Sexual Health After Cancer: A Guide to Restoring Intimacy and Connection

For many navigating a cancer diagnosis, the conversation often centers on treatment protocols and physical recovery. Yet, for countless patients, the journey profoundly impacts an equally vital, albeit often unspoken, aspect: sexual health and intimacy.

The emotional and physical toll of cancer can redefine a person's relationship with their own body, leading to anxieties, fears and frustrations that significantly alter their experience of connection and pleasure. Ignoring these deeply personal struggles can leave patients feeling isolated and misunderstood at a time when comprehensive support is most crucial.

This is where specialized mental health support becomes invaluable.

In an interview with CURE, Kelly Dyckman, clinical social worker and therapist, delves into the nuanced challenges faced by patients with cancer, offering insight from her work at Mary’s Place by the Sea in Ocean Grove, NJ, a wellness retreat for women with cancer.

Dyckman’s approach focuses on validating the full spectrum of emotions patients experience, from the initial shock of diagnosis to the long-term impacts on self-perception and relationships.

"Something's happening that I can't control... My body's a stranger,” Dyckman explained of patients’ concerns and frustrations. “It's not an ally."

In the interview, Dyckman shed light on the specific anxieties women often face regarding intimacy post-cancer, addressing misconceptions and fears surrounding physical changes, sexual performance, and a partner's perception.

CURE: What sparked your passion to be a therapist, and how do you strive to help patients with cancer?

Dyckman: Unfortunately, and fortunately, in this interesting way, cancer has always been in my world. Since I was a child, there's been someone I know with cancer, someone I've loved who's been navigating cancer, and since it's been a trend in my life, it seemed to lend itself to what I do professionally. By recognizing that when we're talking about oncology, from the patient experience and the family experience, there's nuance there. In many traditional mental health settings, to not have the oncology background, [it's important to understand] that there's a barrier that can exist in the psychotherapy world.

I was motivated to always continue my work in oncology in some capacity. [We] recognize there has been a need for patients with cancer to have additional support, to understand and give them space to process what they're going through, and to help them to develop tools in navigating healthy coping skills by working with families and supporting patients. We look at the big picture of the cancer experience overall and support people in coping and navigating as effectively as possible.

What are examples of emotions that patients express that you work to help them with?

The cancer experience runs the gamut [of emotions, including] fear and anxiety [that may begin] even pre-diagnosis, such as when your doctor calls you back in and wants more information, more testing done in your body.

Inevitably, there's going to be emotion that exists there, such as anger or frustration. Anger is especially an emotion that people have discomfort with, because there's this experience of body betrayal with cancer. There can be anger internally and externally. [People think or say things like] “Why is this happening to me? What did I do to deserve this?” Anger is pulling on that fairness piece of what's happening. There is that fear of not knowing necessarily what's going to happen [with your diagnosis], so there are concerns around what this looks like for a patient, for their family, their loved ones, and there is definitely disappointment in self and in providers.

Unfortunately, I've worked with many people who have had complicated relationship experiences with medical providers. [This is found in] misdiagnoses and not necessarily attending something in the way that maybe they thought [their providers] should. [A patient may say], “I run five miles a week. I lift weights. I drink milk. I do all these different things. I don't eat carbs. What do you mean I have cancer?” There is that disappointment and frustration. There is a spectrum of experience, and in the therapy space, normalizing and validating that all the emotions that somebody experiences make sense. It's not the emotions that inherently create issues. It's what we tend to do with those emotions that we can see some concerns pop up.

What services do you provide here at Mary's Place by the Sea?

Mary's Place is just a wealth of resources and a wealth of services. I generally provide individual therapy services for guests who come into Mary's Place, and in meeting with those guests and understanding their experiences. I work hard to develop different workshop and group ideas to round out what we can offer here. I've done different virtual workshops about mental health, boundaries, sexuality, and we're also currently working on a group for metastatic guests as well in the area.

What are some common feelings and misconceptions that women experience or worry about as it relates to intimacy?

