Cancer is one of the most dreaded diseases, can involve almost any organ of the body, and has a reputation of being invariably fatal. In fact, cure rates have increased dramatically, and some cancers are now more than 90% curable. Still, cancer can kill, and a diagnosis of cancer is usually accompanied by shock, numbness, and gripping fear. Also, as in other illness, partners may need to become caretakers, and roles can change. For these reasons, cancer can lead to a decrease in sexual desire and activity, even when it attacks nonsexual organs. Sexual dysfunctions are often high among cancer survivors (Auchincloss, 1991).

For example, surgery is required for a number of cancers of the digestive system, and

ostomies

Operations to remove part of the small or large intestine or the bladder, resulting in the need to create an artificial opening in the body for the elimination of bodily wastes.

it can lead to ostomies (OST-stome-mees). People with cancer of the colon often need to have part or all of the large intestine removed; the rectum may be removed as well. A surgical opening, called a stoma (STOW-mah), is made in the abdomen to allow waste products to exit the body. This is collected in a bag which, for many patients, must be worn at all times (others can take it off periodically). Ostomy bags are visually un-

stoma

Surgical opening made in the abdomen to al­low waste products to exit the body.

pleasant and may emit an odor, and the adjustment to their presence can be very difficult for some couples. Having a new opening on the body to eliminate bodily wastes is itself a hard thing to accept for many people, but most people eventually adjust to it and, bar­ring other problems related to their disease, go on to live healthy and sexually active lives. One woman wondered how an ostomy would change her self-image:

I had to go through a total reevaluation of my physical appearance. I couldn’t ever imagine myself attracting somebody in a bikini or in any of those normal, stereotypical ways. I would eventually have to confront the reality that I was having this ostomy, and if I was to develop any kind of an intimate relationship with anybody, that was go­ing to have to be dealt with. So I had to look deeper down beyond the flesh. (Register, 1987, pp. 38-39)

Cancer can affect sexual functioning in other ways as well. Physical scars, the loss of limbs or body parts, changes in skin texture when radiation therapy is used, the loss of hair, nausea, bloatedness, weight gain or loss, and acne are just some of the ways that cancer and its treatment can affect the body and one’s body image. In addition, the psy­chological trauma and the fear of death can lead to depression, which can inhibit sexual relations. Perhaps the most drastic situations, however, occur when cancer affects the sexual organs themselves.

mastectomy

The surgical removal of a breast.