Physical changes from treatment and how couples talk

This page is for couples when cancer treatment has changed one partner's body. It looks at why partners pull apart, and how to start talking again.

Cancer treatment can change a body for a while, or for good. NCI lists the changes people commonly deal with: hair loss, skin changes, scars from surgery, weight going up or down, loss of a limb, an ostomy, and effects on fertility.

NCI does not try to play these down. It says feelings of anger and grief about changes in your body are natural.

It also makes a point that many people struggling in silence need to hear: even if others cannot see them, your body changes may trouble you. A scar hidden under clothes, or an inner change nobody would guess at, can occupy someone's whole mind.

Couples can get stuck because of a misunderstanding.

NCI notes that a partner may be afraid to have sex, may be worried about hurting the person with cancer, or may think they are not feeling well. If that fear is not said out loud, it can look like a lack of interest.

Fear of causing pain can look, from the outside, like pulling away.

NCI also notes that these physical changes affect the wider family. NCI says seeing your changes may cause relatives to worry more or make comments, which could cause you stress. NCI points out that parents and grandparents in particular worry that changes in how they look might frighten children or hurt close relationships.

NCI's suggestion is concrete: talk openly about whether you want sexual intimacy, or would rather have non-sexual affection such as hugging, kissing, and cuddling.

This framing helps more than it sounds like it would, because it swaps one huge, unanswerable question for one small, answerable one. Nobody has to state how they feel about their body, or about the marriage as a whole. Someone just has to say which of those two things they want today.

General ideas for the conversation (these are our suggestions, not NCI's):

• Have it somewhere neutral, like on a walk, in the car, or in the kitchen, rather than in bed
• Talk about what you want, not about what has gone wrong
• Make it a small, repeated check-in rather than one huge talk
• Let the answer change week to week, because it will
• Say your fear out loud if you have one, even something like "I thought you'd stopped wanting to touch me"

If you are the one who is well, two ideas are worth knowing.

Ask instead of guessing. If you assume someone is too tired, too sore, or too self-conscious, you never actually offer them the choice.

Get your own support too. NCI lists counselors and support groups, and you can ask the care team what is safe and what is not.

NCI's list of helpful steps includes seeing a counselor, joining a support group, staying active with hobbies, talking to sex therapists or other specialists, and raising concerns with the health care team.

Take this sentence seriously: sexual problems may not always get better on their own. Waiting is not a plan, and there are people whose whole job is exactly this.

Ask your oncology team directly. NCI's page also covers physical issues such as vaginal dryness and hormone changes, so it is worth asking about these before assuming the problem is only emotional.

NCI's advice comes back to talking openly. Say which kind of closeness you want, and ask for help when problems do not ease.