Speaker 1: Welcome back to all of my listeners and welcome to all the new listeners. This week I’m tackling the tricky subject of sex after cancer with dr Stephanie Buehler. There’s no way around it having cancer sucks, but Stephanie says you can still have a satisfying sex life that can make you feel more alive. Stephanie, a licensed psychologist and a sec certified sex therapist. That’s the American Academy of sex educators, counselors and therapists works at Hoag hospital in Newport beach, California with many cancer survivors. She’s the author of her bestselling textbook. What every mental health professional needs to know about sex. She believes that although talking sex and cancer may be awkward, we must remember that still having a sex life is very important to most cancer survivors because it can help them feel like they’re getting back to normal. Welcome Stephanie.
Speaker 3: Thank you, Joe. Thank you for having me on to talk about this topic today.
Speaker 1: Yeah, I’m so glad. First of all, so people know, we’ve been colleagues for a long time. I feel very familial with you every year. I see you at the sex therapy conference. You’re super smart. You’ve written several books and I just feel, and you know a lot about a lot of different things, so I appreciate you coming out on this topic.
Speaker 3: Oh, well thank you. And thank you for having me. It is, it is. It’s a very important topic and not one that gets talked about enough, uh, considering all the people that get diagnosed with all different kinds of cancer every year.
Speaker 1: Exactly. Go ahead. Go ahead. Oh, so I was just gonna say, what is one of the most important things you want people to know about sex and after cancer?
Speaker 3: Well, you know, I think that people need to understand that when they are in cancer treatment and, and afterward when everything is over, that their sex life may be different. It may be permanently changed, they can still have sex, but they have to be flexible and they have to be willing to try new things. They need to accept a new normal that, uh, you know what they, there’s sexual script, we’ll call it. So whatever it was that they did prior to the cancer diagnosis, may long no longer work and make cake, for example, it may take longer for a woman to become aroused or a man may struggle with erections after having prostate cancer. And they may need to learn how to integrate, uh, sexual tools and sexual AEs like Viagara into their sexual script. And it can be awkward and difficult, but they can do it. They can figure it out.
Speaker 1: I would imagine that
Speaker 3: things are very creative.
Speaker 1: We are, we are, but I would also imagine there’d be a lot of grief. Do you see a lot of that?
Speaker 3: I do. I do. I actually, I see all different kinds of reactions. You know, sometimes there’s grief and, and people have a hard time reconnecting. They may not have so much of a sexual issue per se, you know, they can both function sexually, but, um, you know, things are changed and life has changed. Like, I suppose they know it has changed. They have been, you know, confronted with the possibility of all kinds of existential possibilities and even the possibility of losing their partner and um, you know, they can, they need to feel that. And uh, because everybody is focused on the positive result, uh, and the remission of the cancer, it can be hard for them to recognize that they have all these other complicated feelings has roiling around inside. Um, but then on the other hand, I just saw a couple recently and because of the potential of loss, they became closer to one another. It’s like, Oh my God, I could, I could lose you. And uh, because of that, I want to feel closer to you than ever. I value you so much. And then they come in, they want to make sure that their sex life is optimized so that they can really enjoy each other, um, after, after going through this experience.
Speaker 1: So those are some of the effects of the cancer on the survivor and the primary relationship, right. About how they try to reconnect with each other.
Speaker 3: Right, exactly.
Speaker 1: W, what would you say are the types of cancer that are most likely to cause sexual problems?
