Renegotiating Sexuality and Intimacy in the Context of Cancer: The Experiences of Carers

Abstract

There is a growing body of evidence to show that cancer can result in dramatic changes in sexuality, sexual functioning, and intimate couple relationships, with significant implications for both quality of life and psychological well-being. However, the experiences of intimate partners are often neglected in research on sexuality and intimacy in the context of cancer. This study used a material-discursive framework and a qualitative methodology to investigate the ways in which intimacy and sexuality are renegotiated in the context of cancer, and what factors are associated with successful or unsuccessful renegotiation, from the perspective of partners caring for a person with cancer. Twenty participants were interviewed, across a range of cancer types, stages, and age groups. Eleven participants reported that they were unable to negotiate other ways of being sexually intimate when penetrative sexual intercourse was no longer physiologically possible or desirable. Nine were able to renegotiate sexual intimacy in the context of cancer to include practices previously positioned as secondary to "real sex," such as mutual masturbation, self masturbation, manual stimulation, oral sex, massage, the use of vibrators, kissing, and hugging. Grounded theory analysis identified two themes associated with renegotiation: "Alternative" sexual practices-redefining sexual intimacy, and couple communication and relationship context. Difficulties in renegotiation were associated with adherence to the coital imperative, sexual relationship or communication problems which existed prior to cancer, and the positioning of the person with cancer as a child or an asexual sick patient rather than a sexual partner. The implications for health professional intervention to ameliorate changes to sexuality in the context of cancer are discussed.

The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis

“…Second, there are articles following a ''restructuring theory'' during cancer (Beck et al, 2013;Boehmer & Babayan, 2004;Fergus et al, 2002;Gilbert et al, 2010Hartman et al, 2014;Juraskova et al, 2003;Oliffe, 2005;Ramirez et al, 2010;Ussher et al,2013;Walker & Robinson, 2011, 2012.Unlike the grief theory, where the patient and partner work through different emotional stages, in the restructuring pathway the patient andpartner sexually adjust tocancer more cognitively,by developinganewsexualparadigm.Flexibilityisthecentralconceptof this adjustment. This pathway is embedded in a social constructionist paradigm, which means there is a strong focus on the social and cultural forces-inherent to the social environment of a person-that shapes his or her experiences of sexuality.…”

“…When they followed these discourses, the following patterns could be observed: Patients and partners had the idea that their sexuality could be normalized through techno-medicines such as operation tech-niques or assistive aids (e.g., Viagra, lubricants) (Boehmer & Babayan, 2004;Fergus et al, 2002;Oliffe, 2005;Ramirez et al, 2010;Ussher et al, 2013). Moreover, patients and partners did not discuss their sexuality with each other, as they had the idea that sex is something you do, not something you talk about (Gilbert et al, 2010). Neither did they want to expand their sexual repertoire, nor to change their sexual roles in the relationship (Wilmoth, 2001;Wittmann et al, 2014).…”

“…At an individual level, this is formulated, for example, as a feeling of inferiority , an altered body image (Gilbert et al, 2010), a sense of disembodiment , or a loss of masculinity or femininity Oliffe, 2005;Ussher et al, 2013).Ataninteractionistlevel,strugglingisdescribedasstigmatization because of sexual dysfunction .…”

“…Renegotiation happens through open and flexible communication (Beck et al, 2013;Ussher et al, 2013), and through challenging the social discourse of shame about talking about sex . Often, this renegotiation is described as an amelioration of sexuality and intimacy Gilbert et al, 2010).…”

“…In contrast to thearticlesusingthegriefprocess,thereisnorealendpointinthis adjusting process. Instead, it is seen as a process of oscillation between struggling and adaptation, between sticking to and challenging the dominant discourses of sexuality (Gilbert et al, 2010Hanly et al, 2014;Ramirez et al, 2010).…”