Dr. Catalina Lawsin, also known as The Intimacy Doc, joined me on the podcast to talk about sex! Through her research and work, she discovered that relationships are core to who we are and how we experience life. She realized that those facing something such as cancer struggled with relationships and intimacy but these issues are not addressed in the field of oncology. She talks about some of the complications experienced by cancer survivors and offers some strategies on how to address some of these concerns.
Dr. Catalina Lawsin, Licensed Clinical Psychologist, joined me on the podcast to talk about relationships and sex. Through her research and experience, Dr. Lawsin came to realize that over time, when faced with a crisis, it became clear how everything came down to relationships and the relationships of those in a crisis tended to be more of an emotional relationship. This led Dr. Lawsin into the work that she does now.
Dr. Lawsin notes the gap that exists between the support survivors need and what is actually provided by their oncology team. Doctors are not comfortable bring up psychosexual issues but many survivors experience difficulties with function, particularly painful sex and lubrication. When women experience vaginal dryness, the vagina shortens, becomes narrow, and tightens. These issues can be so severe that some women even struggle with walking. Many experience discomfort with an internal exam. The pain then turns to aversion and avoidance of intimacy and sex. Survivors struggle through not only the physical pain but also the emotional adjustment that takes place. It is an immediate trauma that many need to grieve.
In her work, Dr. Lawsin has seen many survivors that have not had intimacy in 10+ years. The supportive partners don’t want to bring it up. Time goes by and the body becomes disconnected. Partners experience as much, if not more than cancer patients themselves, during the treatments. They are forced into becoming the primary caregiver and many other aspects of their life shift but no one checks in on them. They can become tired and exhausted, which then can make survivors feel rejected when not pursued by their partners.
Male cancer survivors can struggle with establishing and maintaining an erection. Doctors rarely tell prostate survivors that they will have a dry ejaculation, which comes as a surprise to not only the survivor but also his partner. It shifts the experience for both individuals. Men are often prescribed medication to support them but this changes their mindset and the man struggles to be in the moment.
Sexuality changes as we age, but for many cancer survivors, this comes on very abruptly.
Many breast cancer survivors are very hesitant to touch their breasts, let alone allowing anyone else to touch them. Many times, it leads to survivors thinking that if it cannot be what it was, it cannot be anything at all. It is important to meet your body where it is at and to know that there are things that can be done to get sexual function back and to integrate one’s cancer experience into a sense of self, increased body awareness, and connection.
There are a lot of myths about cancer and sex. Many individuals think they cannot have sex during treatments. There is a lot of stigma about the body being toxic, not sharing the same toilet, etc. Some patients have reported that sex is the one thing that has made them feel normal during chemotherapy. Breast cancer patients often think that their implants might pop. Following an oophorectomy, many women feel a gap and are unsure of what happens during sex when things are gone.
Sexuality will change across all cancers but the most impactful cancers are those that disrupt the functionality of sexual body parts.
While communication is key, it is important that the conversation starts with oneself first. An individual has to acknowledge where she is at. If someone is not accustomed to having open communication and assertive feelings, the person will really struggle in the relationship. Communication is already a struggle in most relationships, but then cancer complicates this even further. Couples have to be able to work together. Dr. Lawsin recommends using I statements and being very clear. It does not take our bodies very long to get conditioned to the physical changes and if someone is experiencing avoidance or aversion, it takes only 2-3 weeks for it to become chronic. Couples have to acknowledge the physical change, heighten the awareness, and communicate with one another without trying to fix it. Survivors need to have a safe space to say, “I don’t feel the same” or “I don’t feel sexy”. Sex is fun when it is safe. Most couples are not accustomed to having to shift or change expectations around sex but when cancer happens, they have to.
For anyone experiencing physical pain, Dr. Lawsin recommends using vaginal moisturizers to rebalance pH levels and bring natural lubrication back to the vagina. She suggests the use of Replense. After chemotherapy and radiation, begin using vaginal dilators to stretch and strengthen the vagina while also reconnecting to the area. She recommends that women work through this on their own at first and at a slow pace. It is important to learn to breathe through the pain and ground oneself. Through the process, the body will become conditioned. She shares that there will be pain as a woman moves through the exercises but be patient, breath, and move through the pain. It is important that a woman build up trust with herself first. Dr. Lawsin recommends playing good music and doing those same things that you might do for date night. After that, the woman can bring her partner into the experience. Lubrication will be good for on the spot and the woman can share what feels good and what works best.
Kegel weights are great to strengthen the pelvic floor and incontinence in both men and women. Dr. Lawsin always recommends that a woman go to a physical therapist specializing in pelvic pain for an assessment and to get guidance on how to work through the pain.
Dr. Lawsin has worked to train oncologists and oncologist nurses to share this information. She feels that if patients are asked how sexually satisfied they are, it will open the door to understanding many things. It speaks to the relationships the person has and will normalize the conversation. It opens a safe space for the conversation. Dr. Lawsin indicated that many providers are embarrassed because they do not know how to advise a patient on psychosexual matters but Dr. Lawsin encourages patients to bring it up and ask for a resource.
Dr. Lawsin acknowledges that the physical changes settle in approximately 1-2 years out, but the psychological changes are the ones that really need to be addressed and managed, even before the physical change. Otherwise, the body will continue to retreat.
Dr. Lawsin has a podcast, provides online courses, and continues to conduct research in this area. She is also trying to connect people with local chapters of organization that provide support for cancer survivors to create a real and open space to talk about sex and relationships. If anyone is seeking more information, go to www.theintimacydoc.com