A Partner’s Guide to Getting Help

Some changes in intimacy after cancer can be worked through slowly between partners.

Others need more than patience, good communication, or trying harder.

Pain during sex, changes in erectile function, severe dryness, difficulty with arousal or orgasm, pelvic floor problems, medication side effects, hormonal changes, body image distress, trauma, persistent conflict, or a long period of emotional and physical disconnection may all deserve additional support.

That does not mean something is seriously wrong with your relationship.

It may simply mean the problem has become more complex than two people should be expected to sort out on their own.

Start with what is actually happening

Before deciding who to call, try to identify the main concern as specifically as possible.

“Intimacy is difficult” can mean many different things.

It may mean sex hurts.

It may mean one person has lost desire.

It may mean erections have changed.

It may mean one partner is afraid to initiate.

It may mean someone feels deeply uncomfortable in their body.

It may mean both people want closeness but no longer know how to find it.

It may mean resentment has built up around caregiving, rejection, or unmet needs.

Knowing what is most difficult helps you find the right kind of support.

Some concerns need medical attention

Sexual changes after cancer are sometimes treated as if they are simply emotional or relational.

They are not always.

Cancer treatments can affect hormones, nerves, blood flow, pelvic tissues, sensation, energy, fertility, vaginal and vulvar health, erections, ejaculation, and orgasm. Medications can affect sexual response as well.

Pain deserves evaluation.

So do significant or persistent physical changes.

You can begin by asking the oncology team:

“Could treatment be contributing to this?”

Or:

“Who works with sexual health concerns after cancer?”

You may be referred to a gynecologist, urologist, sexual medicine clinician, menopause specialist, pelvic health physical therapist, rehabilitation provider, or another specialist depending on the concern.

If the first person you ask does not know, ask again.

Sexual health is part of health.

When the problem is more about the relationship

Sometimes the body is only part of what is happening.

You may both be carrying fear, disappointment, grief, resentment, or uncertainty that has become attached to intimacy.

Perhaps every attempt to talk turns into an argument.

Perhaps one person feels pressured and the other feels rejected.

Perhaps you have stopped touching because neither of you knows how to begin without creating expectations.

Perhaps cancer has changed the relationship so much that you no longer feel like yourselves together.

A couples therapist or sex therapist can help you slow those patterns down and understand what each of you is experiencing.

You do not need to wait until the relationship is in serious trouble.

In fact, getting support earlier is often easier than waiting until both people feel exhausted and discouraged.

A sex therapist can help with more than sex

People sometimes assume sex therapy is only for couples trying to increase how often they have sex.

It can be much broader than that.

A qualified sex therapist may help with desire differences, fear of intimacy, changes in arousal, communication, body image, rebuilding touch after treatment, adapting sexual practices, performance concerns, and the emotional impact of changes in sexual function.

For couples affected by cancer, it can be especially helpful to find someone who is comfortable working with illness, disability, medical trauma, grief, and changing bodies.

Pelvic health support can make a major difference

If there is pelvic pain, painful penetration, tightness, weakness, changes after surgery or radiation, bladder concerns, or difficulty returning to sexual activity, pelvic health physical therapy may be useful.

Pelvic health specialists work with muscles, scar tissue, mobility, pain, and other physical factors that can affect sexual comfort and function.

Many people are never told this kind of help exists.

It does.

When body image is getting in the way

Cancer can change how a person feels about being seen and touched.

Scars, hair loss, breast changes, ostomies, weight changes, genital changes, swelling, weakness, or other visible and invisible changes can affect sexual confidence.

If your partner is struggling with their body, reassurance can help, but it may not be enough.

A therapist, support group, rehabilitation provider, or other professional with experience in cancer and body image may help them process what has changed.

Partners sometimes need support with this too.

You may be trying to reassure someone you love while also adjusting to changes yourself. Those feelings can be complicated, and having a private place to work through them can help protect the relationship.

Partners may need support of their own

You do not have to wait for your partner to want counseling or support before getting help for yourself.

If you are exhausted, angry, lonely, frightened, sexually frustrated, or unsure how much more you can carry, it may be useful to have somewhere you can speak freely.

That might be a therapist, caregiver support group, cancer support organization, trusted friend, spiritual advisor, or another source of steady support.

Sometimes the most helpful thing you can do for the relationship is stop trying to process everything inside the relationship.

What if your partner does not want help?

This can be difficult.

You may see a problem clearly while your partner is not ready to address it.

You can express concern.

You can ask.

You can offer information.

You can explain how the situation is affecting you.

But you cannot force someone into medical care, therapy, or sexual conversations they do not want.

You can still seek support for yourself.

That may help you understand what is within your control, what is not, and how you want to respond.

How to ask for help

You do not need perfect language.

You can say to a healthcare provider:

“Cancer treatment has affected our sexual relationship, and we would like help understanding what is happening.”

Or:

“Sex has become painful since treatment. Who should we see?”

Or:

“There have been changes in erections and sexual response. Is there someone who specializes in this?”

Or:

“We are struggling with intimacy and communication since cancer. Can you recommend someone who works with couples?”

If the person seems uncomfortable or dismisses the concern, that does not mean the concern is unimportant.

It means you may need to ask someone else.

What kind of professional might help?

The right person depends on the issue.

A sexual medicine clinician may be helpful when sexual function has changed physically.

A gynecologist or menopause specialist may help with vaginal, vulvar, hormonal, or menopause-related concerns.

A urologist may help with erections, ejaculation, urinary concerns, or other genital and sexual health changes.

A pelvic health physical therapist may help with pain, pelvic floor problems, scar tissue, mobility, and returning to sexual activity comfortably.

A sex therapist may help with desire, communication, anxiety, sexual adjustment, and rebuilding intimacy.

A couples therapist may be useful when conflict, resentment, communication, or relationship changes are at the center of the problem.

An oncology social worker or navigator may help you find local resources and referrals.

You may need more than one kind of support.

That is not unusual.

You do not need to wait until things are unbearable

Many couples put off getting help because they assume their concerns are not serious enough.

They compare themselves to people dealing with more urgent medical problems.

They hope things will resolve on their own.

Sometimes they do.

Sometimes months or years pass.

If something is affecting your quality of life, your relationship, your comfort, or your ability to feel close, that is enough reason to ask for help.

You are not taking attention away from cancer care by asking about intimacy.

You are asking for care that includes more of your life.

A good place to begin

You do not need to know exactly which professional you need before you start.

Identify the part that feels hardest right now.

Is it physical?

Relational?

Emotional?

Sexual?

A combination?

Then ask one person for help.

One appointment, one referral, or one conversation can be enough to move you out of the place where the two of you are trying to figure everything out alone.

Cancer can ask a great deal of a relationship.

Getting support is one way of asking the relationship to carry less.