Table 135 Questions about Intimacy and Infertility to Ask Your Doctor

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For Women

Will cancer treatment leave me with a temporary or permanent loss of sensation? If so, what can I expect? Will I experience painful intercourse (due to reduced vaginal lubrication or changes in the genital tissue)? If so, what can I do about the changes? Will I undergo premature menopause? If so, how can I treat the symptoms?

For Men

Will I have less feeling in my genitals? If so, how will it affect me? Will I be left impotent or have difficulty maintaining an erection or ejaculating? If so, what can I do about the situation?

For Men and Women of Childbearing Age

How will my cancer or the treatment affect my fertility?

Can I freeze my sperm or eggs?

What are my options for having children after treatment? For Everyone

When can I safely resume sexual activity? Will I experience less sexual desire (decreased libido)? Will I experience less physical pleasure with intimacy and sexual intercourse?

Are there any special precautions that I should take?

Will any of the medications (or other treatments) I am currently taking affect me emotionally or physically with regard to intimacy? Are my issues with intimacy going to be permanent? Can you offer me suggestions (about creams, medications, devices, etc.) on how to improve my ability to be physically intimate? Can you refer me to a professional who specializes in the type of intimacy issues that I am dealing with?

You may also want to consider other professional help with intimacy issues. Cancer centers often offer sexual rehabilitation services such as an evaluation of the physical problems that might contribute to difficulty with sexual intercourse and counseling for those who are dealing with emotional issues that can impact intimacy. Sexual dysfunction clinics may be conducted by your local hospital or a private group in your area. These clinics typically offer the same types of services as a cancer center does and can include health professionals such as gyne-

cologists, urologists, endocrinologists, psychiatrists, psychologists, and clinical social workers. Sex therapy, another option, usually involves working as a couple with a mental health professional for a specific period of time (usually around ten to twenty visits). The goal of sex therapy is to treat issues specifically related to intimacy. Underlying marital problems are better addressed in traditional couples therapy. For more information on resources, see the Appendix.

Regardless of where you are in terms of your treatment, improving intimacy with your partner is an important goal. Physical intimacy is a significant part of most adult couples' relationships, despite age and illness. But cancer can and does get in the way. As psychologist Leslie Schover writes in Sexuality and Infertility after Cancer, "Sex and cancer are two words that do not seem to belong in the same sentence. We think of sexuality as a force for joy and new life, whereas cancer is a death force. Increasingly, however, men and women survive their cancers. . . . Being able to enjoy sex is one important battle in winning the war against cancer."

Note also the part that nonsexual physical intimacy can play. Joyce and Barry Vissell (a nurse and a psychiatrist, respectively) write in The Heart's Wisdom: A Practical Guide to Growing Through Love, "Snuggling, hugging, and touching each other (especially in a non-sexual way) is an essential ingredient for every relationship. . . . Such a simple act can carry much power to sustain and heal our relationships far beyond what the mind thinks possible."

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