Rama Sivaram, breast cancer survivor and now patient counsellor talks about the issues of sexual wellbeing brought about by breast cancer and its treatment and how couples can bring back intimacy into their relationship
“My coming of age was celebrated with such pomp and grandeur; I was just 13. I suddenly transitioned from being a girl child to woman physically, sexually and spiritually. On one hand I was embarrassed and scared and on the other rite of passage is a milestone –a social message in celebration announcing fertility, the readiness to enter marital life and childbearing. 30 years of the menstrual cycle, with the remaining 3 gone in pregnancy and lactational amenorrhea. At age 39, suddenly the woe of the monthly cycle was lifted out of my womb when I had my cancer, leaving me bereft. The treatment while killing the cancer, left me with a triple loss of breast, womb and my fertility. Today, my eyes are wet and my sex dry, even though I am not sensate in my breast I feel the phantom pain. Now, I am not able to differentiate is it my breast or my heart, what is my pain? I am beginning to feel disconnected sexually with myself and my partner. Will I fail if I become asexual after breast cancer?”
Not every woman is expressive of her feelings and her fear openly and suffers alone
The gist of every woman’s concord -confrontation with natural or treatment induced menopause skirts around bodily changes- connecting it with body image; physical symptoms - pee and urgency issues, dryness, discharge, pain, gas, atrophy, a shrinking, thinning and narrowing vagina- more so with infrequent sex, a loose and sagging labium, lowered libido, orgasm issues etc. More importantly her symptoms reflect in the mind- which processes them in retro – the impact from menarche to motherhood, her own individual self and the roles she plays as wife, mother, member of her community etc, all imbibed through socio-cultural exposure and experiences. While a natural menopause is a gradual transition, giving a woman the time to adjust, breast cancer induced menopause is an abrupt ending which the body and mind do not easily accommodate and accept change, which stem from her beliefs and feelings of castration and exile from womanhood. A partial or complete removal of breast and womb is experienced as going from full to null, is not a normal transition, but an overnight catastrophe for any woman young or in perimenopause. Symptoms are the same and in the Indian perspective we are somewhere between our myths, misconceptions and emerging awareness depending on many co- factors. Perspectives differ, cultural mindsets, select mindsets and learned mindsets vary. Being a very personal issue, the collateral damages of breast cancer need to be addressed with sensitivity encouraging every woman to adapt to a new normal and navigate her own body image and her relationship with satisfaction and poise.
The most striking lacuna in treatment related menopause and sexuality, is one of intimacy.
We address physical symptoms, increasing the libido for better and more sex, bettering the body image for the self, etc because women present themselves with this. Perhaps they feel safe broaching this subject medically and veil the deeper underlying issues related with their own sexuality and sexual needs. Their beliefs and their symptoms endorse clinical validity – treating physical symptoms and restoring well-being. While this is essential, the more subtle aspect which is not about simply women themselves but about women and their relationships, especially with their own body image, spouses and partners is missing. Where is the intimacy? It is being recognized that even when the physical act of sex may or may not be possible there is this important component, we must mindfully become aware of, take a relook and relearn intimacy which opens up all possibilities in an overall satisfying relationship with the self and other. Sometimes all of us in a relationship go through this unless we review, rejuvenate and restore. Intimacy is the key to unlocking sexuality related angst. It is easier, more romantic and not always about the act of intercourse itself, it is all about those unconnected gestures that connect us to ourselves and our significant other. I recall the song, ‘You don’t bring me flowers, you don’t sing me love songs You hardly talk to me anymore?’ by Neil Diamond. There are so many ways to love oneself and the significant other besides possessing the imagined perfect body or mind-blowing sex.
So, what is this intimacy and why is it so sacred?
It is an interpersonal emotional closeness where two people can cross and enter the other’s personal space without causing discomfort or disharmony. This closeness, familiarity and deep understanding of one another allows for bonding and loving personal relationship with each other on many and different levels, without judgement. This is an affective relationship (one that satisfy our needs for emotional interactions with significant others; which include the need for emotional support, exchanging warm attention, and giving nurture) felt cognitively and bodily by individuals in social contexts. Experiencing intimacy does not always require physical copresence (which means we can still be a beautiful and deeply connected couple without the flowers and without the sex). It is a satisfying reward in itself, an important component of healthy relationships. One can sum it up in the lines of the English poet Ben Jonson,
Drink to me only with thine eyes
And I will pledge with mine
Or leave a kiss within the cup
And I'll not ask for wine
Our lives and our relationships rest on a foundation made up of more than one value
What constitutes healthy lives and healthy relationships are shared values like and trust and respect, open communication and the levels of multiple quotients- which are our emotional, social/cultural, sexual, adverse, cognitive and mutual support quotients. These are closely connected, and today more and more women are recognizing that the out of context and out of time beliefs passed down are detrimental to personal fulfilment. For those of us who are fortunate enough to have our cups half full the chances of overcoming the co-lateral damages of our disease and menopausal status become easier. Those whose cups are half empty need greater support to overcome their losses because cancer sucks and some women tend to withdraw into their own dark shell of self and other written scripts. Isolation means disconnected. Should we not then talk of building and nurturing deep relationships with the self and significant other without the copresence of sex, sexuality, asexuality in physical acts and physical forms? I have met men and women who are intimate in sex and have great sex, but pull them out of bed and apart, they don’t hold. There are men and women too who I have met for whom sex and body are less important than the mutual trust, warmth and respect that emanates from their small otherwise insignificant gestures like a glance which tells its own story to the people exchanging it. Frank Sinatra has immortalized it in, “Something in your eyes was so inviting, something in your smile was so exciting …. Love was just a glance away” in his song strangers in the night. This is the quintessential intimacy.
