Читать книгу The Lovin' Ain't Over for Women with Cancer - Ralph Alterowitz - Страница 30

A Cauldron of Emotions—and Hope

Emotions often range widely from the time of diagnosis through treatment and thereafter. Depressed, positive, or somewhere in between, feelings are often volatile and driven by reaction to events or to the side effects of therapy.

The bedroom is a potential domestic war zone. Anxiety over what the future holds co-exists with worries whether the partner will still desire the woman after a mastectomy, or whether the woman with a gynecological cancer will still be able to be a good loving partner, even if she cannot handle intercourse. Post-surgery, nervousness accompanies the woman and her partner into the bedroom.

The emotional stage may be set in the hospital corridors, the treatment facilities, and other places, but it is at home where the drama plays out. Bombarded by the physical and emotional effects of the cancer treatment, it is easy for a couple to feel overwhelmed, lose their connection to each other, and start to drift apart. They may stop talking, stop touching each other, and become more and more isolated from each other, which will make them feel even worse. This is utterly unnecessary and entirely preventable.

The remaining chapters of this book provide you with the tools to overcome the considerable difficulty that cancer treatment can create for your love life. Rebuilding your self-esteem and taking steps to energize yourself are the basis for regaining your balance and being a strong and confident sexual partner and life partner. Some of the things you can do are discussed in Chapter 4. A person needs a good foundation for self-renewal.

The essential tripod of exercise, good diet, and sufficient sleep, along with the motivation for getting and staying well, are covered in Chapter 8. Chapter 5 sheds light on how partners can be helpful, and Chapter 7 has suggestions on how to best get help from your doctor. Chapter 10 has advice and observations for single women. Chapter 11 shows many techniques, exercises, approaches and devices that do not require pills and prescriptions, and Chapter 12 discusses prescription items and supplements that may address sexual dysfunction and you could discuss with your doctor. The very core of the book for couples are Chapters 6 and 9 - the essential question how to communicate with each other, how to regain the magic between you, and how to reinvent loving together.

A good sex life is about a lot more than the release of sexual urges. It is part of being healthy and happy, feeling connected to the person you love, feeling valued and desirable, giving of yourself and receiving love and affection, delighting in all your senses - in short, it is part of feeling fully alive. Isn’t it worth a little effort to get there?

Table 1: Major Cancers and Some Available Treatment Options

Disease	Surgery	Radiation Therapy	Chemo Therapy	Other
Anal Cancer	Wide excision for anal margin tumors. Radical therapy: bdominoperineal resection removal of anus with permanent ostomy for anal tumors where anus cannot be preserved.	External beam or interstitial brachytherapy (seed implants). Radiation combined with chemotherapy to decrease local recurrence rate.	Chemo-radiotherapy has become standard of care for this disease.
Bladder Cancer	Transurethral resection. Cystectomy. Radical cystectomy	External beam. Brachytherapy (interstitial) (seed implants)	Systemic chemotherapy (oral or infusion)	Intravesical immuno- therapy
Breast Cancer	Lumpectomy. Mastectomy (with or without reconstruction). Sentinel node (lymph node )biopsy and removal. Lymph node removal not recommended for early stage breast cancer based on recent research.	External beam.Brachytherapy (interstitial) (seed Implants)	Systemic chemotherapy (oral or infusion)	Monoclonal Antibody. Hormonal (selective estrogen response modifiers, i.e., Tamoxifen, or Aromatase inhibitors)
Cervical Cancer	Removal of the cervix. Hysterectomy. Radical trachelectomy	External Beam	Systemic chemotherapy (oral or infusion)	Hormone (Progestin).Cryotherapy (freezing)
Colo-rectal cancer	Bowel resection (with or without reconstruction). Laparoscopic- assisted. Abdominoperineal resection for anal tumors or low rectal cancer where anus cannot be preserved. Colonoscopy-polyp removal, sessile scraping	External beam. Brachytherapy (Needles, seeds, wires, catheters)	Systemic chemotherapy (oral and IV or IV alone, depending on stage). Chemo given to shrink tumor to try to spare anus. Many chemotherapy drugs are used for colon cancer.	Cryotherapy (freezing). Chemotherapy may be accompanied by a monoclonal antibody
Gynecological Cancer - see: Cervical Ovarian Uterine Vaginal	Total pelvic exteneration	External beam. Brachytherapy (intracavitary or interstitial) (seed implants)	Systemic Chemotherapy (oral or infusion). Cytotoxic chemotherapy	Hormone (Progestin). Intraperitoneal chemotherapy (only for ovarian)
Ovarian Cancer	Total abdominal hysterectomy, with removal of ovary, tubes and omentum (only for operable disease)	External beam. Brachytherapy (Intracavitary or Interstitial) seed implants	Cytotoxic chemotherapy used adjuvantly and palliatively. Intraperitoneal chemotherapy
Rectal Cancer	See colo-rectal cancer
Uterine Cancer	Hysterectomy. Radical hysterectomy	External beam.Brachy- therapy (intracavitary or interstitial) (seed implants)
Vaginal Cancer	Partial or Radical Vulvectomy. Vaginectomy	External beam for those undergoing less radical surgical procedures
Vulvar Cancer	Vulvectomy Vulvar excision surgery	External beam	Chemo combined with radiation

