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This is the transcript of an episode of our podcastThat Cancer Conversation. You can listen to the episode here

Sophie (Host) 

Hi and welcome to That Cancer Conversation, a podcast by Cancer Research UK that brings together the science and the stories behind cancer. I’m Sophie from the digital news team here at Cancer Research UK. And in this episode, we’re talking about sex, intimacy and cancer. But before we get into the conversation, I’d just like to flag that due to the nature of the subject, this episode has instances of sexually explicit content, and if that’s not for you then feel free to listen to some of our other episodes instead or you can come back next month when we release new episode.   

Cancer and cancer treatment can affect many areas of a person’s life, including their sexual wellbeing, both emotionally and physically. Sex and intimacy in relation to cancer is often a topic that doesn’t get talked about much in the headlines, but around 46% of younger people with cancer say it negatively affects their sex life, and across all age groups, 37% of people feel the same according to research by Macmillan Cancer Support.  

Isabel  

Some people will have experienced sexual difficulties even prior to their diagnosis. But then when they’re diagnosed and start cancer treatment, of course, the things that they’re experiencing difficulty with can be made worse by cancer treatment itself.  

Sophie   

That’s Dr. Isabel White, a cancer nurse by background but also an accredited psychosexual therapist with over 20 years of experience. She set up and led the first psychosexual therapy service at the Royal Marsden Hospital in London. And I chatted with her about how a cancer diagnosis and treatment can impact someone’s sexual wellbeing  

Isabel   

I think emotionally the most common problems after diagnosis which impact on sexual wellbeing, or actually increased anxiety around the cancer diagnosis and the treatment and low moods. So people who really feel quite low are quite depressed as a consequence of being diagnosed with cancer and going through treatment. And both of these emotional states can have a real impact, particularly on sexual interest, or sexual desire. Medication for anxiety and mood can also impact so for example, if you’re on something like an antidepressant, that can sometimes affect your sexual wellbeing as a side effect of the treatment. But of course, you’ve then got to weigh up the pros and cons of being treated effectively for depression or low mood, which will also have impact on your sexual wellbeing versus actually being on medication that may have some side effects that can impact on your sexual well being too. And for many people, there are other negative emotions in terms of living with and beyond cancer, such as there’s fear, there’s doubt, and there might be grieving some of the losses that they’ve experienced as part of their cancer treatment. There’s a loss of self-confidence, which can be there throughout, but it’s particularly a focus, I think, when people are trying to resume different aspects of their lives, again, getting back to work, you know, picking up friendships and such like that they may have not been actively engaging in while they’ve been on acute treatment. All of these can negatively affect sexual interest in confidence in being sexual, either by yourself or indeed with a partner. And then I think from a physical health perspective, there are general impacts that are, I suppose, to do with the impacts of treatment have on your overall which are not perhaps specific to the site of the cancer. And then there are those that are, I would say, are more cancer site, or treatment specific. So for example, if you lose, or if you have altered function in parts of your body that’s normally associated with sexual activity.  

Sophie  

Those are quite a few very different ways that cancer can affect somebody’s sex life. And so I guess it’s not just limited to certain cancer types?  

Isabel

No, I think that’s really important to emphasise, Sophie. I think it’s fair to say that any cancer diagnosis regardless of its type can actually have an impact on a person’s sexual wellbeing and sexual confidence and can detract from the enjoyment that they’ve experienced sexually with, either by themselves or again with a partner. But I guess there are some types of cancer and treatments that have very specific and significant sexual function impacts that I would say particularly pelvic cancers such as Gynaecological Cancers, like cervical and endometrial cancer and ovarian cancer, prostate cancer, other pelvic cancers, such as those affecting the rectum, or the lower bowel, or indeed the anus, breast cancer. And again, as I say, and don’t forget haematological malignancies, particularly for individuals who have gone through stem cell transplants, where they have multiple impacts on their bodies, physiologically, and that includes adverse impacts and from a sexual perspective.  

