For many, cancer treatment can bring changes to the way the body looks and feels. Some of these body changes are short-term while others will last forever. Either way, the way you look may be a big concern for you during or after treatment. For example, some people have to take certain drugs that cause swelling or fluid retention which makes them feel unattractive. Or for those with ostomies after colon or rectal surgery, they sometimes feel afraid to go out in public. They worry about carrying equipment around or fear that it may leak. Some may feel ashamed or afraid that others will reject them.

Every person has different changes in their body due to cancer treatment. Other people may notice some of them, while other changes only you will notice. For some of these you may need time to adjust. Issues you may face include:

• Hair loss
• Skin changes
• Scars or other changes in the way you look caused by surgery
• Weight changes
• Loss of limbs
• Ostomy
• Loss of fertility, which means it can be hard to get pregnant or father a child

Even if others can't see them, your body changes may trouble you. These losses are real and it's okay to feel upset about them. Feelings of anger and grief about changes in your body are natural. Feeling bad about your body can also lower your sex drive. This loss may make you feel even worse about yourself.

Changes in the way you look can also be hard for your loved ones, which in turn, can be hard on you. Seeing your changes may cause them to worry more about you or make comments, both of which could cause you stress. Or patients who are parents and grandparents may worry about how they look to a child or grandchild. They fear that changes in their appearance may scare the child or get in the way of their staying close.

How do you cope with body changes?

• Mourn your losses and know it's okay to feel sad, angry, and frustrated. Your feelings are real, and you have a right to grieve.
• Seek help from a counselor. Ask your doctor or nurse to suggest someone who you can talk to about your feelings.
• Try to focus on the ways that coping with cancer has made you stronger, wiser, and more realistic.
• If your skin has changed from radiation or other treatments, ask your doctor about ways you can care for it. Or ask for a referral to a dermatologist or other skincare expert.
• Look for new ways to enhance your appearance. A new haircut, hair color, makeup, or clothing may give you a lift. If you're wearing a wig, take it to a salon where they can shape and style it for you.
• Join a support group or talk to other patients for advice.
• If you choose to wear a breast form (prosthesis), make sure it fits you well. Don't be afraid to ask the clerk or someone close to you for help.

Coping with these changes can be hard. But with the passage of time and getting help from others, many people adjust to them and move forward. And know that some changes may be temporary. Ask your health care team for resources and support groups that might be helpful to you.

Many people find that being active can help their self-image and the way they feel. If you have the energy, some things you can try are:

• Walking
• Swimming
• Playing a sport
• Taking an exercise class
• Weight training
• Stretching or yoga

You may find that being active helps you cope with changes. It can reduce your stress and help you relax. It may also help you to feel stronger and more in control of your body. Start slowly if you need to and take your time. If needed, ask a trainer at your local gym or a physical therapist for tips. Talk with your doctor about ways you can stay active.

Try hobbies or volunteer work

Hobbies and volunteer work can also help improve your self-image and self-esteem. Think about what brings you comfort or joy. For example you may like to:

• read
• listen to music
• do crossword or other kinds of puzzles
• garden
• write in a journal
• do woodwork or carpentry

Volunteer work may also be something that takes your mind off things. You could volunteer at a church or a local agency, or become a mentor or tutor, for example. You may find that you feel better about yourself when you get involved in helping others and doing things you enjoy.

It's common for people to have problems with sex because of cancer and its treatment. When your treatment is over, you may feel like having sex again, but be aware that it may take some time. Sexual problems can last longer than other side effects of cancer treatment. It's important to seek help from your doctor or other expert to learn how to adapt to these changes.

Until then, you and your spouse or partner may need to find new ways to show that you care about each other. This can include touching, holding, hugging, and cuddling.

Treatment-related sexual problems

Sexual problems are often caused by changes to your body. Depending on the cancer you had, you may have short-term or long-term problems with sex during and after treatment. These changes result from chemotherapy, radiation, surgery, or certain medicines. Sometimes emotional issues such as anxiety, depression, worry, and stress may cause problems with sex.