Speaker 3: Well, definitely for men, it’s, uh, any kind of urological cancer, anything that, uh, affects the reproductive system. But, you know, the prostate cancer is the most common male cancer, and then their cancer also has an effect. Um, and then for women, it’s breast cancer. And then the gynecological cancer is cervical cancer, uterine cancer, uh, you know, and anything, uh, ovarian cancer, although, you know, ovarian cancer, very serious, um, very, very serious cancer. So, uh, you know, those cancers are more likely to affect people, but then also the things that we don’t maybe think about like head and neck cancers. Um, because you know, we use, we use our heads for sex, right? We’re kissing, we’re nestling, we’re stroking, you know, and with those cancers, sometimes there can be, um, changes in function, uh, and salivation, for example, or disfigurement because of radiation, uh, and functions. So those would be, the cancer is more likely to affect sexual function. But really any cancer, any cancer can get in the way because it’s such a, um, it’s traumatic,
Speaker 1: very traumatic. And we really don’t talk about this. Like you, what you just said. I never even thought about it. I mean, I’ve not had cancer. I’ve really not known anybody who’s had cancer. Even if I have, we’re certainly not talking about their sex lives, even, um, I mean, outside of my therapy room, but I haven’t had, uh, I’ve had a couple of clients who’ve had cancer in my therapy room. But like you said, also, we’ve, we’ve talked about that most, um, medical professionals aren’t trained in to talk to talk about this. Isn’t that right?
Speaker 3: That’s right. So recently I spoke at a conference, uh, it was, uh, focused on breast cancer and they did give us some time to speak about sexuality and cancer. But, you know, I ha I had 15 minutes to speak. And it’s a topic that I, I, you know, I could go all day talking about the effects of cancer on sexual function, but also on the relationship. Um, you know, so if we take breast cancer as an example, um, you know, the relationship becomes kind of medicalized. So sometimes when, you know, the, the, uh, partner who doesn’t have cancer becomes a real caregiver and they’re doing medical things. I mean, these days, you know, they send people home with all kinds of medical equipment. They all this other changing drains and bandages doing wound care and all kinds of things that really are not very sexy. And, you know, then at some point it’s like, well, that we’re, we’re done.
Speaker 3: And you’re just supposed to kind of flip a switch and see your partners. This sexual being again, plus their body has changed. And, um, you know, there’s research that just recently research that has been done that shows that, you know, men really do sometimes have like a, Oh my gosh, a reaction to changes in their partner’s body. Uh, and nobody, you know, we all want to think like, Oh, they, they figure it out. They just get over it. But, you know, the fact is that there’s some times quite traumatized and nobody’s asking them about that. So it’s, it’s very problematic. Um,
Speaker 1: it takes away the sexy, right? I mean, making things unsexy anymore,
Speaker 3: right? Things are not, Oh, I’m so sorry. Um, things are not sexy anymore. Uh, sometimes, you know, if couples had sexual problems before they had cancer or the one person had cancer, then, uh, that that just exacerbates everything. Maybe their sex life was just so, so, and this isn’t helping. Uh, and then couples that had a great sex life, they’re kind of surprised that, uh, they need to change things up or that the partner who used to have, you know, easy orgasms isn’t, and, uh, it can be very devastating.
Speaker 1: Now, what about, what are the most common problems women have with breast cancer and, and being sexual?
Speaker 3: Well, because many of them are, um, not only is the breast removed, uh, if there’s a mastectomy, uh, and so, you know, some women, that’s funny, you know, because I talked to a lot of women about their breasts and how they feel about their breasts. And some women are like mad, take them. I don’t care. They have disease. I, you know, whatever others are. Oh my gosh, you know, this is, this is really part of my identity, who I am as a woman, you know, because of course, you know, when we hit puberty, what makes us female, it’s the development of breasts, you know? And so it’s such a huge part of female identity. So the female identity, the loss of a tissue and sensation in the breast. And even if they have reconstructive surgery, sometimes the breast is, you know, it just doesn’t look the same as it did. Some women get a good result, that’s great, but some women really are disappointed. Um, so there’s all of that. And then on top of it, some women are needing to take medication like Tamoxifen that takes away all estrogen in the body.
Speaker 1: Oh my gosh, I didn’t know that.
