[Music]

I'm Dr Isabel White and I'm a Clinical Research Fellow in psycho-sexual practice

based at the Royal Marsed NHS Foundation Trust in London.

When women are facing the outcome of cancer treatment

the types of sexual difficulties that they come to speak to me about are largely

difficulties associated with having lost desire for sex.

Sometimes it's in relation to being fearful of resuming their sexual relationship with their partner,

and the other common problem is actually sexual pain

where when they try to be sexual it's actually uncomfortable for them.

Other problems might include things like changes in orgasm for example, where it's less satisfying,

or just generally a loss of sexual satisfaction.

When it comes to men who have had treatment for cancer the types of problems that are dominant there

are probably first of all erection difficulties but more specifically in terms of them coming to see a psycho-sexual therapist

these would be difficulties that haven't responded well or not adequately to

drug therapy for erection difficulties which are very commonly used.

And then again, like women, men may experience loss of sexual interest or desire which again might cause them distress

And then there are also some ejaculation and orgasm changes that might occur as a result of cancer treatment as well

so those would be the main reasons that they come to see me.

I think there are key problems or issues and challenges that are different at different age stages

If it was, for example, someone who was quite young, who was maybe a teenager or someone in their early twenties,

Who was still relatively inexperienced, hadn't had very many sexual relationships,

For them a lot of it is about their concerns about not being the same as their peer group,

Worries that they might not find a partner, who might be prepared to understand

the changes that have occurred as a result of their cancer treatment,

and fears that they might not be able to have confidence to form a sexual relationship.

I think when it comes to adults in their middle years who are in an established relationship

the biggest anxiety they have is whether or not the sexual difficulty might cause a strain in the relationship

and make the relationship break down.

And then for older people, maybe those well over 70,

they might be more accepting of some of the functional changes that might alter their sexual relationship

although they'll still experience sadness at those changes perhaps.

There are far more physical treatments or drug-related treatments available for male sexual problems

than there are for female sexual problems.

The types of physical treatments that there might be would be certainly drugs for erection difficulties

which are very commonly spoken about things like Viagra, or Cialis or Levitra.

There are also treatments such as vacuum constriction devices which are pumps that can actually help men create erections

And then if the difficulty is that they can create an erection but find it difficult to sustain the erection

until the end of sexual intercourse

then there are constriction rings that can actually help keep the erection firm

so that they can finish off their period of intercourse with their partner.

On the female side the sorts of physical treatments tend to be more limited.

Largely, again, you're looking at if there have been changes in the lady's vagina as a result of cancer treatment

either by becoming more narrow or shorter, you can use both lubricants to help with sexual pain,

but also you can use dilators that then help gently stretch the vagina

and help the woman, again, gain greater confidence in knowing what her vaginal anatomy is like after treatment

You can also use vibrators, as an alternative to dilators,

but you can also use them, again, where you've got orgasm changes and difficulties,

again to help improve orgasmic sensation.

I think for both men and women you've also got the possibility of using hormone treatment

People whose sex lives and relationships have been affected by cancer

are often very anxious about addressing those fears and concerns with each other.

And I think the main message would be to get the couple to talk to each other,

actually acknowledge that it's not an easy topic to discuss, for anybody,

But perhaps it might reassure them to hear that actually we have heard it all before.

These are very common difficulties that people experience after a cancer diagnosis and after cancer treatment.

And the positive thing is that there is lots of help out there and lots of information out there compared to many years ago.

Why not try to look at the Macmillan website? Or indeed phone the Macmillan helpline?

And through looking at the website or talking to someone on the helpline

that will help you identify where you might actually go.

But the majority of sexual difficulties can be very well helped with better information

and perhaps some brief discussions with either a specialist nurse,

someone from the likes of the Macmillan helpline,

or indeed a small amount of brief counselling maybe only four or five sessions.

For information, help, or if you just want a chat

call the Macmillan Support Line on 0808 808 00 00 or visit macmillan.org.uk