What types of problems occur? Common concerns are:

• Worries about intimacy. Some people may struggle with their body image after cancer treatment. Some worry that they won't be able to perform or will feel less attractive. Hair loss or being seen without clothes may also be stressful to some.
• Changes in your sex drive. Pain, worries that sex will hurt, feeling bad about your body, loss of interest, depression, or cancer medicines are just some examples of what can affect sex drive.
• Changes in your sex organs. Some cancer treatments cause changes in sex organs, such as:
  • Some men can no longer get or keep an erection after treatment for prostate cancer, cancer of the penis, or cancer of the testes.
  • Some treatments can weaken a man's orgasm or make it dry. Less common problems include being unable to ejaculate or ejaculation going backward into the bladder.
  • Some women find it harder, or even painful, to have sex. Some women also have pain or numbness in their genital area or changes in sensation. While some cancer treatments can cause these problems, there may be no clear cause.
• Having menopause symptoms. When women stop getting their periods, they can get hot flashes, dryness or tightness in the vagina, and/or other problems that can affect their desire to have sex.
• Losing the ability to have children. Some cancer treatments can cause infertility, making it impossible for cancer survivors to have children. But keep in mind that:
  • Depending on your age, the type of treatment you received, and the length of time since treatment, you may still be able to have children.
  • Families can come together in many ways. Some people choose adoption or surrogacy. Some people get involved in the lives of nieces or nephews, or in child mentoring programs.
  • You may choose to focus on other interests and passions in life.

If you're single, body changes and concerns about sex can affect how you feel about dating. As you struggle to accept the changes yourself, you may also worry about how others will feel. Common concerns include:

• You may wonder how someone will react to physical things, such as hair loss, scars or ostomies.
• It can feel awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.
• You don't feel like the same person after going through cancer treatment.

Starting to date again may feel like a challenge. You may wonder how and when to tell a new person in your life about your cancer and body changes. For some cancer survivors, the fear of being rejected keeps them from seeking the social life they would like to have. Others who choose not to date may face pressure from friends or family to be more sociable. Here are some ideas that can make it easier to get back into social situations:

• Focus on activities that you have time to enjoy, such as going to festivals and group outings, taking classes or joining a club.
• Try not to let cancer be an excuse for not dating and trying to meet people.
• Wait until you feel a sense of trust and friendship before telling a new date about your cancer.
• Talk to your friends about dating or get advice from other cancer survivors.

Think about dating as a learning process with the goal of having a social life you enjoy. You get to choose who or how often you date. And not every date has to be perfect. If some people reject you (which can happen with or without cancer), you have not failed. Try to remember that not all dates worked out before you had cancer. And perhaps, your cancer experience gives you a sense of purpose and appreciation for a relationship that you didn't have before.

Even for a couple that has been together a long time, staying connected after cancer can be a challenge at first. How do you start the conversation and express your needs when it comes to sex?

It is important to talk about your concerns, feelings, and beliefs about your sex life and what would make you feel better. It is also important to take your partner’s concerns, feelings, and beliefs into consideration.

Having an open, honest conversation is key to moving forward. Here are some tips—

• Pick a private time to talk about sex outside the bedroom.
• Ask questions to understand your partner’s concerns better.
• Focus on your partner’s comments, not on what you plan to say in response.
• Repeat what he or she says in your own words.
• Be specific and positive about what you’d like to change.
• Acknowledge that your partner’s views matter to you.

By approaching the topic of sex and intimacy openly, you can avoid blame, keep the conversation positive, and give your partner a better sense of how you’re feeling.

Starting Fresh: Dating as a Survivor

After cancer, you may experience physical and emotional changes and concerns, especially around sex, that can affect how you feel about dating. It is normal to worry about how another person will react to physical things like scars or hair loss. You may also find it awkward to bring up sexual problems or loss of fertility, which can make feeling close even harder.

