Conversation with Helena Green, Clinical Psychosexual Therapist

30 Sep 2021

Sexuality is an integral and significant part of our lives – yet talking about sex and sexuality can be difficult for many people. 

As a Clinical Psychosexual Therapist, I provide a safe environment with open and honest communication about sex and access to accurate information, to support my clients with issues related to sexuality and pleasure. 

I was inspired to become a Sexologist while working as a Specialist Breast Cancer Nurse in the early 2000s.  At that point in my career, I was dismayed by the lack of information, support and counselling for individuals and couples dealing with side effects of treatment that impacted their sexuality and sexual wellness.  This led me to return to university to study Sexology, the study of human sexuality across the lifespan.

If you are in a relationship or not, when you feel good about yourself sexually you will have increased confidence in many other areas of your life, and this adds to your quality of life.  We all have moments when we feel uncomfortable or embarrassed about sex and sexuality.  How we manage this depends on a range of issues: if you are concerned about any area of your sexuality or sexual relationship, speak to a Sexologist or Sex Therapist, who has expertise in the area you are concerned about.  This area can clarify and enhance your sexual self-esteem and sexual quality of life especially after a diagnosis of cancer.

Sex is often viewed as private or taboo!  As such, real discussion about sex can be challenging.  Many people do not have the appropriate language or skills in this area, and many would feel uncomfortable or embarrassed talking about sex. It is common that this silence is mistaken as a lack of interest or rejection in relationships.

Re-negotiating sexual intimacy after cancer diagnosis and treatment can be difficult.  If you are single or newly dating this may create extra worry about how, what, and when to have this conversation.  A Psychosexual Therapist can support you to develop greater understanding and acceptance of changes. It’s not uncommon to feel a bit ‘stuck’: a loss of sexual libido due to cancer treatments and medication is not unusual but can make it difficult to be motivated to engage in sexual activities.  If this sounds like you, as a couple, an intimate team, seek professional support to improve communication and create a new sexual dialogue to reduce conflict.  This will provide you with knowledge of potential consequences of treatments that may impact negatively on sexuality and support you with skills and strategies to improve your sexual intimacy.

When one partner has a cancer diagnosis, the other might tend to feel ‘like a Carer’:  First thing to do is ‘take the pressure off’.  Remember, sex is more than just intercourse, it’s about  how we express ourselves in everyday life as wonderful human beings, and even if you are not having ‘sex’, it doesn’t mean you stop being sexual or stop expressing your sexuality that is individual to you.  And second:  learn to create a willingness with an open-heart to find a way to enhance a ‘new intimacy’ for you both, or for you if you are single or newly dating. 

Learn to build a safe environment and create emotional intimacy to enable you to talk about issues of concern.  It is a delicate balance of being there for each other, while ensuring your intimate relationship is nurtured.  Sometimes though, if one person is unwell, the other partner will want to give support and care and yes, sometimes there maybe a shift in how you experience each other at that time.  When feeling better with less need to be ‘cared for’, re- create together-time in a relational way:

  • have gentle chats about how each of you are feeling and thinking - no blame
  • watch tv together
  • have a movie night
  • have a date night
  • non-sexual touch

A common side-effect of cancer treatment is vaginal dryness and tightness which results in painful sex.  This can result in hesitancy resuming sexual activity because of fear and anxiety about how it will feel, which in turn may lead to a lowered sexual self-esteem; reduced libido, difficulty to orgasm, and a decrease in your confidence.   You might try vaginal lubricants but be guided by your Sexual Therapist: if you have Vaginal Atrophy, a medical condition where the vaginal mucosa and tissue becomes thinner, vaginal moisturisers may not help.  In this case, a physical examination and discussion with a health care profession who is knowledgeable in this area, is vital.  A referral to a pelvic health physiotherapist can be beneficial if there is ongoing pelvic pain or pain during sexual activity.

Change can be difficult to navigate.  A change in body image often occurs following diagnosis and treatment of cancer and feelings of insecurity.  This can lead to frustration, resentment and communication difficulties affecting sexual self-esteem, sexual functioning, and quality of life.  In this case, I encourage talking honestly about your feelings and thoughts, what it is you want and need to enhance your sexuality and intimacy in a realistic hopeful way in the context of your individual situation.  Acknowledging the changes experienced and differences in how you feel can be helpful – speaking out about such things creates an opportunity to move beyond them.  Consider doing this in conjunction with a Sexual Therapist – it does make it much easier to do. 

One of the most important things to remember, is that a healthy attitude and a sexual self-esteem are not just about sexual intercourse. With yourself or with a partner, create a playful way of communicating intimacy, sensual massage, touch that is nonsexual, reconnecting - over a meal, going for walks together or having a date night to share time together. All these things and more make up your sexual self-esteem.

It can seem like a huge task especially after experiencing treatment which can potentially impact negatively on body image, fatigue, financial strain, and relationship changes.  Be open, be honest, be kind and compassionate to yourself and relationship/s and do seek support with a Sexual Therapist if you have any concerns.

Helena GreenClinical Psychosexual Therapist