For both men and women, cancer and the treatment of it can have a devastating impact on body image and self-esteem with obvious consequences for one's relationships and sex life.

It’s not every day that one hears the words “mind-blowing sex” used in the same sentence as “cancer”. But it’s what Patty Brisben, founder of the US-based Foundation for Women’s Sexual Health, would like anyone who has had to deal with the dreaded “Big C” to enjoy.

“Any man or woman who has been diagnosed with cancer knows that there is an endless amount of information available about different types of cancer, symptoms, tests, treatments, side effects and even how cancer can affect sexual performance,” says Brisben, who has just published an e-book, Sexy Ever After, which deals with the issue of intimacy for women who are dealing with cancer.

What is not generally available – and in fact very difficult to come by given taboos that exist when it comes to talking openly about sex – is information on how to overcome, and work with, the impact of cancer and its side effects as they relate to sex, sexuality, body image and relationships.

“A cancer diagnosis can require a redefinition of what sex is,” says Brisben. Cancer treatments can change not only the physical body, but also the way a man or woman experiences pleasure. In fact, it can impact a person’s entire relationship with their sexuality, their partner and themselves.

Chantal Edouard-Betsy, co-founder of The Bedroom “boudoir boutiques” in Durban says it is common for women to visit their stores “pre- and post-mastectomy, as well as while undergoing chemo. Their biggest concern is the lack of libido and lubrication, which is caused by the chemo.

“We usually counsel them to assure them, first of all, that what they are experiencing is completely normal for their circumstances. Hearing this is often even more important than any product we can give them because they are often too afraid or embarrassed to ask their doctors about libido and lubrication issues and they feel alone.”

“Sexuality is typically a below-the-radar topic when it comes to cancer,” says Donnée Ness, a Durban physiotherapist who specialises in working with men and women impacted by cancer. Ness is a member of the “C-Sisters”, a group of women touched by cancer, personally or through their work, responsible for a new book, A Practical Guide to Breast Cancer in South Africa. Sponsored by Novartis, it is available free in print form and as a downloadable e-book in English and Zulu.

The book includes a chapter on breast cancer and sexuality by Professor Elna McIntosh, a clinical sexologist and president of the sub-Saharan Africa Society of Sexual Health Advisors, Educators, Researchers & Therapists (Sassert).

“In our culture, sexual pleasure is still a dangerous commodity with dangerous overtones,” she writes.

“It is one of the first things we toss overboard during life’s storms. We forget that it’s as much a part of us as the need to eat and breathe.”

Brisben, whose US-based direct-selling company (Pure Romance) specialises in relationship and intimacy aids, agrees.

“Not only does maintaining an active sex life keep the intimate connection between you and your partner strong (and a cancer diagnosis can sometimes cause a rift), but toe-curling orgasms don’t hurt either,” she says.

“So yes, learning to love one’s body all over again after a cancer diagnosis is important, even if a change is required in the bedroom in order to accommodate new sexual needs.”

For both men and women, cancer and the treatment of it can have a devastating impact on body image and self-esteem with obvious consequences for one’s relationships and sex life.

A man faced with impotence or erectile dysfunction can feel stripped of his masculinity; a woman who has had a mastectomy, cervical cancer or ovarian cancer can feel she has been divested of her femininity and that she no longer has a right to be sexual. Body image and self esteem issues can result in depression.

Durban financial consultant Val Logan, who writes about her relationship with what she calls “my new partner” – the drug Aromasin that she has been taking for two years and has to take for three more – in the “C-Sisters” resource guide, says the least discussed subjects when it comes to cancer are sex and libido. She says the Aromasin, which she is taking to reduce the risk of recurrence, turned her off sex as one of the many side effects – which include arthritis and insomnia – is severe vaginal dryness.

“Being female and having cancer creates a lot of mental challenges,” she says.

Logan, 58, had a mammogram in May 2008 and was given an all-clear. In August of the same year the cancer was diagnosed. By then it had spread into the lymph nodes. “When I lost a breast, I feared my husband would reject me. He was, however, wonderfully supportive,” she says.

“But very little is said about sexual implications… It’s all very well being advised on what one should do, but it’s difficult to not shy away from sex when there’s discomfort… ”

“It is essential post-cancer to communicate, communicate, communicate with your partner,” says Brisben. “And if it’s your partner who had cancer, then listen, listen, listen. Take the time to get to know your body again and your partner’s body. Explore how your hot buttons have changed and what you can do to rewrite your sexual script.

“Just remember that redefining sex requires an open mind, constant communication, a little bit of effort and some creativity.”

Studies show that 40 to 100 percent of men and women who have been treated for cancer – and 95 percent of young survivors of breast cancer – have had their sexuality adversely affected by the cancer or experienced some level of sexual dysfunction, says Brisben.

“Traditional intercourse is not the only option you have when it comes to intimacy,” she adds, suggesting that men and women think of making love “with your hands, your mouth, your tongue (or all three).”

Masturbation should not be ignored. And, she suggests, “consider it a personal challenge to find all the ways in which you can bring each other to orgasm without having intercourse”.

Heightened intimacy, Brisben adds, is not only possible, but desirable.

“Sexuality is a vital part of one’s health and sense of well-being. To put it under the carpet because you’ve been sick is shutting off an area of your life that is a source of vitality,” she says.

“As soon as you can, go back to having sex regularly and aim to eventually have it at least once a week. Engaging in sex this regularly increases libido levels. It’s a win-win.” - Sunday Tribune

* Sexy Ever After can be found at http://goodinbed.com/

* A Practical Guide to Breast Cancer in South Africa can be found here: http://www.physiosolutions.co.za/downloads/resource-guide-for-breast-cancer/