GLOSSARY for Table 1

Abdominoperineal resection - usually includes removal of anus with ostomy

Adjuvant - in addition to other therapy

Axillary node dissection - surgical removal of the axillary (armpit) lymph nodes is often performed on breast cancer patients during the course of a mastectomy

Brachytherapy - radiation therapy in which the source of the radiation is placed close to or implanted into the tissue to be treated (e.g., radioactive “seeds” are implanted in the prostate gland for the treatment of prostate cancer). This allows specific tissues to be treated without radiating and harming the surrounding normal tissue.

Colonoscopy - use of an endoscope to examine the large intestine (colon) to look for early signs of cancer in the colon and rectum

Colostomy - establishment of an artificial opening through the skin into the colon

Cryotherapy - also called cryosurgery, cryoablation or targeted cryoablation therapy, is the application of extreme cold to destroy diseased tissue, including cancer cells

Cystectomy - removal of all or part of the bladder

Cystotomy - an incision into the bladder to drain urine from the bladder

Cystostomy - creation of an opening in the abdomen that allows a tube catheter to be inserted in order to drain urine from the bladder

Cytotoxic - detrimental to cells

Enervation - to weaken or destroy the strength or vitality of something (e.g., organ)

External beam radiation - radiating an area of the body from an external source

Hysterectomy - removal of the uterus

Immunotherapy - a nonspecific term indicating treatment of a disease using one or more substances intended to stimulate the patient’s immune system

Incontinence - the inability to control the discharge of urine or feces

Intensity modulated radiation therapy - computer-calculated, this delivers the appropriate radiation dosage to the target and surrounding areas

Interstitial - relating to spaces within a tissue or organ

Intracavitary - within an organ or body cavity

Intraoperative - occurring during a surgical operation

Intraperitoneal - the way medication is administered directly into the peritoneal cavity

Intravesical - inside the bladder

Intravesical immunotherapy - Treating disease by administering antibodies inside the bladder

Laparoscopy - use of an endoscope to examine the abdominal cavity. The endoscope is usually a very narrow cylinder containing a lens attached to a fiber optic cable.

Lumpectomy - removal of a cancerous or noncancerous lesion from the breast without removing much surrounding tissue

Mastectomy - removal of the breast

Ostomy - an artificial opening such as made be made into the colon, urethra or trachea

Palliative care - reduces the severity of the symptoms without curing the underlying disease

Perineal - relating to the area between the thighs extending from the coccyx (tailbone) to the pubic bone

Peritoneal Cavity - the cavity inside the lining of the abdominal wall

Polyp - a mass of tissue projecting from the surface and visible macroscopically (without use of magnifying devices). Polyps may be benign or malignant tumors, or the result of inflammation or degeneration of the affected tissue.

Radical cystectomy - removal of the bladder, cervix, fallopian tubes, ovaries, uterus, vaginal front wall

Radical hysterectomy - removal of all the female reproductive organs (including the ovaries)

Radical vulvectomy - extensive surgical removal of the vagina and lymph nodes

Resection - removal of all or a significant part of an organ or bodily structure

Selective estrogen response - Cells in many organs in a woman's body are generally sensitive to estrogen. However, some compounds have been developed that are precisely targeted to cells in specific organs, because they are customized to these cells' estrogen receptors.

