Sexual Health and Colorectal Cancer Talking about sexual health, especially sexual issues, can be difficult and feel awkward. But it doesn’t have to be that way. Talking about sexual health, especially sexual issues, can be difficult and feel awkward. But it doesn’t have to be that way. Sexual Health Resources Let’s Talk About Sex…and Colorectal Cancer (February 2022) What you Need to Know About Sexual Health and Colorectal Cancer Webinar (May 2018) Sexual Health Podcast (August 2020) Sexuality, Intimacy, and Colorectal Cancer Podcast (November 2017) Caregiving and Relationship Changes Podcast (September 2016) Addressing sexual health and intimacy can be a new and uncomfortable experience for anyone, especially those facing colorectal cancer and their partner(s). We asked Dr. Chelsea Holland, DHS, Relationship and Sex Therapist at The Intimacy Institute to help patients find courage in the bedroom. Chelsea Holland, DHS is a Relationship and Sex Therapist based at The Intimacy Institute in Boulder, Colorado. She helps individuals, partners, and groups regardless of their sexual orientation, sexual interests, ability, and age with concerns and questions around their sexuality and relationships. How do you keep intimacy alive when you’re not feeling “in the mood”? When most of us think of intimacy we think of sexual intimacy, which often includes genital touching, penetration, and/or orgasm. You, like many, might feel the expectation that physical touching needs to ultimately lead to sex. With this expectation and when you’re experiencing a CRC diagnosis/treatment, your desire to be sexually intimate is likely low or nonexistent. The tendency is to then shy away from intimacy because of the concern that it always has to lead to sex. So what can you do? The best place to start is to remove the concept that sex is the only destination for intimacy. Instead of sex being the goal of every intimate situation, add in physical intimacy and emotional intimacy where you focus on activities that can pull you close to your partner but that don’t have to include intercourse or orgasm. It can be helpful to think of intimacy as being an assorted box of chocolates that includes not just intercourse, but an array of yummy options for sexual, physical and emotional intimacy. Each “chocolate piece” of intimacy is something different you can enjoy with your partner that helps the connection between you. Occasionally you might want to enjoy the sex piece one night from your intimacy box. Many other times you may be in pain or uncomfortable and the intimacy-pleasure piece you pull from the box is taking a nice hot shower together and soaping each other down. And yet other times you might want to enjoy both of you cuddling up on the couch and chatting about your day. Ultimately it doesn’t matter whether you choose something sexual, physical, or emotionally intimate from your assorted intimacy box because they all function to bring the two of you closer. If your partner initiates sex, you can say “honey thank you so much for reaching out. I am just feeling very blah right now so could we be intimate by exchanging foot massages tonight?” or “I want to connect with you and being sexual just doesn’t feel like a good fit for my body right now. What I would really like to do is soak in the tub together.” The intimate possibilities are endless, get creative! What are some ways to open up conversations about sex and intimacy with a new partner who may not know the details of your treatment, surgeries, etc.? When opening up to a new partner, it is important to have a good base of emotional intimacy first. This means being able to talk about aspects of your treatment and surgeries before introducing the sexual talk. That isn’t to say you need to divulge all the details, but sharing this vulnerable part of you helps your new partner understand more about you and your needs. It also helps you feel a sense of trust in your partner, which lays a nice healthy foundation for a sexual talk to occur and provides more understanding as to why you may not always want intimate encounters to lead to sex. Any recommendations for overcoming self-conscious feelings? Self-consciousness is certainly a tough feeling within most of us, especially when your body is going through big changes. It is completely normal. You have the power to not let these feelings take over and prevent you from being intimate. Because your mind is a very powerful organ, making sure you are feeding yourself with feel-good behaviors in your day and positive thoughts will help weaken the self-conscious thoughts. This will not only help you feel better about yourself, but will also open yourself up more to potential intimacy with your partner. Feed into your feel-good behaviors by adding things in your day that have you feeling confidence, relaxation, happiness, pleasure, etc. Some examples include exercising as your body allows, wearing an outfit that you feel good in, having coffee with a fun friend, reading an enjoyable book, and eating healthy. You also want to minimize the things that feed into the self-conscious feelings such as not showering for three days, not exercising, eating a ton of pizza, and wearing grubby clothes. Also add in warm thoughts about yourself as well, such as “I am handsome/beautiful”, “I am enough” and “I am a sexual being”. Writing these or similar statements and putting them up around you, like on the visor of your car or the background of your phone, can help remind you when the self-conscious thoughts and feelings get strong. Remember that with your body going through big changes it is important to be gentle on yourself and to not isolate yourself – you are not alone. Find a support group where you can talk about these changes and feelings of self-consciousness and not feel alone in them. If you feel you are unable to turn toward your partner or a support group, get the help of a therapist (I suggest an Emotionally Focused Therapist) so that he or she can help. Is it normal to experience emotional/mental/physical changes associated with colorectal cancer that affects sexual health? Yes, a million times yes. And is it normal that these changes affect your sexual health? Most certainly. Your sexual desire and arousal is sensitive to changes associated with things like medication, pain, self-conscious feeling, or feelings of “blah.” These are like clogs in a drain that can block feelings of desire or arousal. That isn’t to say you can’t be a sexual being because intimacy isn’t only about intercourse or orgasm. Instead it means making adjustments to how your sexual self is expressed. The focus doesn’t need to be on intercourse or orgasm, but rather it is on intimate connection. I’m a partner of someone diagnosed with CRC. What are some ways I can be supportive? There are several ways that you can be supportive of a partner who is diagnosed with CRC. First, make sure you are taking care of yourself. Not only is CRC emotionally difficult for someone diagnosed, it is also emotionally difficult for you. If taking care of yourself means exercising, seeing friends, and going to see a therapist, do it. Secondly, educate yourself on what your partner is experiencing. Read up on CRC and also ask your partner what he or she is feeling. Be curious and open. Third, re-read above about broadening the scope of intimacy. Your partner and you are going through a lot of changes and sexual intimacy might not be as frequent. It can be easy to be confused and take it personally when your partner doesn’t want to be sexual, but keep in mind it is not about not wanting you. Be open to broadening the scope of intimacy and to negotiating different ways of connecting.