Sex And Cancer

I want to become a father – please help me ! •

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I have been treated for testicular cancer in 2003 and one of my testicles is removed with a surgery. Before and after the surgery I have undergone 4 cycles each of chemotherapy. Every 6 months I get the blood tests done and everything seems to be normal for me. Last year April I have undergone testicular biopsy and it resulted in azoospermia. Last month I got the FSH blood tests done and it came out as 23.51.I have consulted many doctors and they have suggested ICSI for us. As FSH is high one of the doctor has referred us to sperm donor program. I want to know what are the chances of getting my sperm in this case for ICSI. Also as of now I am ready for sperm donor concept. But out of your experience how many couple are happy with a baby out of sperm donors and how feasible is it practically.

• “I am a cancer survivor – but I am also a Dad. When I look at my three beautiful children and realize that they would not be here if I wasn’t told to bank my sperm, I feel overwhelmed with gratitude. They are my life – they are my legacy. Every cancer survivor deserves the chance to be a parent!” Lance Armstrong, Chairman, Lance Armstrong Foundation

Cancer, sex and fertility – love, life and death. The importance of Information Therapy !

Dr Aniruddha Malpani, MD www.drmalpani.com

Cancer – still some taboo topics • "Cancer is not a death sentence, but rather it is a life sentence; it pushes one to live." Marcia Smith • “Getting cancer can become the beginning of living. The search for one's own being, the discovery of the life one needs to live, can be one of the strongest weapons against disease. “ Lawrence Leshan

Cancer – it’s all about living ! • “This diagnosis is a reminder that this is the life you’ve got. And you’re not getting another one. Whatever has happened, you have to take this life and treasure and protect it. “ Elizabeth Edwards • “That is the beauty of cancer, it tells you that your days are limited, that you could die at any point. It is that perspective that allows you to live a better life while you're here.” Shelley Hamlin

• Fertility is an expression of life’s longing for itself; and sexuality is the ultimate expression of being alive. • Having cancer does not change this • Unfortunately, cancer patients ( and their loved ones) are often ashamed to talk about these natural desires • Don’t know whom to talk to – or how to talk

Fertility • Hope for the future • A new beginning !

Your feelings about losing your fertility • Infertility can be very hard to come to terms with. • Some seem to accept it easily and feel that beating cancer is more important • Others seem to accept the news calmly when they start treatment but find it hits them later when the treatment is over • You may feel you have lost a part of yourself and are less manly or less feminine if you can't have children. • You may be very sad or angry that the disease and the treatment ( surgery or drugs ) have damaged your fertility

How chemo affects women's fertility • Chemotherapy can stop your ovaries from working for a while, or possibly permanently. Whether your infertility is temporary or permanent depends partly on the drugs and doses that you have. During chemotherapy, it is best to continue using reliable contraception even if your periods do stop. The chemotherapy drugs could harm a baby if you do get pregnant.

Temporary infertility • If the infertility is temporary, your periods may become irregular or stop during treatment. But they will go back to normal once your treatment is over. This happens in about a third of all women whose periods stop because of chemotherapy. It takes about 6 months to a year for your periods to go back to normal after your chemotherapy has finished.

Early 'menopause' •

You may have an early 'menopause'. Your periods become irregular and then stop completely. You may also have • Hot flushes; dry skin; Vaginal dryness ; Loss of energy ; Less interest in sex • Your doctor may prescribe hormone replacement therapy (HRT) to reduce menopausal symptoms. This is started after the chemotherapy and helps to prevent the symptoms of the menopause. But the hormones don't mean you start producing eggs again. They cannot stop the infertility.