Sentinel node - removing the first node in the lymphatic chain that would receive drainage from a malignant tumor

Sessile - colon lesions having a broad base of attachment (i.e. not on a stalk)

Transurethral - through the urethra

Urethra - the tube which carries urine from the bladder to the outside of the body

Vesical - relating to the bladder.

(The majority of the definitions were obtained from Stedman Medical Dictionary.)

Table 2: Sexual-related Biological and Psychological Effects of Different Cancers and Their Treatments

Disease	Effects on Women
Anal Cancer	Major effect on sexuality. Possible decreased clitoral stimulation and pain on intercourse. Surgery reduces fat pad cushioning area around vagina, anus, pelvis - may have increased pain with vaginal intercourse. If surgery to remove anus, many organs affected. Radiation also reduces vaginal lubrication.
Bladder Cancer	Incontinence. Altered body image due to ostomy for urine collection. Chemotherapy also causes side effects, e.g., fatigue.
Breast Cancer	Body image. Hair loss. Early onset of menopause. Symptoms associated with hormonal therapy (weight gain, night sweats, vaginal dryness, etc). Reduced breast arousal after mastectomy (with or without reconstruction)
Colon Cancer	Pain. Cancer in upper colon may have some effect on sexuality. Psychological impact of colostomy. If lower rectum is operated on, there is less padding between vagina and sacrum, causing pain during intercourse. Diarrhea due to chemotherapy and surgery if significant part of colon is removed.
Gynecological Cancers incl. Cervical, Uterine, and Vaginal and Ovarian Cancer	Body image changes due to surgery. Hair loss from chemo. Lack of lubrication. Pain in pelvis and on intercourse. Loss of desire. Arousal difficulties. Orgasmic difficulties. Loss of clitoral stimulation.
Other Pelvic Malignancies	Lubrication problems. Thinning of vaginal tissue. Vaginal collapse.
All cancers	Chemotherapy may lead to loss or reduction of libido.

Table 3: Female Sexual Problems Caused by Cancer Treatment

American Cancer Society (ACS) booklet, “Sexuality and Cancer.” 2007.

Treatment	Low Sexual Desire	Less Vaginal Moisture	Reduced Vaginal Size	Painful Intercourse	Trouble Reaching Orgasm	Infertility
Chemotherapy	S	O	S	O	R	O
Pelvic radiation therapy	R	O	O	O	R	O
Radical hysterectomy	R	O*	O	R	R	A
Radical cystectomy	R	O*	A	S	R	A
Abdomoperineinal (AP) resection	R	O*	S	S	R	S*
Total pelvic exteneration with vaginal reconstruction	S	A	S	S	S	A
Radical vulvectomy	R	N	S	O	S	N
Conization of the cervix	N	N	N	R	N	R
Oophorectomy (removal of one tube and ovary)	R	N*	N*	R	N	R
Oophorectomy (removal of both tubes and ovaries)	R	O*	S*	S*	R	A
Mastectomy or radiation to the breast	R	N	N	N	R	N
Tamoxifen therapy for breast or uterine cancer	S	O	S	S	R	A
Androgen therapy	N	N	N	N	N	U

*Vaginal dryness and size changes should not occur if one ovary is retained or if hormone replacement therapy is given.

