CANCER AND LOVE IN THE TIME OF CORONA

So you are a cancer patient or survivor hunkered down with your honey, social distancing from the rest of the world. You would enjoy the comfort and intimacy of lovemaking, but since your cancer treatment, sex has become problematic. (And maybe you are so sick of each other that you just wish you had some time apart, or you are too exhausted after a day of home-schooling and entertaining your kids to do anything but sleep!)

 

Or perhaps you do not have a partner available, but you would love to distract yourself from the global catastrophe with sexual pleasure and an orgasm or several—but you fear disappointment if you try.

 

Do people tend to have more sex when a natural disaster interrupts our modern lives? Boredom and fear certainly can motivate people to want physical and emotional closeness. The only evidence we have is birth rates 9 months later. Despite the myth that birth rates always rise after events like the great New York blackout of 1965 or the devastation caused by hurricanes or tsunamis, increased birth rates are not routine. If more babies are born after a natural disaster, the culprit may be lack of contraception rather than a lot more sex. In many cases, fewer people conceive babies during a catastrophe. Doctors are suggesting caution right now since we have limited data on the effect of the coronavirus on early fetal development or the health of pregnant women. Women already pregnant are being told to avoid COVID-19 infection.

 

Most cancer survivors are beyond the age of having children—and sadly some of our younger community members have impaired fertility. If you are trying to freeze eggs, sperm, or embryos before starting cancer treatment, these procedures are still going forward. Other infertility treatments have recently been halted to conserve medical resources. This blog focuses on improving your sexual pleasure and feelings of intimacy during this difficult time.

 

Is it safe to have any sexual activity? So far infection from the virus has not been traced to body fluids like semen, vaginal fluids, or breast milk, but the CDC warns that more research is needed. The virus has been found in saliva, fluids from the sinus and lungs, blood, urine, and feces (stool). If only one partner in a couple has the virus, having sex together would very likely increase the risk of the other partner getting it.

 

Most people getting active cancer treatment and many who recently ended treatment have weakened immune systems and should be practicing strict social distancing. Ask your oncology team if you have questions about your risk for complications from coronavirus.

 

Also, the average age of cancer diagnosis is 64, so most of us are within the age group at high risk for complications of COVID-19. Younger or older, if you are not sheltering with a partner, this is certainly not the time to find someone new. However, many singles are continuing to use online dating apps to meet potential partners, keeping actual contacts for now to phone or video chats.

 

If you and your partner are in a monogamous relationship and living together, your partner should be practicing social distancing to protect you. If you are both free of symptoms and have no known virus exposure, many couples choose to be intimate (kissing, sleeping in the same bed, having sexual caressing or intercourse), even though that could increase their risk of infecting each other. If your partner’s job requires interaction with others but you are practicing social distancing, the safest thing, if possible, is for you to stay in another part of your living space and not to share a bathroom. Sexual activity would also put you at more risk for infection.

 

But let’s assume you are part of a couple, both partners using social distancing and not having any symptoms or known recent exposures to the virus (or both having recovered and tested free of COVID-19). Maybe you have been avoiding sex because you do not feel much desire, one partner has an erection problem, or one partner has genital dryness and/or pain during sexual caressing or penetration. This could be a great chance to try out some new ways to give each other sexual pleasure. If you do not have a safe partner at home, you could also work on improving a sexual problem on your own.

 

Ideas for tackling cancer-related sexual problems while you are sheltering at home:

 

If you have a partner, try out sensate focus exercises, in which each of you take turns giving and receiving creative, pleasurable touch, devoting at least 10 minutes to the back and front of the body. Whether you are the giver or receiver, your goal is to notice what you feel in your body. As receiver, try letting go of distracting worries. As giver, think of ways to vary the touch (light caressing, massage, use of oils or furry mitts). The first time you try, the breasts and genitals are off limits. Try not to go on to your more usual sexual caressing or penetration. As you practice over several sessions, you can gradually add light and brief breast or genital caresses, and then have the receiver show the giver the best ways to touch for sexual pleasure. These exercises can help you regain feelings of relaxation and sensual pleasure, getting away from anxiety about having erections or being able to reach an orgasm.

 

If you are on your own, a sensual experience could be caressing your body in the shower or in a bubble bath. To practice mindfulness, which helps you to focus on sexual pleasure rather than on distracting thoughts, try eating a small amount of food you like (chocolate, ice cream, or fruit) and focus all your attention on the taste and feel in your mouth. Hopefully you have not yet been reduced to canned tuna, spaghetti, or peanut butter!

 

Add to these experiences by putting on music that you like or perhaps using a scented candle (only if it is safe from being a fire-hazard) or scent diffuser.

