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What do we mean by sexuality and sex life?

Sexuality describes the feelings and physical characteristics that form your sexual identity as a man or a woman. Several things can influence your sexuality, such as

  • Your genetic make up
  • Personal sexual experiences
  • Religious and cultural beliefs
  • Your upbringing
  • Hormones

Because these influences vary so much from person to person, it’s not very easy to define what sexuality means for each of us. Your sexuality plays a big part in your actions and reactions to others. It’s a very important part of who you are and how you behave socially. Wanting to feel close to others, enjoying physical touch and caring for others are all part of your sexuality.

When most people talk about their sex life they’re talking about the actual physical act of having sex. But your sex life isn’t just about having sex. It involves how you feel about yourself and your sexuality. And how you feel about your body, your desire to have sex and being touched and loved. Our sexual organs play a big part in our sex lives. Certain parts of our bodies respond to sexual stimulation. Unless there’s a problem, these are things we often take for granted and don’t have to think about.

 

Cancer and sexuality

Having cancer and treatment can sometimes cause physical changes to your sexual organs and how you feel and react to having sex. This can be very confusing and difficult to cope with. It can sometimes makes it very difficult to respond to your partner during sexual activity.

It’s important to remember that we’re all different. There is no right or wrong way to feel about your sexuality and sex life. How you feel sexually can change and grow. We all have times in our life when we don’t feel too confident about ourselves or don’t feel very sexual and find it difficult to communicate with the people close to us. This doesn’t mean these feelings will last forever. It is also sometimes possible to work on changing this and finding new ways to communicate your feelings to your loved ones.

It may help to get to know how your body normally works, to help you understand how things may change if you have cancer.

Below there is information about

 

Women's sexual and reproductive organs

A woman’s sexual and reproductive organs include her

The female sex hormones are also important for a woman’s sexuality and sex life. There is information about sex hormones below.

The vagina, vulva and clitoris

The vagina is the passage that leads from the cervix to the vulva. The cervix is at the bottom of the womb (uterus). The vulva is visible from outside the body. It forms the skin flaps around the entrance to the vagina. The outer flaps are called the labia majora and the inner flaps are called the labia minora. The clitoris sits at the top of the labia minora and is very sensitive to touch. This gives women a lot of their sexual pleasure. During sexual arousal there is an increased blood flow to this area, which leads to swelling and extra sensitivity in the vulva and clitoris. There is more detailed information about the vagina in the vaginal cancer section.

Vulva.gif

The cervix, womb and ovaries

These organs are found inside the female body and make up a woman’s reproductive system. The cervix is another name for the neck of the womb. It is the opening from the vagina to the womb. There are two ovaries, one on each side of the womb. The womb (uterus) is the pear shaped, muscular bag that protects a growing baby during pregnancy.

In fertile women the ovaries produce an egg each month. If the woman’s egg isn’t fertilised by a man’s sperm, the thickened lining of the womb is shed through the vagina as a monthly period. Women are fertile between puberty (when the periods start) and menopause (or change of life, when the periods stop). Each ovary is connected to the womb by a tube called the fallopian tube. The ovaries produce the female sex hormones oestrogen and progesterone and a small amount of male sex hormones (androgens).

There is more information about the womb, the cervix and the ovaries in the specific cancer sections.

Your urethra and anal area

Just below the clitoris, near the opening to your vagina, is your urethra. This is where urine comes out from your bladder. Between the vaginal opening and the opening to your back passage (anus) is an area of skin called the perineum. During an orgasm the muscles in this area tighten.

Other important structures and organs

These include the breasts and nipples, which usually enlarge and harden during sexual activity. The dark area around the nipples, the areola, may also become larger. A woman’s buttocks, neck, inner thighs and abdominal area are also very sensitive to touch during sexual activity. These are often called erogenous zones. Everyone is different though. There may be other areas of your body that are more sensitive to touch when you are sexually aroused.

Female sex hormones

These include

  • Oestrogen
  • Progesterone
  • Androgens

Oestrogen is made in the ovaries. It keeps your vagina moist and able to stretch. This natural lubricating and cleaning system is important to help keep your vagina healthy and protect it from infections. When you get sexually aroused the cells lining the vagina release drops of fluid that make the vagina wet.