Sophie  

Yeah, and for people who are going through a cancer diagnosis and treatment, what advice or guidance would you give to someone who wants to have that conversation with their doctor about their sexual wellbeing?  

Isabel

I think we all need to recognise whether we’re a person living with and beyond cancer or indeed whether we’re a health professional working with those individuals and couples, that actually talking about sex in the context of being diagnosed and treated for cancer is actually not very easy. And so our job, certainly from a health professional standpoint, is how do we give overt permission for people to talk about this aspect of their recovery, and their living with cancer. And that’s just as legitimate as any other aspect of their wellbeing, both emotionally and physically.  

Sophie  

But talking about these issues isn’t always easy. Isabel explained that one of the best ways to help talk to your health professional can be using the acronym S.E.A, that stands for being specific, explain what’s important for you, and asking the question in a direct way.   

Isabel  

So for example, you might say something like, “I’ve been having vaginal dryness”, and then explain why it’s important to you to raise that topic with your healthcare professional. So the explanation might be, and it’s making sex painful, and then ask a question. And the question might be, is there anything you can suggest I can try for this. So you’re being very specific about what you’re experiencing? Why it’s important to you, and what you want your health professional to do about it, because we have a duty of care to respond to your requests. And if we are not confident, and don’t know what to see that our duty of care includes finding someone else who can speak to you about it, and making sure that we can signpost you to appropriate resources.  

Sophie   

Yeah, I think that’s a really important statement that there are the resources, and there are other people who can help answer the questions that you have. And so for somebody that feels they don’t want to talk to their doctor about this topic, because for some people, it’s still quite an uncomfortable topic to talk about, what other resources are out there to help answer these questions?  

Isabel 

Absolutely. Sophie, you know, for some people, not just in terms of personal embarrassment, but also culturally and in terms of religious upbringing, these can all impact on our confidence and ability to talk openly about aspects of our life that are often very private. So the different types of resources I guess, I would say are good quality. And the ones that I’ve come across is, first of all, specialist cancer and sexuality website content that’s supplied by key charities and organisations in the UK. Another resource that I would highly recommend would be a website called, or an organisation I should say, called Live Through This. So if, for example, you identify from the lesbian, gay, bisexual, trans queer, plus community, you may find it very helpful to connect with lived through this through their charity team. And you can access support and information specific to your sexual identity and sexual orientation and lifestyle from people who’ve got a real in depth understanding of the very unique and specific challenges that you might be facing. Then the second kind of set of resources I would say, are podcasts. So there are podcasts on cancer and sexuality, obviously, Cancer Research UK are getting on with their own podcast. But there are other podcasts that are already available. And then we’ve got some online apps. And now these are for people with sexual difficulties, but they’re not cancer specific. But the principles of support that are being talked about in these apps can be very helpful for people who are experiencing sexual difficulties, where cancer is the cause of those difficulties, if you like. And then last, but by no means least, there’s an increasing association of psychosexual therapy in the online community. So instead of having to meet with people face to face, there’s far more available now where you can actually meet with people online.   

Sophie   

It makes sense that if you don’t want to talk about these things with your health professional, you turn to the internet. But there are all sorts of resources out there so it can be tricky to navigate. Sex with cancer is an online initiative, which provides a range of resources that covers all aspects of sexual wellbeing for those with and beyond cancer, all in one platform. I spoke to its co-founder Brian Lobel.  

