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Relationships are hard, no matter the decade

As I enjoy my 40s of being single and watch my friends- single, married, divorced- and myself navigate love in all its forms, I keep coming back to the same conclusion- relationships are hard.  As much as I love falling and being in love, the day-to-day of relationships is filled with compromise, stress, reality, while trying to keep it fresh, sexy and passionate.  Don’t get it twisted, as I’ve aged, my expectations have changed, some might even say they’ve lowered.  I don’t expect relationships to only be hot, sexy, steamy Fifty Shades of Grey. I appreciate the excitement of getting to know someone else and trying to merge lives, except now the reality of relationships seems even more real, or more hard.

In the decade of divorcees, career changes, shared custody, and previous heartbreak, no one in or around my peer group comes to relationships unscathed or naïve, unless they’ve they have consciously withdrawn from the game- which has it’s own share of baggage.  With a few decades of relationships under our belt, you’d think they would be easier to navigate, that surely with age we’ve learned from our mistakes and now really truly only appreciate the happy moments and the tedious annoyances of day-to-day fall to the wasteside- but alas, they’re not.  Relationships are still hard, if not harder to start and more importantly maintain as the decades go on.

Through my clinical work, late night chats with bestfriends, and my own headaches in love- I am constantly reminded that we all struggle in relationships and that indeed, no matter our age, they can be hard.

But is hard really all that bad? Or is hard, what makes the juice real?  Initially when getting to know someone we experience the excitement that comes with the freshness, newness, novelty of exploring another person- is the reality of that just impression management until we show the underbelly of who we really are? Then when the underbelly is revealed during those crazy moments, that hopefully while fleeting, nonetheless exist- for everyone.  It seems as we age, we become more sensitive to these “warning signs” or “deal breakers” because God forbid we wrap up ourselves up into something emotional that likely won’t go anywhere and leave us heart broken.  As we age, do we become more pessimistic, closed-off, or just plain lazy to not want to do the work or put up with the crazy to actually make relationships stick?

You read all this crap about how to date, whatever decade you are, and while much of it is about self-awareness, isn’t it mostly about finding a decent connection and if it seems worth it, putting up with the crazy and expecting that it’s going to be hard at times, even at the beginning when the sex is great!  Most relationship or sex therapists seem to categorize women or men or come up with rules or strategies that are meant to guarantee a successful relationship.  Well, I think this is all crap!!  I know the science, but the fact is, relationships are hard, uncertain and never guaranteed- pretty much like everything valuable in life, including life itself.  I’m not trying to get all existential here, but at the end of the day it does seem like a good place to start a dialogue if we all cut the crap and just acknowledge that as enlightened, balanced and healthy we may think we are, relationships are hard no matter how old and experienced we are.   Getting through the hard bits, the crazy bits, the bits that make us question our own sanity when we look back on our behavior- this is the juice that build trust, make sex making love and fosters loyalty and longevity.  This isn’t news, it’s not a strategy that we have to practice- it’s being realistic, not pessimistic, that while we want all the joys and fulfillment of relationships, we have to nurture them, be flexible, put up with bullshit every now and then.  To think anything less is giving up and no matter how confident or put together anyone is, if you’re not open to putting up with or putting in the work, then enjoy those lonely nights.

Relationships are hard- at the start, the middle, and definitely the end- but they’re a major reason for living.  So where does that leave us?  Seems like we have to acknowledge relationships are hard, and keep trying, and trying and trying—because relationships are worth it- even if they’re hard.

Romance may still be lingering in the air, but for many cancer survivors Valentine’s Day was just another reminder of how their sexuality has been scarred by cancer.

Check out the article at:

Over 40 percent of all cancer survivors experience negative sexual changes after treatment, with this percentage dramatically rising to over 90 percent in survivors treated for ‘below the belt’ cancer types, including prostate cancer, ovarian cancer and cervical cancer.

The University of Sydney and Cancer Council NSW identified that cancer survivors are suffering in silence and need support. New research found that 50 percent of cancer survivors did not seek help for their sexual concerns, citing embarrassment and lack of privacy as the main barriers.

“Cancer can take its toll, but it doesn’t have to take away your sexuality. Cancer survivors and their partners have identified sexual concerns and they’re not getting the help they need to address them,” said Dr Catalina Lawsin from the University of Sydney’s School of Psychology.

Changes to sexual wellbeing can leave cancer survivors feeling less confident and less at ease with intimacy. Fatigue, pain, physical discomfort, impotence and anxiety can greatly impact a survivor’s sex life, and if it isn’t dealt with the problem can escalate, breaking down their self-esteem and intimate relationships.