If you have low oestrogen levels your vagina may feel dry and be less able to stretch. This can happen in women who have had their menopause. Vaginal dryness is very uncomfortable and can make having sex painful and less pleasurable. There is information on ways to help with vaginal dryness in the section on sex and cancer for women.

Progesterone is made in the ovaries and affects the female body in many ways. Its most important function is to prepare the womb (uterus) for receiving and developing a fertilised egg. It also maintains the womb throughout pregnancy.

Androgens are male sex hormones produced in the testicles. But women have small amounts of these hormones too. These are the hormones that help a woman want to have sex. In other words, they contribute to her level of sexual desire (libido).

In women, androgens are made in the adrenal glands (found at the top of each kidney) and the ovaries. Even though the ovaries may stop making androgens after menopause, the adrenal glands continue to make enough to support a woman’s sexual desire.

Research suggests that the factors affecting a woman’s desire for sex are quite complex. Both emotional factors and hormone levels play a part.

 

Men’s sexual organs and structures

Male sexual organs and structures include

The male sex hormones are also important for a man’s sexuality and sex life. There is information about these male sex hormones below.

The penis and testicles

The penis is partly inside and partly outside the body. It’s made up of several types of tissue. These include skin, muscle, blood vessels and nerves. Inside the penis lies the urethra. Urine and semen flow through this tube and eventually pass out of the small slit at the end of the penis (the meatus).

The end of the penis is also known as the head of the penis (glans). It is normally covered by a piece of skin called the foreskin (prepuce). But some men may have had the foreskin removed during an operation called a circumcision. This operation is usually done at birth but may be done later in life.

Diagram of a penis

For most men the ridge below the head of the penis (the frenulum) is the most sensitive part of their penis. The scrotum is the pouch of skin that hangs below the penis and holds both testicles (testes). The testicles are part of the male reproductive system. From the age of puberty the testicles produce sperm, which can fertilise a female egg. The testicles produce the male sex hormone, testosterone.

The prostate gland

The prostate is a small gland about the size of a walnut. It surrounds the top part of the tube that carries urine from the bladder to the penis (the urethra). The same tube also carries semen. The prostate produces a thick clear fluid, which is an important part of the semen.

The growth and function of the prostate gland depends on the male sex hormone testosterone, which is produced in the testes.

Other sexual parts of the body

A man’s back passage (anal area), chest and nipples may be very sensitive during sexual activity. Like women, men are all different and there may be other parts of their bodies that are more sensitive.

Male sex hormones

Testosterone is the main male sex hormone. It is made in the testicles. Testosterone is the main cause of male qualities such as

  • A deep voice
  • Body hair growth
  • Muscle development
  • The ability to have an erection
  • Sex drive (libido)
 

What is a normal healthy sex life?

There is no such thing as a normal sex life. Different people have very different sexuality and sex lives. Normal is just what’s right for you, on your own or in a relationship with someone else. If you don’t feel comfortable discussing your personal sexual preferences or how often you enjoy sex, this might make you wonder if your own sex life is normal. Your sex life may include

  • Whatever gives you and your partner enjoyment
  • Having sex daily, weekly, monthly, or less
  • Cuddling, kissing or holding hands without needing to continue to sexual intercourse
  • Touching and pleasing yourself sexually – masturbation
  • Using sexual aids such as a vibrator
  • Losing interest in sex at certain times in your life – this may be caused by stresses such as illness, financial worries or a broken relationship

The list could be endless. It really is up to the individual person. Some people want to have sex more often than others. Some men may feel they should be able to have an erection whenever their partner feels like sex. Some women feel inadequate if they don’t orgasm every time they have sex. But none of this really matters as long as you feel happy with your sexuality and sex life.

If you are in a relationship and you and your partner feel comfortable with your sex life, then reassure yourself that things must be normal for you both. Just feeling close to someone and knowing that they’re there for you, no matter what, may be just as important as having great sex.

Likewise, it doesn’t necessarily take being in a sexual relationship to be normal. It’s perfectly normal for single people to enjoy sexual pleasure without a partner. As we mentioned before, your sex life is how you feel about yourself and your sexuality, and whatever fulfils you sexually.