Brian   

I’m the co founder of Sex with Cancer, along with my colleague, Joon-Lynn Goh, and we worked with two amazing people on the project: Tony Lewis, who’s a sex pleasure activist, and Rashid Rahman, who’s amazing marketing and comms guy. And I had the idea for thinking about Sex with Cancer a number of years ago, maybe 2015/2016. It was kind of a quiet thought in my brain. But I was realising that no one was talking about sex and sexuality and cancer, but there was just like vast silence around sex, sexuality and intimacy. And in my own experience of cancer, I noticed that there was plenty of conversation about fertility and you know, sperm or egg preservation, a lot of conversation about that, I had testicular cancer, but so little else about pleasure, about the body, about intimacy. So we could talk about function, or the idea that like we can save the sperm so people can have the babies that they were always expected to have, but a lot less about, what do we do with this scarred body that we don’t love the way that we should? Or how do we share our scars with lovers? How do we experience pleasure despite having vaginal dryness or erectile dysfunction, etc. And so it was kind of bubbling in my brain. And then when my friend Joon-Lynn Goh got diagnosed with breast cancer, I believe in 2018, it was so crazy because I just went to her, you know, of course she’s struggling, she has cancer, people often reach out to me because I was kind of the famous cancer patient and in people’s groups of friends for a long time. So if they have cancer they’d come to me. And Joon-Lynn is this amazing cultural organiser and artists and presents. And I said, Joon-Lynn, should we just start a business about sex with cancer right now? I don’t know why I thought it. But I was I was like, maybe it’ll be the project that kind of keeps her mind thinking through something. One of the biggest problems that people have when they have cancer is that like, all the work that they were supposed to be doing goes out the door, or they have all the work that they’re supposed to be doing and all the cancer work, and I thought what would a project look like? Would it be a nice way to think through this experience? So, we started thinking about sex with cancer as both a business and is an artwork. And it is an attempt to create a space where we can talk excitingly about sex and cancer and illness and pleasure. It’s broken down into a number of parts. There’s a place with questions and answers. We got I think we had over 500 questions that were asked of sex with cancer, we put the word out to the public, we got and we selected the top, I believe, 14 questions. And then we had those questions answered by a number of different professionals. These there’s a number of questions that come up a lot. We know that every individual is as individual as their sex life and their partners and their diagnoses, but there are some general themes, tiredness, dryness, erectile dysfunction, sadness around scars, or discomfort around lovers, etc. So we enter those with different kinds of professional sex therapists, patient perspective, doctors, nurses, therapists, we then also have links to shops for our partners with ‘Sh!’ a women’s focused sex toy space, they’ve been a real community advocate for a really long time. So it has that link. It has number of artworks, which we commissioned to try to expand the narrative and the conversation, to get people to feel less lonely, to get to see other people’s true life stories. So I’m really happy with those. And then we have the sex with cancer champions who are to medical professionals that were nominated, and were chosen because we also believe that we should be highlighting what is good that is happening inside of the medical space.  

Sophie  

So you also have a sex shop that sells all sorts of products to help people with and beyond cancer with their sexual wellbeing. What was your thought process behind having a shop as part of the resources for sex with cancer?  

Brian   

Our top priority was for people to feel empowered by asking questions, getting an answer and then seeking out something. Our central focus was simple, no nonsense kind of descriptions, clear understandings. If someone has cancer, and they’ve been on a journey with sex toy products for a really long time, they will probably not need sex with cancer in the same way. But if people have never really thought about sex or intimacy, in a way, which was not totally normative, or heterosexual, or you know, in a committed couple, etc. If they’re just starting that journey, sex with cancer will help them understand like, actually, you should buy a lubricant. Not all people know that. And they have to know that especially if you’re a woman who’s on Tamoxifen for your entire life, and one of the side effects is causing vaginal dryness, you need to start a journey on getting with together with a lubricant. Now, we don’t believe that we have the only lubricant that anyone can ever use. We’re saying try this. We have two different ones. We’ve got one that’s totally organic, we have one that’s a little bit less. So we’re trying to keep the things affordable, accessible and no nonsense. We’ve tried to keep everything as queer friendly and gender inclusive as possible. That just comes from the politics of the people that made it. For some people, and actually I think for most people whose sex lives are impacted by cancer, that journey will be a lifelong one. So trying to find the joy of that process instead of where most people are, which is frustration, which is they tried this, it didn’t work, they tried this, it didn’t work. They tried this, it didn’t work. We’re trying to say, try this, see if it works? Because you’re on a journey. And that’s not a cop out. I hope that’s not a cop out. But it’s really to say like, there are no quick fixes on the body and pleasure. If you are someone who like many medics do insist exclusively on talking about function, something either works, or doesn’t. It’s either painful, or it’s not. We believe that there’s so many gradations in between this and that. So much sex is partner specific tiredness specific, where you are in a hormonal cycles, specific, all of those things are affected, you know, where your hydration is, you know, it’s so complicated, that we’re just trying to bring a little bit of joy and interest in the exploration.  

