spontaneity in a long-term relationship, or all of the above. Women may also feel as though her partner no longer desires her sexually, especially after surgery. Without a conversation about this, it may not be clear if the partner is no longer interested in her, scared of causing physical pain through intimacy, emotionally flooded by all the treatment, or feels pushed away.

In many relationships, partners often try to read one another rather than talking and asking questions. Maybe we think we are saving our partner’s from having to explain things to us. Or, we are trying to save ourselves from having difficult conversations. Sometimes we can be correct in our readings, though many times reading rather than talking can lead to a lot of misunderstandings.

Here are a few points specific to having a discussion about sex and intimacy that you might find helpful:

  • Do not start a discussion about sex right after you have had sex. Only say positive things directly afterward because most everyone is feeling vulnerable after sex.
  • Start a conversation by stating something positive like, “I love you and I want to be closer to you. I know this might be a little awkward, but I would really like to talk about…”
  • Try to have a discussion about sex when you have your clothes on and in a room other than the bedroom.
  • Since the mind/brain is the #1 erotic zone, a discussion about sex may lead to some sexy time, but this should not necessarily be the goal.
  • Know that there may need to be ongoing discussions; this topic is not usually covered in just one conversation.
  • Start the conversation with things that you enjoy about sex with your partner.

Here are a few main points of broader discussion topics, just to start a discussion with your partner:

1 – Discuss your history with sex – where did you each first learn about sex both verbally/non-verbally? Did your parents talk to you about ‘the birds and the bees’ or did you learn from friends, siblings, television? Did you have anyone talk to you about sex growing up at all? Were you raised in a religious household – if so what was the message from your church about sex? What messages were you given about sex/intimacy that may not have been verbal at all? If sex was not talked about – what message did you receive there?

2 – What are your turn-on’s and turn-off’s? Share with each other. I just finished reading “Come as You Are” by Emily Nagoski. This is an excellent book and highly recommended!

In the book, she discusses this as the dual control model, using the metaphor of a car’s accelerator and brake – some things are accelerators and make you step on the gas sexually (turn ons), while other things can be like the brakes and bring you to a screeching halt sexually (brakes).

Share what your accelerators and brakes are with each other. Examples: For some, certain erotic zones being kissed or touch in a particular way can be an accelerator. Also, some areas of the body being touched or even looked at may act more like a brake. This can be especially true after breast cancer surgery. It is important for your partner to know what seems to work as a brake and what is working like an accelerator. Think about and discuss times before, during, and after sexy time to express what are your accelerators/brakes.

3 – Context, Context, Context – It is all a matter of context. Try and remember the last 1 or 2 times you really enjoyed sex with your partner. Share those times and what made them so good. Take note of the context they were in. Were you really relaxed? If so, what helped you feel relaxed? Were you on vacation?

Going along with accelerators and brakes, what made a positive/sexy context, sexyand positive for you? How was your physical and emotional wellbeing? Body Image? Worry? Stress level? Think through all your senses – Smell, taste, touch/feel, sight, hear – what was happening in all these areas? What setting were you in? How were you feeling about the relationship? What kind of sex was it or what really worked well for you – oral, intercourse, gentle/sexy touch, holdiimagesng hands, massage, caressing, etc.

This can all be found in Emily Nagoski’s book, “Come As You Are”

4 – Discuss if intercourse might be better taken off the table for a period of time while you learn how to be intimate in other ways. We often think of sex only as penis-vagina intercourse. This can be challenging during and after cancer treatments, of course. This can also set couples up for being bored or stuck in routine sex

To help couples get closer together through intimacy, it can be useful to remove this particular kind of sex from your repertoire for a period of time. This is especially true when women are experiencing pain or discomfort.

Taking intercourse off the table can help women feel less anxious about getting close physically, without the pressure of intercourse weighing on them. Sometimes women can feel as though every touch, caress, or physical gesture is presented as a lead into sexual intercourse, even when their partner simply wants to be physically close. Without a discussion around this, there can be times when women pull away in an effort to avoid sex, and other times women might engage in intercourse to please her partner. Over time, women may feel resentment or even physical pain because she was not interested or aroused.

Limiting intercourse does not mean that you cannot be intimate or connected through sex. There are so many ways to have sex and by removing the most common, routine way, you are forces, as a couple, to come up with new ways to connect and be close. Think of this as rediscovering each other and being playful rather than a loss.

You may still need to mourn the loss of the way things were and that they may not be the same, but this can create something more intimate in many ways and soon you can celebrate your new connection!

 

Kimberly Atwood is a holistic psychotherapist working with individuals and couples in private practice in Princeton, New Jersey and Doylestown, Pennsylvania. She specializes in women’s health and sexual wellbeing, intimacy and relationship issues. For more information, please check out her website: kimatwood.com

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Kimberly Atwood, MA, LPC
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