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Ways to tackle changes in body image and intimacy after cancer

As treatment outcomes for cancer improve and the numbers of cancer survivors increase over time, there is a shift of focus to cancer survivorship issues. We are concerned not only about treating the cancer but also about preserving function and maximizing patient quality of life. One of the under-rated and –treated problems in cancer survivorship is changes in body image and relationship intimacy.

What exactly is body image and relationship intimacy? 

Body image is the view, thoughts and feelings one has about their body's state, appearance and function. For cancer patients and survivors, it is more than just how a person thinks they look; it is also how comfortable they feel with their body and its ability to do the things they want to do. It is a subjective, personal view that is not necessarily related to the degree of physical changes brought on by cancer and its treatment. For instance, two cancer patients can react very differently to a similar surgical scar or cancer-related fatigue.

Relationship intimacy can refer to emotional, physical and sexual closeness of a relationship. Different couples place different emphasis on these aspects of their relationship. This may change during cancer treatment and recovery which is perfectly normal. For some, the changes are temporary while for some report the changes to be more permanent. Regardless, we know that changes in body image and relationship intimacy are linked and can affect one's mood and quality of life.

It is normal to report changes in body image and intimacy. 

In a study conducted in 2016, we found that although majority of women felt positive about their bodies and sexuality, 1 out of 4 women reported dissatisfaction with their bodies and 1 out of 5 reported feeling less feminine and sexually attractive. It was not a surprise then, to find that more of these women cancer survivors reported disturbance in their romantic relationships compared to women without cancer who were similar in race, age and education.

There are many reasons for these changes. 

Cancer and its treatment and side effects can bring about changes that can affect body image and relationship intimacies. For instance, mastectomy for breast cancer, placement of ostomies for colorectal cancer, and surgeries for head and neck cancer that affect facial appearance can make people self-conscious, while radiation in the pelvic area can cause pain or discomfort during sex. 

Hormonal treatments can sometimes cause onset of menopause, which is linked to mood changes and certain sexual dysfunctions. Certain treatments can also drastically affect energy levels that have a big impact on libido. There is also stress from dealing with the cancer and its treatment that can put pressure on a couple. 

Additionally, there are cultural beliefs surrounding talking about intimacy that come into play. For instance, inaccurate beliefs about sexual activity worsening illness or diluting the effects of treatment, or sexual transmission of cancer.

A difficult topic to talk about. 

This is indeed a sensitive topic to broach. One study on Asian women with cervical cancer found that majority of those who were interviewed did not talk about their sexual difficulties with their husband or doctors due to embarrassment; they further believed it should be their doctors who raised the issue. Unfortunately, this mindset makes it difficult for patients and survivors to receive help that they need.

What you can do. 

If you are experiencing unhappiness from changes to your body image and relationship intimacy, seek assistance. Many people brush off getting help because they think they should be thankful to be alive, however quality of life is important. 

Feeling happy and contented with our bodies and sexuality is a life-affirming aspect of the human experience.

NCCS and KKH are currently conducting a study called Renewing Intimacy and Sexuality (RISE) to evaluate if a pilot programme may enhance the relationship between breast and gynaecological cancer survivors and their significant others. 

If you are interested to hear more, please contact 66015145 or email