Sophie  

Absolutely, and for each person, this exploration can look so different. And you said earlier that you had so many questions that weren’t just from people who had lived with cancer, they were from partners, friends, and health professionals, too. So thinking about all those questions you had to go through, I wonder if there were any that stuck out for you? Are there ones that you still think about?  

Brian   

Oh, it’s a great question. I think about a few of them all the time, I’m really thinking recently, I tried to resist for a long time talking about fertility, in terms of sex with cancer, because I think there’s a lot of resource about fertility. But I think something that came up, and that really sits with me now is that there’s quite a lot of fertility grief that’s happening, or people being frustrated by the fact that that they can’t get pregnant, or, you know, like, or their, their sperm no longer works, or their eggs are no longer harvestable, etc, because of cancer. And actually, though, that is about fertility. I think that I sometimes forget that, for, for a lot of people, fertility and sex are deeply related. And that it doesn’t doesn’t happen with me, it’s the kind of sex that I have doesn’t naturally make babies when I have them when I have sex with men. But I think for a lot of people, there’s a lot of grief that is there in the body. And there’s feelings of failure. And that is not just about fertility, but it really sits with people’s bodies fully. So I think about that a lot right now. And I’m thinking about better ways that we can deal with that. The other thing that I think about a lot, the other question that I really think about a lot is, a lot of people think about cancer as moments that we can come stay together with our partner forever. They’re so amazing, wonderful, but actually cancer also gives some people a push to be more adventurous to leave a crappy partner. And so I’m also inspired by people who are like, You know what, I never did this, that or the other with my body. And then my body had all these problems and so I gotta get out there! I want all the pleasures! And for people who are really trying to say, you know, my body was a thing before and now it’s, it’s a difference. It’s different. And, and actually, I think people think that their bodies will become more shy but there’s a small but vocal and really energised minority who are really using the opportunity of these cancer as a way to think more adventurously about their sex life, about their intimacy about their relationships. So I’m excited both about the grief and about the adventure  

Tara  

You are given these applicators neither now they’re not um obviously, they look like the instrument but aren’t very flexible. But you’re, there’s different sizes of applicators, of course. So I had mentioned in a joke, almost like masturbating (laughs). And the lady said, Oh, no, no, no, don’t talk about that there (laughs). That was my first I was like, okay, that’s weird. Why would you not?  

Sophie  

This is Tara. She was diagnosed with cervical cancer and as part of her treatment opted to take part in a clinical trial called the interlace trial. This included six weeks of chemo and radiotherapy followed by three rounds of brachytherapy, which is internal radiation. brachytherapy is a way of giving a high dose of radiation to cancer but very little to surrounding tissues. It’s delivered through applicators which are made up of tubes and More needles designed to shrink cancer and relieve symptoms. But a few people, including Tara can experience side effects like tightness and scarring of the vagina. We spoke to Tara about how her cancer diagnosis and treatment affected her sex life. Now, it’s important to say that this is Tara’s own lived experience. And other people will have hugely different experiences and feelings depending on their own individual circumstances.  

Tara   

But long term, I still have effects from it. I’m very tight up up up there, and my undercarriage, and I would have sort of scarring. Whenever I had discovered that I, you know, obviously, I was bleeding a lot, and I had a lot of blood clots from my vagina, that I didn’t really want to be intimate anyway, and I was travelling at the time. So I was in Bangkok. And there wasn’t a lot of opportunity to be intimate with my other hal anywayf.  And then whenever I get married, I kind of just had planned to do psychosexual counselling. But I think after my counselling session, I kind of give that up and then started my adventure of self self exploration. I used to be able to have sex to three times a day, but now I have to wait a day to heal inside before I can do it again. Yeah, it’s just different, you know, so,.But like, it’s, you know, at the end of the day it’s sex, we’ve all got with wiggly bits, we’ve all got you know, pinchy bits and scars. And if you’re gonna laugh and enjoy and just be naked together and cuddle laughter, then, you know.  

