Tuesday, September 24, 2013

Love, Sex, Intimacy and Affairs

In most literature about cancer and couples you see the words, “love”, “sex” and “intimacy”. Those topics get some attention and ink even though the word intimacy is often used euphemistically for the word, “sex”. And of course you know by now how I feel about “cuddle” as a euphemism for sex or intimacy.

But there is a nodding awareness that a couple dealing with cancer is going to have issues around their intimate lives. What is often not acknowledged is that it’s no so easy to predict where the pressure or initiation for the issue will begin.

The common stereotype is of a woman with breast or gynecological cancer becoming reluctant to have sex with her husband and so the “work” is coaxing her back to the bed and to intercourse. Because of that stereotype a lot of the literature is addressed to men with the admonition to “be patient and to engage in non-sexual intimacy”. Hence the cuddle messages.

But that is not the whole story. And this is why it is crucial for healthcare professionals in Cancer Land to talk openly about sex. In many cases the person with cancer is the one who wants the direct sexual contact but the caregiving partner (male or female) is the reluctant one. And it’s also true that while chemo and repeated surgeries can diminish a patient’s libido, in many cases the stress of caregiving diminishes the libido of the “healthy” partner.

So if you look at those combined dynamics and the unpredictable nature of who wants what when—then you realize that you cannot assume that the “patient” wants less sex and the caregiver wants more. That is also why the word “affair” also has to be included in the “What about our sex life? conversation for the couple.

But I’ve never seen a piece of cancer care literature include a discussion of affairs or “sex outside marriage” –well, until I read “The Caregiving Wife’s Handbook” by Diana Denholm.

The whole book is a breath of fresh air and Denholm can be thanked for her stunning honesty. She writes about all aspects of caregiving and the mostly unmentioned parts like resentment, codependence, finances and sex. Bless her. And she adds a section on affairs to say that sometimes the caregiver is the one who has an affair because their needs are not being met (physical or emotional) but that it is equally true that the person with cancer can be the one who has an affair in order to feel masculine again or feminine again and to have the validation of a new partner—or to play out the anger they feel at having cancer. We know that affairs meet more needs than just the physical and so a couple dealing with cancer has to face the long list of needs being deferred or delayed or lost for both partners.

The subject of adultery or infidelity is so taboo in our society that coupled with the still taboo subject of cancer it’s understandable that no oncologist is saying, “Hey folks, we need to affair-proof your marriage.” But wouldn’t that be a wonderful and compassionate and healthy conversation to begin? 

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