Different sexualities and more

February 18, 2010

In the February 9 entry of this blog, I discussed some issues surrounding fertility among female cancer survivors. The take-home message is that fertility and sexuality issues among female survivors are surely physical issues, but they also present emotional and interpersonal relationship issues for survivors. I encouraged survivors to consider commonly used measures to preserve fertility, and I encouraged survivors to seek help from mental health professionals trained to deal with fertility and sexuality issues.

Two days ago, Dana Jennings, wrote on his New York Times health blog about his sexuality issues following the treatment he received for a Stage 3 prostate cancer diagnosis. Jennings explains that the treatment (hormone therapy, radiation, and surgery) + antidepressant medications have left him with a less-than-desirable level of desire.  Jennings agrees that it is a problem, but he also subtly blames our “oversexualized” culture for making the predicament even more difficult. He wrote passionately about the difference between “manhood” and male sexuality, and he conveys a sense of clarity that has obviously come with some work. I recommend reading Dana Jennings’ blog because it is wonderful example of how one man processed and dealt with a serious issue. But he is only one man. But it is important to remember that Jennings’ example is just one model; it is just one way to deal with one issue.

Too often, we fall into a trap. I certainly fall into it. The trap? Well, it would be easy to look at Dana Jennings’ story and see the parallels in your own life. Maybe you are a survivor suffering from erectile dysfunction. It would be easy to say – “That’s what I have to do. I have to realize that manhood does not equal sexuality, and I have to realize that time will heal all of this, and if it doesn’t, it will all be ok anyway because I am happy with what I have.” But here is the really nasty truth of survivorship – actually, it is a nasty truth of life – what works for Dana Jennings may not work for you. Even worse, forcing yourself to think or act like someone you are not could send you deeper into a depressive hole, and it could make the fallout from the issue even more devastating that it was in the first place.

Research shows that even adult survivors of childhood cancer experience problems in sexual functioning. A study published in Psycho-oncology, Sexual functioning in young adult survivors of childhood cancer, estimated that 32% of male adult survivors of childhood cancers experienced some sexual dysfunction problems while a whopping 52% of female reported the problem. Not surprisingly, statistical analysis showed that reporting sexual problems was associated with other poor outcomes in the health-related quality of life arena. Other research, specific to cancer type or specific population, suggests the same trend. This isn’t very scientific, but I think it covers the point – many cancer survivors will experience sexual dysfunction, and dealing with it can make other areas of life difficult too.

So read Dana Jennings article, but don’t be disappointed if you try his path, and it doesn’t quite work for you. Moreover, don’t be discouraged if you read his ideas or other cancer survivors’ ideas and find that they “don’t feel quite right.” You can find coping methods that work for you. An article in the Journal of Cancer Survivorship from the March 2010 issue (Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer) examined the broad issue that Dana Jennings discussed in his blog. Namely, both the article and the blog look at the relationship between communication and intimacy between couples after prostate cancer. Dana Jennings contextualized it for us – one big issue that may require communication is sexuality. The study found, not surprisingly, that communication or lack-there-of can either facilitate or dull intimacy. Jennings explained that intimacy – built through communication - with his wife is what helped him in his ordeal, and it continues to help him. So the study would seem to support Jennings’ anecdotal evidence. I’m not a psychologist, but I do know that communication is a nuanced issue. More is not always better. Less is certainly not always bad. There are countless medium through which we communicate, and each medium (it would seem to me) interacts with each of the others.

I guess what I’m saying is this: sexual function, intimacy, communication, partner-relationships…These are all facets of life that work uniquely in each survivor. Inspirational stories about coping are good, but they are only good if they are used as inspiration to find the right coping strategies for you. Maybe I am a cynic, but I couldn’t stop thinking after I read Jennings’ blog that his methods won’t work for everyone, and I tried to put myself in that type of survivor’s shoes. I guess I realized reading about someone else’s success story could make me feel lonely or hopeless or inadequate. I wish there was one more line at the end of his blog (at the end of every survivorship story in fact) that said “But this is just one way to deal with the problem. I encourage you to find what works for you.”

by Christian McEvoy

christian@ctchallenge.org

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