Sophie  

Yeah and y’know, you were with your partner for several years during and post your cancer treatment. But then you had separated by the time you wanted to lean back into your sexuality, and were referred to a sexual psychologist at the time. And they said to you that if you don’t keep the area open, that there was a danger of your vagina canal closing, which would need surgery to undo. So at that point, really, you were exploring not only your sexuality, and your body, but your singleness, too. And what was that like for you?  

Tara   

It was really fun, actually. So if you’ve ever been with a partner for, I was with him for seven years, and there, not only do you have sex, but you always have this extra part of it with the relationship. So whenever I, I had actually just asked a friend to come around to my house, have a cup of tea or coffee. And I, you know, I trusted him. And it was really nice to start with him. And, yeah, it was really fun. And then I said, Okay, well, could you do this weekly? And yes or no, we did that for a little while.  And yeah, so that I just kind of like was on the Tinder. And I was honest, like, this is what I need. I’m not into having a relationship right now. And if you want to meet and chat, great. But yeah, this is actually just what I want and what I need. It was really fun (laughs). But yeah, guys have always been very, like supportive, and they will go slow until you’re happy. And you can tell them to turn up the speed or the pressure or however and I, a lot of have I had one fellow who his erection dropped because he thought he was actually hurting me. And so that took him a lot of time to get over that. This is the norm for me, and this is I want you to do this, I want to have sex with you and I want this is going to be this is going to happen. And that’s okay, because I’m not actually in pain and a little, it’s uncomfortable, but it’s actually enjoyable when you get going and stuff. So I had to really kind of make sure he was okay with any pain that he thought I was feeling.  

Sophie  

Mm, yeah. And that communication is really important, actually, with a partner, just to let them know where you are, and to make sure everybody feels comfortable. And so is there any advice that you’d give to someone who perhaps is in a similar position? To where you were at the beginning before exploration?  

Tara   

Yeah, okay. So if I’m, if I was in my position, I would just be like, like, you need to be a little bit more selfish. We see the sex is like, something between two people that is to express your love. Honestly, this is gonna be a little bit different. This is sex for you. Okay, so this is sex until you are happy and comfortable. So say, if I’m having sex, sometimes if I’m not relaxed enough, it is sore sex, sometimes you’ll be so relaxed, and it’ll be amazing. And you won’t bleed and you’re like, yeah, it didn’t bleed. But then sometimes you will really bleed. And that’s okay, d’you know. So as long as you like, sometimes I would put like a little towel underneath, don’t make it about like. Oh, this is my recovery, I have to have sex. And Tuesday night at six o’clock, you know. And then sometimes it was like that because of libido is a little bit lower as well with your HRT. So it’s nice sometimes as well. I would tell a fella, actually, that I had been in a relationship with since I said, you know, if you want to have sex, like, just, it’s okay to let me know, because I can mentally prepare my mind to do that. Because sometimes it’s easy to shut off – you’re like, why, why should I want to have sex, I don’t wanna have sex, I don’t want to have sex ever again! And then you’re like, oh, you have sex and think oh actually this is really fun. So you set aside a little bit of time and mentally prepare yourself to do that, and then it kind of helps as well.  

Sophie  

So yeah, um, when you were ready to start exploring sex again, after your treatment, did you feel you could go to your health team for some advice and guidance?  