Ways to keep your fertility It is not as easy for women to preserve their fertility as it is for men, but there are ways of doing it, such as • Freezing embryos • Freezing eggs • Freezing ovarian tissue • These techniques are done before the chemotherapy starts and involve having eggs collected. •

Ways to keep your fertility There are 3 possible problems with this. Firstly, you can't have this type of treatment with some types of cancer. If you have a hormone dependent breast cancer for example, your specialist may advise against it. Secondly, it can take a few weeks to stimulate your ovaries and collect the eggs. Your specialist may not want you to wait to start your chemotherapy for that long. These are expensive techniques; not easily available; and some are still experimental

Ways to keep your fertility The approach to infertility treatment that has been used the longest is the 'test-tube baby' technique or IVF. The embryos that are created are then frozen until you want to have a baby. It is also now possible to have just your eggs frozen using a new technique called vitrification. The process is much the same as for IVF. Some research is looking into removing ovarian tissue ( by laparoscopy) and freezing it before chemotherapy starts. The idea is that after treatment, the ovarian tissue can be put back. If the ovarian tissue then starts working normally, eggs may be produced and so fertility is

IVF

ICSI

Vitrification – Egg Banking

Getting pregnant after treatment • Most doctors will advise women that it is best to wait for 2 years after chemotherapy treatment before becoming pregnant. They recommend this because, if your cancer is going to come back, it is most likely to recur within the first 2 years after your diagnosis. If the cancer came back, you'd need more treatment. As you might expect, this could be very difficult if you were either pregnant or had a young baby. There is no evidence that pregnancy increases the risk of breast cancer or melanoma coming back - two of the types of cancer that women are often told can be affected by pregnancy hormones.

How chemo can affect male fertility Chemo kills all rapidly dividing cells, including the sperm producing cells Not all drugs affect your fertility. But some can • Reduce the number of sperm you produce • Affect the sperm's ability to fertilise the egg If this happens it may be temporary or it may mean that you will no longer be able to father children. However, it is important to use contraception throughout your treatment as it is not advisable to father a child while you are having chemotherapy - the drugs could harm the baby. Chemotherapy drugs don't normally have any permanent effect on your sexual performance or your enjoyment of sex.

Sperm banking If your chemotherapy treatment is likely to cause infertility, you may want to store some of your sperm before you start your treatment. The sperm can be frozen and stored for many years in a sperm bank. If you later want a baby, the samples are thawed and used for IVF/ICSI ( since these are precious sperm and worth their weight in gold !) It is important to talk to your doctor about the risk of infertility before you start your chemotherapy treatment. You can then make decisions about whether to use a sperm bank. Even teenage boys can store sperm. Sometimes your doctor may want to start your treatment very quickly. In this case it may not be possible to store only one sample.

Checking your fertility • If chemotherapy has made you infertile it can be difficult to predict whether your sperm production will go back to normal or not • Some men stay infertile • Others find their sperm returns to normal and their fertility comes back • It can take a few months or sometimes years for fertility to return to normal. Your doctor can do regular sperm counts for you when your treatment is over.

What to ask your doctor about fertility and chemotherapy • Will the chemotherapy make me infertile? Will it be permanent? • Do I have any choice about the drugs I can have? • How can I bank sperm before my treatment starts? • Is it possible for me to store eggs or embryos before my treatment? • Will the treatment affect my periods?

What to ask your doctor about fertility and chemotherapy •

If I do become infertile, are there ways I could still have children? • Can you tell me about ovarian tissue freezing? • Is there someone I can talk to about how I feel about infertility? • Explore all your options ! IVF technology has improved dramatically in recent years – and many cancer specialists are still not aware of these advances

Coping with losing your fertility Infertility can be very hard to come to terms with. The sense of loss can be strong for people of all ages. Discuss this risk with your doctor before you start your treatment. Your partner (if you have one) will probably want to join in during the discussion. Then you both learn all the facts and have the chance to talk over your feelings and choices for the future.

Talking about your sexuality and sex life • Some patients find it difficult to talk about their sexuality and sex life. Your diagnosis of cancer may mean that you can't have sex or just don’t feel like it. These issues are very private. • If you’re in a relationship and try to keep your concerns to yourself, your behaviour may confuse your partner. They may feel rejected or think that you no longer love them or feel attracted to them. • If you and your partner stop having sex it often means that other types of intimacy also suffer. You may avoid hugging and kissing because you worry that it may arouse your partner and then upset them because you don’t want to go on and have sex.