Speaker 3: Terrible. And they’re left with a lot of, um, you know, terrible effects to their vagina. So, you know, there’s a lot of dryness and that can make intercourse uncomfortable or painful. Uh, Nick, uh, make it more difficult to become sexually aroused in a couple of night, need to change up. You know, maybe, maybe they’re used to having, you know, five minutes of foreplay that’s not gonna work anymore. And, and then of course, desire sexual desire can change as well because not only have you been through this whole thing that kind of makes you into kind of desexualize as you. Um, and then you have these chemicals that do a further number on your sexuality and you know, you have a partner going, well let’s get going like that. Okay, that sucked and it’s done. Let’s get back to, uh, being ourselves. And you know, that’s a sometimes a very tall order for a woman who’s had breast cancer
Speaker 1: and if they’ve taken her nipples, right, cause a lot of women choose to have right then, then they’ll have sensitivity. Oh that’s gone.
Speaker 3: Right. So, you know, like some women really enjoy nipple play and you know, that’s what gets the, actually some women have orgasms, your nipple play. So, you know, you take away that and then they’re okay. They’re kind of lost. Like, what now what do I do? We do now, how do I have an organism now? And so, you know, telling, I mean it’s, you know, it’s easier said than done. I mean, we can say to a woman and her partner, you know, well, you can try, um, seeing what other parts of the body are still sensitive. You know, like, you know, you lose sensitivity in one place, but maybe there are places that you haven’t explored, you know, on the neck or, um, like the inside of the thigh for example, where there might be a lot of sensation that that can be very arousing. And it can people, I mean, I, I’m sure you’ve experienced this, you know, people look at you like, what I can say a playing with my breasts are supposed to play with my neck. Yeah. What does that look like? Like, you know, you’re really having to ask people to change, change up the way that they have sex and the way they think about sex, the way they think about their bodies. Um, it’s, it’s a lot. It’s a lot to process. I think.
Speaker 1: What are the most common problems in men with prostate cancer? And before you answer, I think about this one client I had many, many years ago who said, you know, he struggled, he had some urination problems that, um, uh, what do you call the incontinent? Is that what the word is?
Speaker 3: Yeah, yeah, yeah, yeah.
Speaker 1: And he had a, you know, he was struggling with getting erections, but they were coming back. But he said one thing that he, that he missed was the ejaculate. And I never thought about this, but he said, you know, Joe, that’s all part of it. And it is, you know, cause that’s like the end explosion and you, the, the, it comes out, you’re like, Oh, if it’s the visual that you had that pleasant experience and that’s gone. Right,
Speaker 3: right. And that is gone. And you know, having a dry orgasm is just, it can be very distressing. Um, and it also, uh, the other thing that is not spoken about is sometimes it’s pain. It becomes painful. Like a dry orgasm. It doesn’t feel good. It doesn’t feel the same. Uh, the orgasm is not as strong sometimes. Uh, you know, so, so you’re having to take, so you know, let’s, let’s think about this. You know, you have a guy that’s had PR gone through prostate cancer and it’s treatment. Then he has the whole thing, you know, if he’s younger, if he’s like in his fifties or sixties, and maybe he hasn’t needed to use by Agora or some other sexual aid, now he has to start figuring out how to do that. And then his erection isn’t the same as it once was. And then his a dry orgasm. And it’s like, man, so, you know, the desire starts to fade too. It’s like, well, that wasn’t, that really wasn’t very much worth it. Uh, you know, and if they have a partner, it’s like, well, I, I love my partner, but you know, that, that, that just sucked. I mean, it wasn’t that I didn’t, I didn’t enjoy that, uh, you know,
Speaker 1: [inaudible]
Speaker 3: and that can be very confusing. Uh, whether partners, male or female, you know, it’s like, well, what do you, what now? What, um, what now can we do now? Uh, so, you know, for men, I mean there are options that may work better. So you know, by Agora is kind of the most common medication, but there’s also, uh, using, um, injections. You use the same medication but in the form of an injection directly to the penis. Right. But you know, I’ve had so many men look at me like to what?
Speaker 1: Yeah, I know cause I think it’s going to hurt, right?