To address these issues, the University of Sydney and Cancer Council NSW have developed a world-first online resource, called Rekindle, to improve the sexual wellbeing of all cancer survivors, and their partners.

“Many cancer survivors don’t know that sexual changes are common after treatment. They have never discussed the possible impact on their sexual wellbeing with a health professional or their partner.

“We created Rekindle so people don’t feel alone and overwhelmed but can access practical advice and learn skills in a confidential environment to improve their sexual wellbeing.” said Dr Lawsin.

Annie Miller, Cancer Council NSW said, “Survivors are sometimes expected to bounce back to how they were before their illness, but if someone’s sexual identity has changed then that can alter how they feel, act and interact with others.

“Rekindle offers a wide range of tools and practical advice – whether that is information on the side effects of treatments, overcoming fear and insecurity, how to communicate better with your partner to help you feel better about you and your relationships or practical advice on the use and availability of sex aids.”

Twenty-four year old cancer survivor Sam Patterson praises the resource for sharing real life stories and encouraging partners to work together. He says that coping with sex and intimacy challenges is “impossible if you don’t communicate. Lack of sex after cancer can make people feel guilty and can ruin relationships. If you open the conversation you’ll both feel better for it and will understand each other’s concerns and needs.”

Rekindle is designed for a wide range of possible users affected by any type of cancer. There are 12 versions of Rekindle tailored to gender, relationship status and sexual orientation. Rekindle is self-led, once you log on and answer a survey you follow the pathway designed to best suit your needs, all within the privacy of your own home.

Seventy percent of Rekindle is video-based including a range of scenarios brought to life by actors, with humour and insight. Narrated by Noni Hazlehurst, Rekindle has extensive activities and information, including real stories from cancer survivors and oncologists.

Source: University of Sydney

Sex After Cancer Amongst Latina Cancer Survivors

A community-based approach for developing novel web-based psychosexual resources for
Latina cancer survivors

Changes to sexual wellbeing have been reported as one of the most distressing quality of life issues among cancer survivors. Over 60% of breast and gynecological cancer survivors experience sexual dysfunction after treatment12 including vaginal atrophy, painful intercourse and decreased desire. Latinas present at later stages of disease13 and require more aggressive treatment. Compared to non-Latina cancer survivors, Latina survivors have reported worse sexual function, less sexual desire, greater difficulty relaxing and enjoying sex, becoming aroused and reaching orgasm.4 Recently, Bober & Varela5 proposed a biopsychosocial model that integrates the combined influence of biological (physical functioning), psychological (sexual satisfaction, body image) and social (cultural norms surrounding sexuality) factors in the development and treatment of sexual concerns.  This model emphasizes the importance of including sociocultural phenomena, such as gender roles machismo and marianismo and the significance of familia, to provide a theoretical framework that appreciates the impact of culture on sexual concerns.  Unfortunately, the majority of the research on sexual changes after cancer has focused on middle to upper-middle income, non-Hispanic White women (NHW).4 It is imperative that culturally-sensitive interventions be developed specifically for Latina cancer populations.

Numerous strategies have proven effective in managing sexual changes after cancer6 stemming from the broader sex therapy literature. Web-based psychosexual interventions have proven as efficacious7 as face-to-face interventions; web-based approaches overcome barriers to access including shame and embarrassment amongst both survivors and providers.8,9  Unfortunately, clinical referral and uptake of psychosexual support continues to be low,7 and among Latinas uptake is almost non-existent, leading Latina cancer survivors to live in a “sexual silence”.10  Even if information about sexual wellbeing is presented in Spanish, it is likely that it is not presented in a culturally congruent fashion.11Compared to NHW and African American (AA) cancer survivors, Latinas report not only the greatest psychosexual concerns, but also the greatest interest in receiving support for managing sexual changes.912Intervention approaches that provide individualized tailoring and presentation of skills and strategies in culturally sensitive ways may be useful to engage and retain Latinas in a psychosexual intervention.13

Despite the importance of sexual wellbeing to this population, no prior interventions have been developed to address sexual concerns among Latina cancer survivors. We have recently translated evidence-based interventions into an accessible, highly tailored, video-based and interactive psychosexual web-based resource, Rekindle.14 Rekindle has exceeded recruitment expectations and highlights the need for and receptivity of tailored, web-based, psychosexual resources for cancer survivors.  Building on our work with Rekindle and guided by Bober and Varela’s5 model and a Community Advisory Board, the proposed study will apply a “ground up”1516 approach to confirm how to best address sexual concerns among Latina survivors and develop a novel psychosexual resource that is socio-culturally and linguistically sensitive specifically for this underserved population. Data from this preliminary study will inform the application for funding of a future larger-scale randomized controlled trial.

