[Sarah]

All cancer survivors whose sexuality, and specifically sexual organs, have been affected by cancer or cancer treatment can benefit from taking time to explore sensations in other areas of the body. The areas of the nipples, inner thigh, ears, neck, and face are all very sensitive to stimulation. Try different types of touch, from a light touch using the fingers, a piece of silk, or a feather, to a deeper, massaging type of touch, until you discover techniques that work for you and your partner.

It's also possible that sexual function may be affected in ways that are not directly related to the sexual organs. For example, survivors who get short of breath during physical activity need to plan ahead for sexual activity. Survivors who use supplemental oxygen should make sure that they have enough oxygen in the tank and that the tubing is long enough to allow them to move around freely during sexual activity. These people may find breathing easier if they lie flat on their backs. Positions that involve either sitting upright or standing may be more comfortable, since they allow the lungs to fully expand and take in more oxygen with each breath. These people should be sure to tell their partners if they are getting short of breath. If so, they should take a rest or slow the pace of their activity until they no longer feel short of breath.

Survivors who have conditions that make their bones fragile, like multiple myeloma or bone metastases, may be concerned about the possible impact of sexual activity on their bones. Careful positioning may make sexual activity possible, comfortable, and safe even for these people. Generous use of pillows, rolled towels, and blankets can provide for comfort and support. Any survivor who experiences pain at any time during sexual activity should tell his or her partner immediately, and check if the affected part of the body can be moved without pain. They should contact their doctor right away if there is redness or swelling at the site of the pain, or if the pain does not go away in a reasonable time.

Finally, anyone who is sexually active, whether they have cancer or not, should take precautions against sexually transmitted diseases. Any exchange of body fluids between people creates a risk of transmitting an infectious disease. The best protection against sexually transmitted diseases is to always use a latex condom, which can be used with water-based lubricants, such as K-Y jelly. These should be used for oral sex, vaginal intercourse, or anal intercourse. Before performing oral sex on a woman, a dental dam or plastic wrap should be placed over the woman's vulva to prevent possible transmission of infection. When performing oral sex on a man, the use of flavored condoms or topping a regular condom with flavored, water-based lubricant can diminish the taste of the barrier.

[Narrator]

Your doctor, oncology nurse, or social worker may have talked to you about fertility issues before you started treatment. Survivors who do not want to have children should practice an effective method of birth control. Survivors who knew before their cancer treatment that they would want to keep their options open were probably offered the chance to bank sperm, or to freeze embryos, ovarian tissue, or eggs. If you did not do any of these things before treatment, and you later decide that you do want to have children, there are things you should consider. You may want to talk with a reproductive endocrinologist or a fertility specialist. New techniques are constantly being developed to treat infertility.

A growing number of doctors, nurses, social workers, and other providers are not only comfortable talking about sexuality and intimacy, but they have developed a great deal of expertise in it. Sometimes, all that's needed is to simply bring up the question. If you don't feel comfortable with the provider you have, ask for a referral to another provider with the expertise you need.

In summary, the desire for intimacy is a basic human trait. It brings joy to our lives and allows us to give joy to others in a variety of ways. Survivors may find that using survival skills, such as finding information, communicating, negotiating, solving problems, and making decisions, which are found in earlier Toolbox programs, helpful as they explore new ways of expressing intimacy and sexuality in current and new relationships.

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