While you’re undergoing treatment for cancer, sex is likely not at the top of your mind. But once the treatments are—thankfully!—behind you, while you’re getting the rest of your life back on track, you might yearn for the sexual intimacy and pleasure you used to have. You may have new challenges post-cancer, but there are many solutions.

Unfortunately, most patients are left in the dark about the sexual side effects of their cancer. Health-care providers don’t bring up the topic while discussing treatment options—partly because they don’t want to embarrass their patients, and partly because they’re focused on more serious health concerns. Patients also may feel too embarrassed to mention sex. And for patients older than age 50—especially those without a partner—­oncologists may assume that sex is no longer important.

So it’s up to you to start the conversation. For instance, you might say, “I’m having a lot of discomfort and things have really changed in my sex life. Can I talk to you about it or can you tell me who I can talk to?”

Here are some common sex challenges that cancer survivors face…

•You just survived a life-threatening illness—now you feel guilty for even complaining about something as “trivial” as sex. Many patients believe that a nonexistent sex life is the price they have to pay for surviving cancer. Nothing could be further from the truth! Sexual health is essential to quality of life and an important contributor to your whole health. And intimacy with a loving partner can help you heal by releasing feel-good hormones, including oxytocin, that ease anxiety.

•Your genitalia just aren’t the same. Chemo and hormone treatments can dry out the vagina and cause it to atrophy, making sex, masturbation and gynecological exams painful. Radiation, surgery and chemo can cause erectile dysfunction in men, even if their cancer was not directly related to their genital area, such as prostate or bladder cancer.

For women: Using a vaginal moisturizer on a regular basis can bring better long-term relief than lubricants. Lubricants temporarily relieve vaginal and vulvar dryness and reduce friction. Vaginal moisturizers provide longer-term relief for dryness, itching and irritation—and also can restore the health of the vaginal lining.

You may need to apply a moisturizer more often than is recommended on the box for the most effective relief—at least three to five times a week is ideal, applied at bedtime for the best absorption. Good options: Replens, Hyalo-gyn, PrevaLeaf Oasis…or pure coconut oil. Ask your health-care provider to recommend what would be best for you.

For men: While doctors are quick to solve erection problems with a prescription for a phosphodiesterase-5 (PDE5) inhibitor such as sildenafil (Viagra), there are other options. Penile injections—sometimes called intracavernosal injection therapy—are more effective than taking PDE5 pills. While the idea may seem daunting, men are often glad to hear that there is another option when the “little blue pill” doesn’t work. Vacuum erection devices that increase blood flow into the penis to help achieve an erection and penile rings to help maintain one are other options.

For both women and men: A ­pelvic-floor physical therapist can help restore sexual function with massage, dilators and exercises to build up pelvic-floor muscles, loosen tight muscles and stretch and desensitize scar tissue. Bonus: These therapies also can reduce urinary and fecal incontinence, a common side effect of cancer therapies. If there isn’t a specially trained pelvic-floor PT near you, a regular physical therapist may know where you can find one…or may know some exercises that can help.

•You’ve tried having sex, but it’s just not the same. Sexual pleasure depends on more than the mechanics of intercourse. Think about ways to achieve intimacy and pleasure without the pressure of reaching an orgasm…or even penile penetration of the vagina. Do what you did when you were dating—hug, cuddle, touch and kiss.

Explore using toys, such as a vibrator, or try new foreplay techniques—experiment with what feels good. Starting slowly, taking your time and expanding your repertoire are all key. A satisfying sex life won’t happen overnight. But the journey can be enjoyable, too!

•You’re willing to get help from a professional, but you have no clue what kind you need or where to find one. Online resources can provide useful information to help you recover your sexual health on your own…or point you toward a trained professional who can assist you. Will2Love.com is a site founded and run by medical doctors and psychologists that focuses on sexual health for cancer survivors. It’s a self-help program that you can do at home and lists psychologists who provide phone counseling.

You also can find providers who specialize in sexual medicine at the International Society for Sexual Medicine.  And there are online forums filled with men and women who are going through the same issues you are at Breast Cancer.org…the American Cancer Society’s Cancer Survivors Network…and FORCE (Facing Our Risk of Cancer Empowered).

Sometimes, all it takes is talking to the right person—perhaps a urologist, a social worker, a nurse or a fellow patient—to rediscover the intimacy you once had.

If It’s Your Spouse Who Had Cancer…

When your love life was fine, you probably didn’t talk about sex. But now that it’s not going as well, while you don’t want to stir up negative emotions, it’s important to bring the topic into the open for discussion. Framing concerns, fears and wishes using “I” statements instead of “you” can keep the conversation from sounding accusatory.

Example: “I know you feel self-conscious about your body, but you are as beautiful/handsome to me as ever, and I’ve never stopped wanting you. Can we talk about this?”

Pick a good time and a safe, neutral place to talk, even if you have to schedule it. (For instance, don’t launch into this topic when the two of you are getting into bed.) You might be happily surprised at how relieved your partner is to talk!

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