Tara   

My oncology doctor was amazing. She gave me lube. And, you know, told me to contact if I ever had any questions or wanted to chat to anybody. So that was really nice. And I felt very welcomed to contact for whatever reason, and they’re always very nice to hear, like, they always seemed pleased to hear from me. I don’t mean, I think it is honestly, like, it’s because it’s an intimate thing, like, you kind of have to just find your own way. But I know, there was a sex and intimacy event that I was invited to with a few other patients, and well, survivors, or however you want to call us. So they all were married. So that was a very different situation where they had to maybe approach sex differently, because it was different from what they their partner was, what was, I was starting with brand new partners, there was no norm. Yeah, I think it’s good to talk about everything. And I am a kind of personal, if it helps somebody else. Great. So yeah, I don’t know if talking was any helpful to me. But definitely with guys, yeah, just if you’re sharing, and you’re open, and just be honest, and just have a clear conscience. You’re not you’re not here to fill anybody. You’re not here to like be cruel, or you know, you are genuinely, you’re a genuine human being on this particular path. And this is where you’re at, and this is what you want, and this is what you need. And it’s okay to ask for those things and let other people know, where you, you know, let tell other people like, ‘hey, this is what I want, this is what I need’. And if you can do it great. And if you don’t, that’s okay, too. So, it’s all good.  

Sophie  

So we’ve heard how cancer impact sexual wellbeing and the experiences those with and beyond cancer can have. But when having these conversations, they can be varied and individual just like we’ve been discussing. But the question is, are we making these conversations easier to have, whether they’re with loved ones or health professionals? I asked Isabel and Brian, how can we move things forward?  

Isabel   

I think if it was left solely to health professionals, it would probably continue progressing at what I would refer to as a glacial pace. And that perhaps is a little unkind, but you know, bearing in mind that I trained as a sex therapist back in 2003. And we’re now in 2023. And I think we really should have and could have made much more progress than we have done within oncology. But I think what’s made a real sea shift has actually been patient advocacy and patient involvement. So I think what I find now compared to when I initially moved into this field of work, is that patients are much stronger in their ability to advocate for what they need. And by becoming social media experts. And by really taking things out into the public arena, they’ve really raised awareness. And so as a consequence, health professionals are having to also raise their game, which I think is excellent news.  

Sophie  

It’s true. Patient advocates have led the way talking about sex and cancer. Take Brian and Joon-Lynn whose own experiences and questions led directly to their work at Sex with Cancer.  

Brian   

I emailed every cancer charity 2014 2015 When I was starting this work, starting this thinking, and no one wanted to talk about it. Mostly said, I want to start a sex toy shop for cancer patients. So maybe they didn’t realise how subtle I was meaning for it to be. So maybe they weren’t turned off by that. But it is crazy to think that 50 years ago, people didn’t talk about cancer at all. And now it’s everywhere. And we bake for cancer, and we bike for cancer, and we, you know, we you know, we do everything for cancer. So for me sex, it stops that inspiration. But I think that attitudes are slowly changing in part because of amazing kind of feminist and queer and disabled voices that have led the way for a while in this area. And how just kind of poking through into the mainstream. So the democratising of social media, and who has access has allowed us to say ‘Oh, I follow a sex therapist on Instagram’. And I can get that instead of waiting for Dr. Ruth’s radio show to come on when she would come on one hour a week or whatever. And there was one person doing that, or Dan Savage’s sex column or, you know, a column in Diva magazine. Now we’re seeing a lot more access so people can find things better.  

Sophie  

The willingness of people like Tara and Brian to open up and share their experiences is changing things for the better. But research isn’t necessarily keeping up. Some people’s issues still attract much more investment and attention than others.  