Cancer survivors can have a fulfilling sex life – we need to talk about how

Revisit:  Check out an article I wrote about sex and cancer for The Conversation:

Sex and cancer are words rarely uttered in the same sentence. But they should; after treatment ends, many cancer survivors are left with sexual changes that, when left unaddressed, can become long-term problems.

While vaginal dryness is a common side-effect for female cancer survivors and impotence often affects males, both sexes can experience loss of libido, difficulty achieving and maintaining arousal, and pain during and after sexual activity.

These physical sexual changes are often accompanied by fatigue, causing survivors to reduce how often they have sex, or to avoid sexual activity all together.

Emotionally, many cancer survivors experience changes to their identity, body image, and their roles in relationships, leading to distress, anxiety and uncertainty about their future. This can exacerbate the physical sexual changes creating long-term quality of life concerns.

To better understand these sexual concerns and how we can address unmet needs my colleagues and I at the University of Sydney conducted on line surveys and qualitative interviews with cancer survivors.

A two-party story

We had cancer… it’s a two-part story,” explained Janette, a breast cancer survivor. Partners of cancer survivors experience similar sexual changes, reporting decreased sexual activity and satisfaction associated with the survivor’s worsening health.

Unfortunately, partners often feel uncomfortable raising their sexual concerns for fear of placing pressure on the survivor and appearing unsupportive.

Partners may not know the cancer survivor is experiencing these sexual changes and in turn, interprets avoidance of sexual activity and intimacy as rejection.

Andrew, whose partner had lung cancer, shared:

My wife going through menopause, you know, at 38 was very, very early and sort of very difficult.

Most supportive care neglects partners’ needs, which may leave them feeling isolated and unable to cope.


Too often, cancer survivors and their partners avoid talking about the sexual changes they’re experiencing. Survivors describe feeling guilty worrying about their sex life when they feel lucky having survived cancer treatment.

As time goes on, habits change and survivors and partners can become accustomed to a relationship without intimacy or sex, assuming that this is the new normal. Roles as lovers evolve into caregiver and survivor.

Communication skills training is a key component of most treatments. ChapendraCC BY-NC

Silence is a problem at home and at the hospital. Providers are unsure or may feel uncomfortable or embarrassed asking patients about their sexual well-being, while patients often don’t think they should be raising these concerns in the clinic.

New research shows that among a sample of breast cancer survivors, 43% wanted to learn more about why sexual changes occur and how to manage them (44%) after treatment. These women sought support from reading books (37%) or from the internet (34%) rather than from their oncologists (19%).

Help is here

The good news is that there are strategies and treatments that can manage these sexual changes and enhance sexual well-being. We know what works based on previous research within the field of sex therapy and psycho-oncology.

Medical strategies such as a penile pumps or vaginal dilators can help manage physical sexual side effects after treatment. Couples can try alternative sexual positions to accommodate pain, discomfort and changes to body image.

Communication skills training is a key component of most treatments. This aims to improve individuals’ ability to talk about their sexual concerns and assert their sexual needs.

To improve intimacy and relieve performance anxieties, a behavioural technique called sensate focus can also help. Sensate focus involves three stages, during which couples refrain from sexual intercourse and instead focus on the physical sensations of touching one another and communicating how and where they experience pleasure.

While these strategies can be helpful, they take practice, patience and perseverance. “It’s an adjustment… it’s not just spur of the moment,” shared Glenn, a prostate cancer survivor. “So the question comes up, do I take a pill tonight? If the answer’s yes, we’re looking good!”

Unfortunately, most cancer survivors are unaware of what, where and how to get support. Lack of access to clinicians and counsellors who know how to treat or manage sexual side effects is a primary barrier, particularly in more remote regions.

In collaboration with Cancer Council NSW, my research team and I have developed a web-based resource for all cancer survivors and their partners of all genders and sexual orientations, called Rekindle, to address sexual concerns in the privacy of their own home. Rekindle teaches proven strategies to enhance sexual well-being and answers many of the questions survivors and partners are left with after treatment.

Adjusting to sexual changes after cancer can be challenging, but with proper support, survivors and their partner can have a fulfilling sex life.