Talking about your sexuality and sex life • Sometimes people with cancer avoid physical contact with their partner, because they are so unhappy with the changes to their body caused by cancer or its treatment. Changes in your appearance or physical ability (if you have had a breast removed or have scars from surgery) to have sex may make you feel less confident about sex. If you are single you may avoid getting into a relationship as a result. If you’re able to talk to your partner about your worries, you’ll both gradually get used to your new situation and things will feel less awkward. A caring and loving partner can help to ease your concerns.

How cancer can affect your sexuality and sex life • Does cancer always affect your sexuality and sex life? • How cancer and treatment can affect your sex life • • • • • •

How practical issues can affect your sex life Loss of confidence and self esteem Changes in your ‘body image’ Emotional and psychological changes What if I don’t have a partner? Getting help and support

Does cancer always affect your sexuality and sex life? Not everyone who has cancer will have changes in sexual desire or how they feel about themselves sexually. You may find that the changes cancer causes to your body image affect the way you feel about yourself and having sex. At the other end of the scale, some people say that they want to make love more than usual. If you are in a relationship, a crisis can sometimes bring couples very close together. Because we’re all so different and have different sexual needs, it’s impossible to say exactly how cancer will affect each person’s sexuality and sex life.

How cancer and its treatment can affect your sex life • Having cancer or its treatment can cause: • Tiredness (fatigue); Irritability ; Low mood or depression , Anxiety or tension ; Pain Bowel problems such as diarrhoea ; Bladder problems ; Mouth problems ; Breathing problems ; Skin changes or scarring ; changes in your sex hormones • If you have any of these side effects or feelings, you may not feel like having sex. • Conversely, your partner may not feel like having sex with you • But most people come out of this phase once their treatment is over, or their symptoms are better controlled.

How cancer and treatment can affect your sex life • Simply touching can help you feel cared for and reduce any anxiety and depression you may have. So if you have a partner, you can focus on showing your feelings for one another in other ways by • Enjoying being close to each other ; Touching and stroking ; Kissing ; Massaging ; Talking ; Holding hands • It may help to know that even if you don’t feel like having sex, a caring partner may still be able to arouse you and help you enjoy sexual activity. • It is important that you both agree on what is acceptable to each of you. Do talk to each other about your worries and fears. Don't be afraid to ask each other what is OK and what is not. While talking about sex can be difficult, checking out each other's feelings and what they want can

Emotional and psychological changes • Cancer doesn't just change you physically. It can cause many different emotions such as fear, depression and anger. These intense feelings may also affect how you feel about sex and about yourself. You might find that you look at the world differently after having cancer. Some people really do find that they can use cancer as a new beginning. However your outlook on life changes, you and the people close to you will need time to get used to it.

What if I don't have a partner? • If you’re single, you still need to feel sexual and attractive to others. This means first getting used to the changes yourself. It can be more difficult when you don't have someone close to support you and reassure you. Try talking to a close friend or family member who can help you deal with the changes that cancer and its treatment have caused. Talk to them and explain how you

Getting help and support • You will probably find that any problems you have with sex after cancer will get better with time and a little patience. But some people need a bit of help. Remember - problems with sex are very common. They just aren't always talked about much. Talking about sex can be difficult and many people find it very embarrassing. Talking to a counsellor or seeing a sex therapist can help you to find ways of overcoming difficulties. You can see a sex therapist if you are single. If in a relationship, you can go alone or with your partner. It may be better to talk things through as a couple, if you can. • Not talking is the worst option

Vaginal dryness • This is very uncomfortable. It can make the vagina become very sore, especially during intercourse. And it can also make you more prone to vaginal infections because the natural lubricating and cleaning process is not working. Even if you can't take HRT, you may be able to use vaginal oestrogen. This is oestrogen in a cream or tablet (called a pessary) that you put into the vagina about twice a week. Or you can use KY jelly or other water based lubricants just before you have intercourse.

