“The beginning of the pandemic saw a decrease in sexual activity amongst young singles because the normal places where people would meet up disappeared,” says Dr. Sharon Domb, a staff physician in the Department of Family and Community Medicine at Sunnybrook. “And people were afraid to pick up COVID, so there was certainly more anxiety and stress about meeting new people.”

But with fears easing, restrictions lifting, and most activities back on, Dr. Domb says she suspects singles will return to “normal” behaviours in terms of sexual activity — which can have benefits and risks. She shares helpful insight that people should be aware of if they hope to engage in more sexual activity.

Many people, especially singles, experienced a dry spell in terms of their sexual activity throughout this pandemic. But now with things opening up again, it looks like that could be changing. Can you talk about why this is a good thing?

Sex in the right context for most people usually is a positive thing. From a psychological perspective, from a physical perspective, all of those things.

Young singles certainly suffered a lot in terms of the isolation and the change in their social behaviours and normal social interactions; it was very challenging for the demographic. So, it’s great that they can rekindle social relationships, to be able to get back to sort of normal behaviour, to interact with friends and meet people and hang out.

There’s a huge mental health benefit, not just with sex, but also with the relationships that lead to that.

As we know, the pandemic isn’t over. So, for those who are trying to get out and date and meet new people, how worried should they about COVID-19?

I think everybody sort of needs to take stake of their personal situation.

Are they living with somebody who’s immunocompromised or with an elderly relative? Is it going to be catastrophic if they get COVID? Are they immunocompromised or unwell themselves? If yes, then I think they have to be extra cautious, understanding the ramifications if they get COVID.

If they’re not particularly at risk, they’re vaccinated, and if they live by themselves or they’re not putting anybody they live with in danger, then the risk is probably not huge. I think they should take reasonable precautions, but I wouldn’t say to a 20-something, “Stay at home and never go out.”

At the end of the day, everyone needs to find a point of some moderation.

Aside from COVID, what else should singles keep in mind as they start getting out there again?

By and large, it’s going to be the same issues that demographic dealt with before: you should take precautions, both for pregnancy and for sexually transmitted infections (STIs).

STIs are fairly common. Have a conversation with whomever you’re going to be with and understand their history and what your risk is. Condoms are always a good idea, but they don’t protect from everything. Often, people use condoms for intercourse, but they don’t use condoms for oral sex — and you can certainly get an STI through oral sex.

On top of using condoms, I encourage people to ensure they’re vaccinated. HPV vaccines weren’t offered in schools until quite recently. Females in grade 8 were offered them in Ontario in 2007, and males in grade 8 weren’t offered HPV vaccines until 2016. So, unless people were on the ball and retroactively went to their doctors to get it, most people aren’t vaccinated for HPV.

Another important thing to know about STIs is that we can do a screen, but it doesn’t mean it’s a 100 per cent clear bill of health. Standard screens don’t include every STI, and some STIs can be easily missed if symptoms aren’t active.

So again, it’s important to take all the precautions you can, and have a conversation with whomever you’re going to be with.

Any final messages for those who are hoping to become more sexually active?

Go have fun, just do it responsibly.

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The project, led by psychology PhD candidate Molly McCarthy and psychologist Dr. Karen Fergus is based on a previous study that interviewed people who had a colostomy after colorectal cancer as well as their partners. That study found that nearly all of the couples identified intimacy and sex as something that changed significantly as they adjusted to life after colostomy. A colostomy is a surgery that connects the colon to the abdominal wall to allow for the drainage of fecal matter. A colostomy bag sits outside the body to catch the waste.

The new project invites people who have had treatment for bladder or colorectal cancer and are living with a temporary or permanent ostomy and their partner to participate in a two-part online intervention. The intervention provides couples with the opportunity to have therapist-facilitated discussions about the sexual and intimacy changes they have experienced as a result of the cancer and ostomy.

Here, Dr. Fergus and Molly answer some questions about their research project and how they hope it helps patients and their families.

What led to your interest in research in this area?