Nourishing different types of intimacy in relationships
Those of us who have perhaps received a greater share of wounds, which we certainly didn’t deserve need to review, rejuvenate and restore our whole persons before we can fully experience the joy of womanhood with or without the complements. To achieve a level of closeness with the self and the other in our relationship where we feel safe and validated, we need to nurture our emotional, physical-sexual and asexual mental, and spiritual intimacy. However, since we are on the topic of menopause, nurturing sexual and emotional intimacy with the partner can be an enrichening experience. One can be fulfilled and enriched with intimacy alone minus sex, and sex with a romantic outlook which is also intimacy, both intimacy without sex and sex without intimacy exist. It is what you choose with your partner.
Ways to nurture intimacy with and without sex
In this context men and women are equal with equal power dynamics. Remember when we were romantic, we pleased each other and did not worry about who is more, we were equal. Intimacy becomes easier to cultivate and nurture if we are on the same level. Let us also know that what we were 10 years back cannot be the same, our needs and desire change with age, time and the roles we play being mothers and father, etc. We may have taken things for granted or navigated these changes naturally, if not we may have to work harder. So, intimacy requires you to be stress free- be with yourself first then be with your partner.
Let us maintain that both of us are of equal status –men may suffer their own menopause and your loss too in their own way. The Mars and Venus exist, but developing intimacy in the relationship increases the fluidity where men and women can put themselves in the other’s place and virtually experience feelings, there is an androgyne in all of us. Be there for each other.
Resolve anger or resentment and ego issues within the relationship, don’t take it too far and into the bed if you mean to be together. If this is not possible and there are no other constraints, end the relationship amicably.
Let go of the past look and to the present, enjoy and live in the moment.
Talk about the whole relationship not bits and pieces. Suffocating in a relationship damages. Are you satisfied overall? There are always some chinks in the armor. Afterall we are different people. Your desire, sex and expectations of intimacy in relationships is your identity, do away with the learnt myths and cultural beliefs. Be articulate- speak of your need’s desires, sexuality and relationship, there is no one way there are many possibilities. Connect emotionally and physically. Communicate and share caringly – groom each other, watch a sexy or romantic film, walk, play, dream together, take that unusual adventure that gives you the high. Develop your own intimacy vocabulary and non-verbal cues.
Have sex without intercourse, simply touch, fantasize, role play, fetish, toys, hold hands more often, kiss now and then, leave small love and appreciation notes for each other.
Try new ways for arousal and orgasm to restore sexual intimacy.
Touch and look at your new self with grace, your palpable love handles, the scars your carry- for still their presence is in your heart and mind. It is still you; it is still me we are alive and breathing and let us tell ourselves as in Emily Dickinson’s Sonnet 43- How do I love thee? - ‘I love thee to the level of every day’s, most quiet need by sun and candlelight.’ Intimacy with yourself and rediscovering intimacy after cancer with the significant other makes us more appreciative of this proximity between two where you feel safe and reassured that you are loved and accepted for whoever you are, and you can open your vulnerable self to your loved one. I would like to stop with one of my favorite songs written and sung by Leonard Cohen,
‘Dance me to your beauty with a burning violin
Dance me through the panic 'til I'm gathered safely in
Lift me like an olive branch and be my homeward dove
Dance me to the end of love….
Oh, let me see your beauty when the witnesses are gone……
We're both of us beneath our love, we're both of us above….
Dance me through the curtains that our kisses have outworn….
Raise a tent of shelter now, though every thread is torn….
Touch me with your naked hand or touch me with your glove…
Dance me to the end of love'
Don’t we all want to be danced to the end of love?
Rama Sivaram
KEM Hospital Research Centre, Pune
Nag Foundation Pune
Faculty, Sanjeevani Life beyond Cancer