Speaker 3: Yup. Which I don’t blame them. I don’t blame them, but it works. It’s more reliable than safe. I, Agora is so, you know, that’s what I mean. You know, getting used to incorporating different AIDS into your sex life can, can be very distressing. It’s terracing, it’s humiliating.
Speaker 1: I think about how it also takes away the obvious signs of desire, right. You get an erection. The ejaculate is part of it. Uh, for women. You know, she’s getting lubricated and led and so you’re missing these cues that are normally make you even feel more sexual towards your partner.
Speaker 3: Yes. Yes. Right? Yes. Exactly. Yeah. Like your partner being responsive to you. That’s a turnoff. Hi. You know, my partner’s getting turned on by me. Wow. That’s really exciting. And that makes me more turned on. And when that isn’t happening, you know, it’s distressing to both partners. You know, it’s not just the partner with cancer. Uh, and sometimes I do ask the, the, uh, uh, you know, the survivors partner to come in so that they can talk these things out, uh, out of earshot of the cancer survivor. I mean, they don’t want to make their partner feel bad, you know, but to, to have a forum for, you know, openly, openly complaining. I mean, let’s face it. You know, sometimes they’d be to get things off their chest, um, things that they didn’t, things that they saw that they can’t unsee, you know, like changing drains for someone who’s had cystectomies or you know, these kinds of things. So, um,
Speaker 1: so what can couples do though? Let’s say they got way off track, right? So way off track, they’ve had the cancer treatment and then doing the drains and all that stuff. And now how do you get them back to being sexual?
Speaker 3: Well, I really have to talk to, you know, we have to go through all of these changes and, um, unfortunately one of the things that they’ll have to do is come to some acceptance, uh, which can take a long time. You know, some people get it right away. Okay, yeah. Right. Everything’s different now what do we do? Uh, there is a takes longer and that’s okay. You know, there’s some denial and just wanting things to be the same as they always wore. Um, so that’s kind of step one. And then I, uh, talked to them about [inaudible] what we called in our field, you know, non demand pleasure, you know, just touching for the sake of touch and not on so much on orgasm or having an erection or, you know, lubricating and all of those things. Just start in slowly, you know, just touch, touch arms and legs, right? We have our sensate focus exercises that we take people through, but basically, you know, it’s just like, let’s, let’s keep our clothes on and let’s just kind of make out and let’s, um, you know, rub on each other and, uh, start getting used to this again and, and remember how good it feels just to have this sensual touch.
Speaker 1: This is so important.
Speaker 3: [inaudible] yeah,
Speaker 1: no, it’s very important. Yeah. I didn’t mean to stop you, but I just want to reiterate the basics, right? That’s sensate focus and people can look that up online. And I think you, you read about it in your books. Um, and you know, I just did a talk yesterday to a group of students and on human sexuality and the whole, uh, they weren’t a novice and naive to all of sexuality, most sexual things, but everybody knew about sensate focus and they were a younger crowd. So I wonder if the younger ones, yeah. Do you notice that?
Speaker 3: Yeah. Yeah, I have. I, you know, a lot of couples come in and they go like, Oh yeah, we’ve heard of sensate focus. Like, that’s good. Okay, well now we’re going to do this, this,
Speaker 1: right? And so for people that don’t know, it’s step by step, you know, you’re not having, um, even if you get erections or you get lubricated or you get aroused, the whole idea is to not have penetration, but instead going back to basics, getting used to each other’s bodies. Right?
Speaker 3: Right, right. And, and what that allows people to do is last people to do a couple of things. One is to just learn how to relax with each other, you know, and not be so stressed and anxious about how is this going to work. So that’s number one. Number two is it get to discover, uh, parts of your body or things about your body that maybe you haven’t been in touch with, things about your body that are turn on, that may be overlooked. Maybe you find out that your body’s changed in some things that he used to really love. Don’t feel so good anymore. Um, you know, so, so it allows you to do that. And third is, uh, it, it gives you kind of a, a period of time to reset your sex life and how some, uh, you know, heart to heart talks along the way. How are we going to cope with this change? Like we still love each other. We want to be together, we know that, but how are we going to navigate these changes in, uh, your body, um, in what you want, what you need, what I need, you know, and, and have those, um, have those talks that need to be had as well.