Sexuality and breast surgery •

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Whether you have had part or all of a breast removed, it will be an emotional time for you. You may feel relieved and happy that your cancer has been found and removed. Maybe you will feel some grief and anger about what you have had to go through. And the surgery might affect your sexual feelings. The first milestones will be when you first see your scar. It will take time to deal with your changed appearance. And this goes for your partner too. But you may feel a greater loss if your breasts are important to how you respond sexually. The breast cancer treatments surgery and radiotherapy will cause a certain amount of loss of feeling in that breast. Obviously if you have had a mastectomy, you will have lost the feeling along with the breast. This can't be brought back and it will take time for you to mourn the loss. If you have had a double mastectomy, there may be an even greater sense of loss.

Breast reconstruction • You may be able to have more surgery to reconstruct a new breast shape. This won't bring back lost sensation, but it may help you to recover from your mastectomy. Everyone is different, but if you think this would help you, then talk to your surgeon.

If you have advanced cancer • Having advanced cancer means that your cancer can’t be cured. But it very rarely means that you are already terminally ill. But whatever your situation, you will still have needs and desires. Even if you don’t feel like having sexual intercourse, you may still have sexual feelings even if you are very ill. If your cancer is in the advanced stages you may have an even stronger need for intimacy in your life than before you had cancer. Physical closeness, sharing your feelings and touching may become very important.

Help and support • If you are at all worried about anything to do with your sex life and sexuality you may want to talk through how you feel with a counsellor or therapist.

Surgery to the pelvis or genitals • • • • • • •

Some operations for cancer can affect your sex life. These include Having prostate surgery Having bowel or rectal surgery Having both testicles removed Having your bladder removed Having all or part of your penis removed Surgery to remove lymph nodes from the back of the abdomen

Ejaculation and fertility problems

If you have a radical prostatectomy you will no longer produce semen at all. If you have dry orgasms, you will not be able to have children by natural sexual intercourse because your sperm cannot be passed into your partner's vagina during sex. If you want to have children, it may be possible to take sperm directly from your testicles . The sperm can be used for IVF/ICSI. Problems with erections Depending on the surgery you have, there is also a risk of difficulty getting or maintaining an erection. This is called impotence. After any surgery to the prostate you may be impotent temporarily. Impotence is more likely to be permanent if you had a radical prostatectomy.

Coping with a low sexual desire • Cancer and its treatment can make you lose interest in having sex. Your sexual desire may be lower because of Tiredness ( fatigue); Anxiety about having cancer ; Loss of confidence and self esteem ; Side effects from other treatments such as chemotherapy ; Changes in the male sex hormones • Many of these problems will disappear once your treatment finishes and your desire for sex will return to normal. But it may take a bit of time, so don’t worry too much if you don’t feel like having sex for a while. • If you’re in a relationship it will be important to talk about this with your partner. Kissing and touching can be very comforting and relaxing, as long as you’re both clear about how far you’re expecting to go.

Managing erection problems • Even if you can't get a full erection, you can still have a sex life. You may find you can still get a partial erection and are able to have intercourse. If your erection problems are caused by surgery, they may get better with time.

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Even if you can't get an erection at all, it is worth talking to your doctor or urology nurse specialist, if you have one. There are treatments that may help you including Drugs Injections or pellets Vacuum pumps Implants

Sex and cancer for partners • • • •

Talking to and supporting your partner Physical changes Sexuality More information and support

Talking to and supporting your partner • You can do a lot to help your partner come to terms with the effect their cancer and treatment has on them. The most important way you can help is being prepared to listen. It is also important to talk openly and honestly to your partner. They need to know that you still love them and find them attractive, and that you are prepared to give them the time and space to recover.

Physical changes • It will help them if you are able to face obvious changes like scars. You may also need time to get used to this sort of change. New scars tend to be more visible at first. With time, they will settle down and become less obvious. If your partner has had a mastectomy, for example, she will almost certainly worry that you find her less attractive, and may worry that you actually find the scar ugly and that it 'puts you off'. It can be very healing for a partner to touch or stroke a scar as it shows that you have accepted these body changes.