Colorectal cancer is the third most diagnosed cancer in Canada. Treatment often involves a temporary or permanent ostomy – which is an external bag that catches patients’ urinary or fecal output. While research about sexual health has been conducted with respect to breast and prostate cancers, relatively little research has looked at the experience of colorectal and bladder cancer patients. While individuals can certainly go on to lead fulfilling lives with an ostomy, adjusting to the ostomy can be challenging and often involves changes to both patients’ and partners’ lifestyles in the recovery phase of the illness that most other cancer sites don’t experience. For these reasons, we felt that more research was needed with these individuals and their partners.

For our first project, we interviewed 11 couples about many aspects to living life as a couple following colostomy surgery. Ten out of 11 of the couples told us that they’d experienced significant changes to their sexual health and intimacy. They said they would have appreciated more information and conversations about this with their healthcare team. They wanted more support.

Hearing this, we wanted to take the project a step further and try to find ways to help couples adjust. We want to increase accessibility to psychological support targeting the sexual changes these couples face.

Through those initial discussions and your more recent work, what do you think contributes to these changes in sexual health and intimacy? 

We heard about body image changes, fear of leakages, lack of spontaneity, changes in physical sexual functioning, and worry about their partner seeing or geting near to the stoma. For the partner, there was fear of hurting their loved one.

What we also found was there was a lot going unsaid between the couples, and that silence was contributing to the relationship changes. During our initial interviews with couples, both patients and partners said they were hearing a lot of the issues and concerns from one another for the first time. They were learning a lot from each other during these conversations. This learning through conversation is what inspired the development of our intervention.

The new phase of research involves an online intervention. Why online?

The purpose of this research is to evaluate whether a two-session intervention that gives couples the chance to have facilitated conversations about the changes they have experienced in their sexual health and intimate relationship can help enhance their ability to cope and adjust to the changes.

Thanks to the ease and convenience of internet communication, it is quickly becoming a popular way to deliver health care services. We offer our two-part intervention via secure and private online videoconferencing so that the couples can participate from the comfort of their own home. By making use of online technology, this research has the ability to increase access of valuable services to colorectal and bladder cancer survivors across Ontario.

What do you hope this research means for patients and their families?

Unfortunately sex does not get a lot of attention in cancer care. We’ve heard from patients that they feel bad that they are concerned about sex when there’s so much else going on; they worry that it’s not appropriate to talk to their circle of care about their concerns. We want people to know: sex and intimacy changes after cancer treatment is a common concern and a normal, valid concern. It’s part of your overall health. And it’s something that you can and should get help for, if you need help.

We want to increase accessibility to this kind of support. While we won’t perhaps resolve all of the issues in our two sessions, we want to open up a conversation and get couples connected with other resources, if needed.

The sessions are facilitated conversations for mutual learning and to identifying their strengths as a couple that they can draw upon to help them cope. The focus is intimacy and sexual health – not penetrative sex. Cuddling. Being close to each other. Touching each other. We work with each couple’s goals. We encourage them to share their concerns, and open up the conversation. The motivation is on growing intimacy and closeness as a couple.

You have another portion of this project that involves healthcare providers. Can you explain that part?

We are also interviewing healthcare providers about sexual health and intimacy to find out if, how and when these conversations come up with their patients.

How can we normalize these conversations so people feel comfortable asking and getting help? Maybe better resources are needed or training for the healthcare team. So we are interested in hearing from healthcare providers as well so that we can identify any barriers that they face in initiating conversations about sexual health and intimacy with their patients.

This study is open to individuals who have an ostomy (temporary or permanent) after colorectal and/or bladder cancer and are at least 1-month post active treatment and are in a committed relationship. Couples must live in Ontario and have access to the internet in a private space (webcams can be provided).

[Update August 2019: this study is no longer recruiting.] 

If you’d like more information about this study, please email: molly.mccarthy@sunnybrook.ca

The post Behind the research: opening up conversations about sex and intimacy after cancer appeared first on Your Health Matters.