Speaker 1: You know, I was talking to Joan Price, who does her work have sex after 50 and now things low, the, you know, the laws and your body changes. And I just feel like what you’re talking about while it’s related to cancer should really apply to all of us. We should all be having these conversations as we age, even if we’re young to sexual health conversations. Couples don’t have, don’t you see that? You see the same? Yeah.
Speaker 3: Yes. Because you know, it’s interesting. I, and like I said, I had this couple, you know, they went through cancer together. They got, they felt closer because of it, but they never had talked about their sex life. And he was, uh, he, he was the, uh, non partner without the cancer. He was wanting to experience their sexuality in a different way. Uh, and they had never talked about sex. So, you know, they could have, they had good sex, but I think he wanted to be a little more experimental. You know, it’s like life is passing by and you’re my partner and I wanted to experience things with you and if you’re open to it and you know, she’s like, Whoa, wait, what?
Speaker 1: Mm. Yeah.
Speaker 3: So you know, they, they, they were the ones who said if we, maybe if we’d had these kinds of conversations about our sex life, our bodies, our lives are all the things that are changing all the way along, maybe we wouldn’t be in this place of feeling a little lost.
Speaker 1: Yeah. Makes total sense. Yes. What would you say, we have a few minutes left. What other important thing that we not addressed that you want to make sure all the listeners know about sex and cancer?
Speaker 3: Yeah, I think that, uh, you know, it’s, it is important to talk to your physician about what’s going on because there may be things that you can do from a medical standpoint that you’re afraid of. For example, a lot of women are afraid to use a vaginal estrogen. Uh, some women can’t if they’ve had, uh, breast cancer, some women can, but there are other treatments as well. Everything from laser to using vaginal moisturizers. Uh, but that’s a conversation to have with the physician as a physician. It’s an app for it. Then talk to the practice nurse practice nurses are often into quality of life issues. And I think that’s really important. Um, and, and then, uh, you know, if there’s confusion, if you’re arguing, if you’re lost, uh, if it’s, the whole thing is very upsetting, get, get some help, get some help, you know, a few sessions with, uh, a sex therapist and be so helpful in helping you have the conversation. It’s a hard conversation. I think you’ve been couples that do talk about sex might have a hard conversation about all the changes that have happened and, and just processing the journey that they’ve had together. Um, and then, you know, ultimately, uh, embracing life for sure. And, and you know, you’ve been through all of this. So now let’s have a good life. That’s, that’s the point of going through all the treatment. So don’t suffer
Speaker 1: right, don’t suffer, get the right kind of help. And really this is all about talking about sexual pleasure, which are um, medical field and mental health field often don’t talk about in couples, don’t talk about so yeah. So where can they find you Stephanie, if somebody is interested in talking further with you?
Speaker 3: Yeah, so they can find me on the internet. I have a, I still have a private practice. Um, I’m at the Bueller institute.com and then I do offer training for therapists who want to learn more about sex firstname.lastname@example.org and you, you know, you can find me on all those social media as well.
Speaker 1: Great. I’m so glad to have you on here. Thank you so much for being a part of my show and and talking about this important topic, Stephanie.
Speaker 3: Thank you, Joe. I really appreciate the opportunity.
Speaker 1: All right, thank you. And, and as for the listeners, please don’t forget to rate, review and subscribe and remember, you can find me on Twitter at dr Joe court and Instagram at dr Joe Kort. See you later. Thanks for listening to this episode of smart sex, smart love. I’m dr Joel court and you can find me on Joe kort.com that’s J O E K O R t.com.
Speaker 2: See you next time.