How and When to Bring It Up

You may wonder about the best way and time to tell a new person in your life about your cancer experience. There’s no one “right” answer on when to tell someone. Wait until you’re comfortable and trust the person with your feelings.

It may help to write down or practice what to say. Be ready to answer any questions. You may also want to talk to your doctor or a counselor about your dating concerns and fears of becoming intimate with a new partner.

Feeling Intimate After Treatment

It may be hard to feel intimate after cancer because of physical or emotional changes. When you’re struggling with your body image, remember to—

• Be proud of your body. It got you through treatment, after all!
• Think of things that help you feel more confident.
• Focus on the positive.
• Be open to change.

When Your Partner Is a Cancer Survivor

When your partner has cancer, it can be hard to understand what he or she is going through. Your partner also may have trouble understanding what you are going through. Ask yourself—

• Am I feeling overwhelmed? Stressed?
• Do I feel lonely or abandoned?
• How will my role or situation change after treatment?
• Do I think my partner and I should talk about our sexual relationship?

Even though you may feel awkward, let your doctor or nurse know if you're having problems with intimacy or sex. There may be treatments or other ways you and your loved one can find pleasure with each other. If your doctor can't talk with you about sexual problems, ask for the name of a doctor or other expert who can. Some people also find it helpful to talk with other couples.

Sexual problems may not always get better on their own. Sometimes there can be an underlying medical problem that causes changes. Know that there are ways you can get help. Some common sexual changes and potential solutions are:

• Erection problems. Medicine, assistive devices, counseling, surgery, or other approaches may help.
• Vaginal dryness. Dryness or tightness in the vagina can be caused by menopause. Ask whether using a water-based lubricant during sex, using vaginal dilators before sex, and/or taking hormones or using a hormone cream are options for you.
• Muscle weakness. You can help strengthen muscles in your genital area by doing Kegel exercises. This is when you practice controlling your muscles to stop the flow of urine. You can do these exercises even when you are not urinating. Just tighten and relax the muscles as you sit, stand, or go about your day.

Other issues you may want to talk to your doctor about include:

• Concerns about having children. Discuss family planning concerns with your doctor. If you're a woman, ask if you still need to use birth control, even if you are not getting your period.
• Talking with a counselor. Changes in sexual health can cause feelings of loss and sadness for many. And some people find that sexual problems related to cancer start to strain their relationship with their partner. If this is the case, ask a nurse or social worker if you can talk to a counselor. Talking to someone alone, or with your partner, may help.
• Seeing a specialist. A sex therapist may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.

Tell your partner how you feel

Talking to your loved one and sharing your feelings and concerns is very important. Even for a couple that has been together a long time, it can be hard to stay connected.

Let your partner know if you want to have sex or would rather just hug, kiss, and cuddle. They may be afraid to have sex with you. Or your partner may be worried about hurting you or think that you're not feeling well.

For some, talking about sex isn't easy, even if it's with someone you're close to. But if you can, talk to your partner about any concerns you have about your sex life. Try to be open about your feelings and stay positive to avoid blame.

Find other ways to be intimate

You can still have an intimate relationship in spite of cancer. Although sexual problems may remain for a while, you can still find other ways to show that you care about each other. Feeling close to your partner is important.

Intimacy isn't just physical. It also involves feelings. Here are some ways to improve your intimate relationship:

• Focus on just talking and renewing your connection.
• Protect your time together. Turn off the phone and TV. If needed, find someone to take care of the kids for a few hours.
• Plan time to be together without being physical. For example, you may want to listen to music or take a walk.
• Try new touch. Cancer treatment or surgery can change a patient's body. Areas where touch used to feel good may now be numb or painful. Some of these changes will go away. Some will stay. For now, you can figure out together what kinds of touch feel good, such as holding, hugging, and cuddling.
• Focus on the positive things in your relationship. If you can, try to be aware of your thoughts, since they, too, can affect your sex life.