Sexuality • It may be helpful (or necessary) to put intercourse on hold for a while and concentrate on showing each other affection. Kissing and touching can be very comforting and relaxing, as long as you are both clear about how far you are expecting to go. Many men are afraid of causing a woman with cancer pain, even by touching them. Worries like this can get in the way of a relationship. Talking with each other will help. Ask your partner to guide you either by words or actions and be prepared to go at her pace. And for women who feel rather shy at taking the lead some gentle encouragement may help.

Sex and cancer if you are single • • • • • • • •

This page has information on sex and cancer if you are single. There is information on Your feelings Starting a new relationship If the relationship gets more serious If you can't have children Involving your partner in check ups What if someone rejects me? If you have advanced cancer

Your feelings • If you are single and have cancer you still need to feel sexual and attractive to others. The physical and emotional changes cancer may cause can sometimes make it very difficult for a single person to feel comfortable about their sexuality and starting a new relationship. • You need time to get used to any changes yourself. Try talking to a close friend or family member who can help you deal with the changes treatment and cancer have caused. If you want to speak to someone outside your circle of family and friends you can try counselling. Take your time and don’t feel you must rush into a new relationship. You have been through a lot with having cancer and its treatment. And you will need time to accept any changes to your body yourself before trying to share them with a new partner.

If the relationship gets more serious • Starting a new relationship is one thing, but if it becomes more serious and there is a possibility of staying together long term, there are other worries you may have. As your relationship deepens and you become more secure in being with the person, hopefully you will feel more comfortable discussing your cancer. You may feel that you don’t want to risk upsetting your partner or changing their views of you. But this isn’t always the best way to handle things. There are certain things that need to be discussed before you decide to plan a life together. Refusing to talk about these things may cause problems for both of you.

If you can't have children • You may have lost your ability to have children (your fertility) because of the side effects of your treatment. This can be very painful to deal with. Finding the right time to tell your partner about this can be extremely hard. Even if you can still have children you may worry that your cancer will come back and you won’t live long enough to see your children grow up. Talking to your partner about these issues is very important for you both. A loving partner will be supportive and continue to love you as you are. Involving your partner in check ups You may need to go for regular follow up appointments for several years after your cancer treatment. So it will be important to let your partner know about this.

What if someone rejects me? • Sadly, some people may reject you because of your cancer and its treatment. If this happens it can be very upsetting and shocking. It’s likely to really knock your confidence. You may think that everyone is going to react in the same way and you’ll never meet anyone who will love you for what you are. It is hard, but try not to feel too hurt. Most of us face rejection from a partner at some time during our life. It may be hard to believe at the time, but often the best way to deal with it, is to tell yourself they just weren’t the right person for you. You are probably better off without them. Try not to let it put you off going on to meet someone else.

Some common questions • • • •

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Can I catch cancer from my partner? No. If your partner has a cancer, you cannot catch it from any sexual activity. You cannot catch cancer from sex. Could sex make my cancer worse? No. On the contrary, sex and all the love and caring that goes with it can be helpful to those who have cancer. Many people feel depressed, unlovable, guilty or afraid when they have cancer or are having treatment, and their partner's affection and acceptance can make a big difference. Are there times when sex should be avoided? Yes, there are. First of all, it's safest either to avoid sex or to be sure to wear a condom or use some other form of barrier contraception during, and for a few months after, chemotherapy. We simply do not know enough about whether chemotherapy drugs can be present in semen or vaginal fluids.

Some common questions • Are there any good positions for making love after cancer? • Maybe making love side by side, or swapping who's on top, will be better. • How can I overcome problems of tiredness? • Be flexible about the time of day you make love. Experiment with less demanding positions for lovemaking. And agree with your partner that lovemaking need not always mean a long session. • I'm embarrassed about my scars but still want to make love. Any ideas? • It is a good idea to first talk things through with your partner. Most people find their lovers are much less concerned by their scars than they imagine, and once the subject has been discussed openly they can feel more relaxed about the changes in their bodies.

The Serenity Prayer • God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference. • Reinhold Niebuhr

Humour

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