Table 4: Emotions experienced during and after treatment for cancer

Emotion	Cancer Patient	Partner
Anger - when guilt cannot be expressed, it can surface as anger.	Toward the outside world. “What did I do to deserve this?” “I tried to do the right things for my body and this had to happen.”	“Why will my partner not discuss the situation, not listen to reason, not express intimacy by touching…?”
Anxiety-related to concerns about health implications, incompatible desires	About cancer recurrence or that she can’t fulfill partner’s demand.	Worried about partner’s health and survival; unable to get partner to talk; does not know how partner feels.
Apathy	No sex because of real or perceived inability to “perform.”	“I don’t want to make demands of her.”
Denial - comes, goes, and may return.	“It’s not me they’re talking about.” Often occurs during the time of diagnosis. May suppress it or come out of denial & then accept the situation. Then a bad lab result may push patient into denial again.	Confused, does not know why partner does not take the situation seriously. Or: in denial “This can’t be happening to us.”
Depression	Disease changes life; treatment costly, routines and plans disrupted. Lower quality of life.	Worried about partner survival. Quality of life is lower. Paying for treatment may be a financial burden.
Discouragement	Given a raw deal, has to deal with cancer. Becomes pronounced when treatment goes badly.	Same as for patient.
Distress	Feeling powerless and sad.	May feel distressed and guilty because he/she could not protect the loved one.
Frustration	“Why doesn’t my partner understand what I am going through?” “Nothing’s going right.” “He wants me to feel sexual. But I don’t.”	“I can’t get her to open up.” “I have needs also and she shuts me out.” “I want to help and she won’t let me.”
Gratitude	“I am so thankful I’m alive. I realize how precious every day is.”	“I’m grateful she is still here. This made me realize how much she means to me.”
Guilt	“I’m causing all this worry for my partner and family.”	"I was not able to protect the person I love from this terrible disease.” “I would just like to go on with my life, but I’d feel guilty about that.”
Lack of desire - may be caused by chemotherapy or hormone treatment	Poor body image. Feeling unattractive or not sexual. Poor relationship history.	Poor relationship history. Lack of communication with the partner
Lack of trust - medical establishment, breaking trust	“My doctor did not tell me about the consequences/side effects of the treatment/medication. He/she did not discuss what happens to sexuality after treatment.” “My body has let me down.” Not feeling safe in the relationship.	Similar to patient
Pessimism	“Nothing ever goes right for me.” “He won’t like if he sees I have only one breast.”	“Nothing ever goes right for me.”
Rejected or anticipating rejection	“He can’t stand me because I have only one breast.” “The lumpectomy/hysterectomy scar will turn him off.”	“If I touch her, she’ll pull away.” “I think my wife is having an affair because we have not made love in months."
Relief	“Thank goodness this ordeal is over. Now I can get on with my life.”	Similar to patient.
Self-pity	Why did it happen to me?	“Everything is about the cancer. Everyone focuses on the patient. Nobody asks how I feel.”
Stress	Life is disrupted. Time spent for treatment.	Life is disrupted. Sex life evaporated.

The emotions you or your partner may feel might be expressed in many ways. Table 5 presents seven negative ways you or your partner may express feelings. If you recognize that these behaviors are starting to develop, you may be able to take corrective action.

Table 5: Patient and Partner Negative Actions

Action	Cancer Patient	Partner
Alienation	Negative feelings result in alienating behavior that further reinforces negative feelings.	Partner feels isolated, shut out, and rejected. Partner may have negative feelings about self. “You don’t have to feel paranoid.”
Avoidance (both partners may take this action)	Refuses to communicate and interact. Does not know how to start talking.	No intimate interaction. Does not know how to start talking. Tiptoes around the issues.
Conflict	Conflict predating the cancer. Sometimes the patient has the burden of getting the partner to be supportive and intimate. This can lead to conflict.	Conflict predating the cancer. Pushing the patient to talk and to cooperate. Can lead to conflict.
Rejection (active or passive)	Rejects intimacy, rejects interactions with others. May find reasons to criticize and reject partner in order to avoid intimacy.	In some cases, the partner rejects interactions with the patient.
Repression - automatic restraint of drives & urges; a means for dealing with anxiety	Dealing with irreconcilable desires.	Wants to encourage partner to talk and engage in even simple intimacy - but does not. May be related to interpretation of role in the marriage.
Suppression - willful restraint of drives and urges.	Patient suppresses the need to talk with partner and/or touch and be touched. “This is my problem to solve.”	Partner, concerned about upsetting patient, does not bring up important issues, e.g., intimacy, patient’s feelings and needs, personal needs, family issues.
Withdrawal	Partial or total withdrawal due to feelings of inadequacy e.g., body image, feeling less of a woman.	Concern re: making the partner feel inadequate or fear of rejection by the partner.

The Lovin' Ain't Over for Women with Cancer

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