 

Now may not be a time that a woman can visit her gynecologist to get help for genital dryness and pain, but you can still order some over-the-counter products by mail that can ease the problem: Vaginal moisturizers that contain hyaluronic acid type ingredients can help the vaginal lining retain moisture when used several times a week. Women treated for cancer and in menopause may sometimes need to use them 5 times a week or even daily. Two products that can be directly mail-ordered are Revaree® suppositories (https://hellobonafide.com/products/revaree) or Hyalo-GYN® gel and applicator (https://hyalogyn.com/). Neither reports shipping delays currently.

 

In addition to using a moisturizer regularly, add a water-based or silicone-based vaginal lubricant when you have sexual caressing or penetration (or when using a dilator or sex toy). Although you may experience shipping delays from some online retailers, you may already have some products at home. Pharmacies are open, but it is often hard to find the right product and you should avoid any errands that you can. Most silicone-based lubes will work, but for a water-based lube, products you can order online that do not contain potentially irritating preservatives or glycerin, and are not drying to the delicate vaginal and vulvar tissues include Good Clean Love’s BioNude® or Almost Naked® (https://goodcleanlove.com/), Sylk® (https://sylkusa.com/), or Yes WB® (https://www.ahyes.org/). None of the websites mentioned shipping delays, but you may want to call or chat before you order.

 

A woman who has pain with penetration can stretch her vagina while practicing muscle relaxation using pastel, washable vaginal dilators that vary in size. They can also be ordered without prescriptions over the internet. My favorite supplier is Soul Source (https://www.soulsource.com/). Their website includes instructional videos on how to use them. Remember never to force a dilator into your vagina. Lubricate it with a water-based product and gently slip it in. If you have had treatment for a gynecological cancer (cervical, vulvar, ovarian, uterine) or for colorectal or bladder cancer, ask your oncology team first if it is safe to use a vaginal dilator, unless you have already discussed it.

 

Women who have pain deep in the vagina during penetration may want to check out the Oh-Nut®, a set of 4 soft, stackable, polymer rings that fit around a partner’s penis to give him pleasurable stimulation while limiting how deeply he can thrust (https://ohnut.co/).

 

For men with erection problems, this also may not be the best time to see a urologist to get medication or other therapies. You may be able to get oral medication (pills like sildenafil or tadalafil) through online companies Roman (https://www.getroman.com/) or HIMS (https://start.forhims.com/). At either site, you will fill out a questionnaire that a physician will then review. The medications at these sites are reliable. However, most online sites that advertise ED meds send forgeries that can be ineffective or downright dangerous. Pills are not effective in restoring good erections in many men with severe problems after cancer treatment, but they are often worth a try.

 

Do you have a vibrator at home? Vibrators can add pleasure either to self-stimulation or to partner interactions. If you are a man with an erection problem, have you tried a vibrator to help you reach orgasm? If you are a man or a woman who has trouble getting in the mood for sex, using a vibrator (gently, to avoid irritation) can help you begin to have sexual sensations again. Vibrators are a great way to feel more sexually aroused. Sexual arousal increases blood flow to the spongy tissues inside a man’s penis or a woman’s vaginal walls and vulva. The oxygen in this fresh blood may actually help keep that tissue healthier. Most women get more pleasure and arousal by using a vibrator around the clitoris and vulva than by using one of the traditional, penis-shaped vibrators inside of the vagina, but every person is different. Men may enjoy a vibrator that sheathes the penis or one that can be moved around to sensitive areas. It is very easy to purchase a vibrator online. For companies that sell sex toys, look in https://www.will2love.com/resources in the section: Sexual Health Products: Serious Vibrators and Sex Toys.

 

Some people have an easier time than others in having vivid sexual fantasies. Many could use a boost by reading, hearing, or watching erotic stories or videos, especially people who have lost desire for sex or men on anti-androgen therapy. Women often prefer reading or listening to stories. Of course there are a plethora of erotic sites on the internet, but one story app designed for women in particular is Dipsea Stories (https://www.dipseastories.com/). It is a paid subscription service but is offering a free trial.

 

My best suggestion, however, for improving sex in the time of corona is to subscribe to Will2Love’s online self-help program for men or for women (https://www.will2love.com/personalized-services/). Both the men’s and women’s programs can be used from the viewpoint of a cancer patient/survivor or a partner. Programs include a brief questionnaire to get started that creates a personalized home page with links to your highest priority content. You get a tour of the website and are guided in setting your first 3 goals to learn new facts, prevent or solve problems, and enhance relationships or dating. Each goal comes with links to read something new, try a self-help exercise alone or with a partner, and learn about options for medical treatment. Sexual and fertility side effects of most types of cancer and treatments are explained. Video interviews with real patients and stories filmed with actors help users feel less alone. To help the cancer community during this pandemic, I have reduced the price of a 6-month subscription to the program from $60 to $30 until July 1. Just enter discount code: covidlove in the discount box during registration!