 

Your body during sexual activity

Both men and women go through several physical, mental and emotional changes during sexual activity. Experts describe these as the 5 phases of sexual activity, or the sexual response cycle. The emotional and mental changes are very individual and we all react to sexual stimulation in our own way. But the basic physical changes that happen are generally the same for all of us.

The first phase is the feeling that you want to have sex, known as libido or sexual desire. This can last a few minutes or several hours. You may want to have sex every day or much less often than that. The second phase is arousal or excitement, meaning that your body begins to respond to your desire to have sex.

For women this can mean that their vagina lubricates, their nipples become erect, and their breasts and clitoris fill with blood, making them swell. For men, their penis fills with blood and becomes erect. Because of the increase in blood in the body, both men and women have faster heart rates and faster breathing and their genital area becomes more red or purple in colour. This arousal can last for a while and is known as the plateau phase.

The fourth phase is orgasm or climax, which means the height of sexual pleasure. This is the shortest stage of sexual activity. During this phase you may have a feeling of warmth spread throughout your body. During an orgasm certain muscles throughout the body contract involuntarily, including muscles in the anus and pelvic area. Not everyone reaches this phase every time they have sex. But if you do it can be a very intense and enjoyable experience.

The final phase is called the resolution phase. During this phase your body returns to its normal state. A man’s penis softens and goes back to its normal size and colour. Women’s breasts, nipples, clitoris and vagina return to their normal state and colour. Your heart rate and breathing go back to their normal rates.

During the resolution phase, a man can’t have another orgasm. How long this lasts for usually depends on your age. For most younger men, it only lasts a few minutes. But if you’re ill or elderly it can take a few hours or sometimes days. This is called the refractory phase. Women don’t have this phase and can potentially have orgasms one after another (multiple orgasms).

 

Things that may change sexual responses

Many things can change how your body and its sexual organs react during any of the 5 phases of sexual activity. They can include

  • Tiredness (fatigue)
  • Feeling sick
  • Pain
  • Bowel problems due to cancer treatment
  • Surgery or radiotherapy to your pelvic or genital area
  • Your state of mind – depression, stress, fear, anger and anxiety
  • Side effects from certain drugs such as chemotherapy, blood pressure drugs, alcohol, nicotine, painkillers, anti sickness drugs
  • Feeling unhappy with changes to your body caused by cancer or its treatment
  • Hormone imbalances in the body
  • Problems with the nerves or blood vessels in your pelvic area
  • Personal problems such as financial worries, work and relationship difficulties

Many of these problems can happen when you have cancer, which can mean that you’re less likely to enjoy or want to have sex. This can be hard to cope with. There is more information about sex and cancer for women and sex and cancer for men in this section.

 

Talking about your sexuality and sex life

Some people find it difficult to talk about their sexuality and sex life. Your diagnosis of cancer may mean that you can't have sex or don’t feel like it. These issues are very private. But if you have any worries it can help to talk to a close friend or your partner about them. If you’re in a relationship and try to keep your concerns to yourself, your behaviour may confuse your partner. They may feel rejected or think that you no longer love them or feel attracted to them.

If you and your partner stop having sex it often means that other types of intimacy also suffer. You may avoid hugging and kissing because you worry that it may arouse your partner and then upset them because you don’t want to go on and have sex.

Sometimes people with cancer avoid physical contact with their partner, because they are so unhappy with the changes to their body caused by cancer or its treatment. If you are single you may avoid getting into a relationship as a result. Any changes in your appearance or physical ability to have sex may make you feel less confident about sex. For example, if you have had a breast removed or have scars from surgery.

For men, cancer may have changed their ability to have an erection, so they may not feel they can pleasure their partner anymore. Give yourself some time to come to terms with any changes to your body. It may not seem like it now, but in time most people are able to enjoy a physical and loving relationship with a partner. It may be a bit different from what you were used to.

If you’re able to talk to your partner about your worries, you’ll both gradually get used to your new situation and things will feel less awkward. A caring and loving partner can help to ease your concerns. If you’re single and worried about your sexuality it may help to talk to a close friend or counsellor about how you’re feeling.

There is more about sex and the types of problems you may have and how to deal with them in the following sections

You may also find it helpful to talk to your doctor or nurse about how you’re feeling. They may suggest that you and your partner have some counselling to support you through this difficult time. There’s information about counselling in the coping with cancer section.

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Updated: 24 October 2013