I definitely notice anxiety about different experience with our own bodies. After the cancer experience, if there have been surgeries or different treatments, the experience of self, and especially physical self, can change dramatically. Anxiety plays a huge part in intimacy post-cancer, because there are all these ideas about ‘how my body should perform, what sex should feel like, how my partner is going to receive or perceive my abilities, how my body is now.’ The anxiety piece plays a huge role in intimacy.

There can also be fear based on changes that have happened. There can also be concerns around pain, experience, and around performance. I work with women to identify what those emotional considerations are and how some of them may result as physical barriers. [It's important to] understand the relationship between mind and body, and that if you’re stressed out, it's hard to feel pleasure, and/or to enjoy and experience yourself or someone else.

There is anxiety, fear, frustration, and also the thought that, “My body's not doing what it's supposed to be doing. My body's not doing what I think it should be doing” or this idea that “My partner will be frustrated because my body's not responding the way that it used to respond."”

There can be a lot of different emotions related to intimacy, and I do a lot of work with women on [reframing] expectations from what was to what can be. [This includes] supporting people and understanding how they can embrace their sexuality and their sensuality, even if their physical body has changed, if their experience of body has changed, or if there's discomfort or physical considerations around sex. Just because sex doesn't look the way that it used to doesn't mean there can't be sex at all. It's about helping people understand what ispossible, as opposed to focusing on what doesn't feel possible and what doesn't feel accessible right now.

What is it like for you as a therapist to be that outlet for patients undergoing these intimacy struggles?

I admire the people who are willing to have some of those conversations, especially about physical intimacy. There is this notion or stereotype that sex is so private, it's not something we talk about — women in particular — that so much of what we come to understand about sex and sexuality is from the male perspective, not the female perspective. Therefore, when someone's willing to go there, I'm right on board. Let's do it, let's get into it. I also want to emphasize too, that not talking about it is not resolving anything either. Even if there's anxiety and frustration, even if there are concerns around the discussion, not having the discussion isn't getting anybody closer to where they want to be.

It's truly my pleasure and my privilege to provide that safe platform for people to dive into what some of the physical and emotional barriers are to intimacy, and for women to connect the dots to how emotional intimacy can lend itself to physical intimacy. When we're talking about female satisfaction, there must be emotional intimacy to get to physical intimacy. Because if there's not that emotional comfort or connection, physical intimacy is not going to be on the table in a way that truly is satisfying or gratifying for someone.

How can patients begin to navigate these conversations and reconnect with their sense of sexuality in a healthy way?

It's so important for patients to recognize that even in life outside of cancer, there are ebbs and flows to what it means to being a sexual human being. Obviously, cancer can exacerbate some of those ebbs and some of those flows. We want to normalize having the conversation, and that while having the conversation can be uncomfortable, leaning into that discomfort can get you through to the other side of it. You don't have to navigate this alone, especially if you've attempted to navigate it individually, and it doesn't seem to be getting you to where you to where you would like to be. Utilizing therapy as a platform to understand what's happening, for you to process through it, and to also explore ways to get closer to where you'd like to be in the safety of psychotherapy.

My responsibility to anybody that I come into contact with is to support them in exploring what they want, the steps they can take to getting closer to what they want, and then ways that they can support themselves in being a resource for whatever it is that they're desiring.

We often think of sex in the context of partner, whereas people can be sexual individuals unto themselves, right? We think about the sexuality in a context through somebody else. It is an individual experience. So, it's about getting back in touch with what's pleasurable, what's meaningful for you, where desire comes from, where you can start to experience that physical pleasure, and then step towards sexuality when that makes sense—as it makes sense. [You need to understand] your sensual experience, which can lend itself to the sexual, but none of that happens if we don't have the conversation.

Cancer or no cancer, sex is something I talk about with people all of the time. Normalize that you can [talk about sex] and even if it's hard, that doesn't mean it will be forever. It means hard can oftentimes mean different. When you're stepping outside of your comfort zone, it makes sense that there would be some level of anxiety that goes with that, but it doesn't mean that we can't manage that. It doesn't mean we can't navigate that, and it doesn't mean you have to do it on your own.

Transcript has been edited for clarity and conciseness.

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