Isabel  

I think there’s still a huge gender imbalance, Sophie, in terms of the amount of research that backs the optimal interventions for sexual consequences of cancer treatment. So I think we’ve had lots of studies published and you know, going right back to the 1970s, and right to the current day, which very much clarify for us that sexual impacts are a common effect of cancer treatments, and that we need to now be really moving much more into designing and testing treatment interventions from a psychosexual and sexual function perspective. Now, that has moved more rapidly in male sexual dysfunction, particularly with the launch of Viagra, and the development of other drug therapies that are vasoactive drugs that really help increase blood flow into the pelvis, and particularly into the penis, that can be really, really helpful in supporting and that aspect of sexual function for men. But we’ve tended not to be able to invest quite as much money in research from a female perspective. And the trials that were done with the use of Viagra and other similar drugs in female sexual dysfunction haven’t yielded the same promise, because there isn’t the same close association between blood flow and physical elements of sexual arousal with the actual subjective or emotional aspects of sexual arousal that we feel in our in our bodies more generally, and in our heads, emotionally. So we haven’t had the same promise come out of that limited research in female sexual dysfunction. But there is a lot of work going on, particularly in the States and in the rest of Europe, looking at different aspects of psychological intervention, particularly for female sexual difficulties after cancer and looking at them the use of for example, techniques such as mindfulness therapy. And so we’re beginning to see smaller scale studies coming through that give us a sense that actually psychological interventions for cancer does actually have a, an important role to play, in addition to any of the biomedical interventions that are perhaps at the moment, far better developed in male sexual dysfunction than they are in female sexual difficulties. But I think there’s an awful lot that can still be done. And for me, perhaps I’m biased as a woman, but I think we need to invest more money in female sexual dysfunction research across the board. And within oncology, specifically.  

Sophie  

Awareness can help change that, we’re much better at solving problems we can see than those we cover up. There needs to be accessible information for all. And while things like websites and social media help, the responsibility tends to lie with our health professionals, the people we interact with most when it comes to our health and wellbeing.  

Brian   

So we need to get sex training around sex and sexuality into nursing school into, into medical school. And we need that to be kind of led with a sex positive lens. That’s really, that’s number one, essential. A lot of doctors are really not comfortable talking about sex. A lot of nurses are really not comfortable of sex. One of the women that we work with is a nurse that serves three different hospitals in across a county. And she says I have to go to every place because the nurses at each place don’t want to talk about sex. So so he or she is coming like, I don’t know, like some sex crazed maniac talking about sex when other people don’t want to, we have to build their confidence. The reason why a nurse or a doctor is uncomfortable talking about sex is not because they’re uncomfortable talking about sex, but they’re uncomfortable that they won’t have the answers to the questions. They’re uncomfortable that they might offend the other person that, you know, they make a lot of assumptions about who their patient is. And we want to say like, actually, it makes you more beloved, as a doctor or nurse to find a way to talk about sex, it makes it better for you to throw in a business card for Sex with Cancer into their packet of 50 things that they’re going to look at. So that one night, in the middle of the night, the person goes, ‘You know what, actually I will look into this, because I care about it now’. But in the minute that I was diagnosed, I was thinking about my children’s daycare, I was thinking about my will I was thinking about, you know, amputation, you know, I’m not thinking about orgasm in the same way. But two weeks later, I might. So there’s a lot of different methods that we can be thinking about. But I do you think that also people are understanding that sex, intimacy and meaningful relationships with one’s own body, and the body of their partners or just themselves if they’re single, is meaningful, it’s good for people’s mental health. It’s good for people’s physical health to engage in those questions. It encourages people to understand pleasure and to pursue feeling good. That which is essential to all of our health and wellbeing, so sexual freedom is human right. And, and the ability to have meaningful relationships and meaningful sex are essential. So I think that those things are just changing. And thank God for it. Because really, almost a decade ago, no one would answer the call on that, and now people are enthusiastic to talk about it.  

Sophie  

This has been another episode of that cancer conversation. We want to thank all our guests on today’s episode, Dr. Isabel White, Brian Lobel and Tara. You can explore our show notes for more information and resources on today’s topic. And if you have time, please rate the show and leave a review. It helps a lot and lets us know you’re enjoying it. Also, if there are cancer conversations you want us to have or topics you want us to explore, send us an email at science [email protected] to tell us about your idea. That cancer conversation is produced by the digital news team at cancer Research UK. Thanks for listening and talk to you next time.