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Couples should not expect their sex lives to return to normal after cancer treatments.Todd Keith

Breast and prostate cancer are the most common cancers among women and men. These cancers share another similarity: They have an impact on sexuality.

Depending on the type and stage of breast cancer, hormonal changes with treatment, fatigue, insults to body image and fear about survival can directly and potently affect sexual desire. Premature menopause from the estrogen-blocking drug tamoxifen can lead to vaginal dryness and pain during sex.

Sexual functioning in men is also affected by treatments associated with prostate cancer, including surgery, radiation and androgen-deprivation therapy. Androgen-deprivation therapy can give rise to "menopausal symptoms" in men, such as hot flashes and fatigue. It is often used in combination with radiation therapy, which is commonly linked to the loss of sexual desire and can compound a sense of loss.

Even with nerve-sparing surgeries, in which doctors identify and avoid cutting the nerves that control erections, the vast majority of prostate-cancer survivors do not fully recover erectile function after a prostatectomy.

Excellent books have been written to help survivors (and their partners) cope with sexual changes after cancer and the Canadian Cancer Society has resources online to help patients find a "new normal" in sex after cancer.

Unfortunately, many doctors do not adequately discuss before treatment the sexual changes that are likely to occur, nor do they introduce alternative ways of experiencing and taking pleasure in sex.

For prostate-cancer survivors, the hope that drugs such as Viagra or Cialis will reverse all post-treatment sexual problems is sadly too often overly optimistic since they help restore erections in only a subset of survivors, with the rest not deriving any benefit.

Gay and bisexual cancer survivors are particularly unlikely to have their sexual health needs addressed by a doctor. Several studies have found that men who have sex with men (MSM) and who have prostate cancer face unique challenges not experienced by men who engage in opposite-sex sexual activities (and who are typically, though not always, heterosexual men).

For example, data show that MSM tend to be less informed about the consequences of prostate-cancer treatment and they are more bothered by the loss of ejaculate following treatment compared with straight men. Ejaculation by MSM is a definitive sign of sexual gratification and unlike many other aspects of sexual pleasure that can be masked or exaggerated, it is evident to both partners during a sexual encounter.

MSM are also more likely to have changes in sexual practices compared with men who have sex with women. Erectile dysfunction for a "top" (the penetrating partner) is more challenging for MSM than strictly heterosexual men because it takes a firmer penis for anal than vaginal penetration. Granted, in theory, the MSM have the option of moving from being the top to being the receptive partner (i.e. bottom), but it is not clear how comfortable or natural that shift would feel to many MSM.

Thankfully, researchers have been studying the impact of education and psychological therapy on sexuality in survivors of all genders and sexual orientations, and there is good evidence to show that starting a dialogue about sex after cancer can be immensely beneficial. For many, the sexual changes that result from cancer provide a unique opportunity to cultivate new ways of being sexual that they had not considered precancer.

What you can do:

– Talk to your cancer health care provider or ask for a referral to a qualified sex therapist about broadening the ways you engage in sex.

– Read books such as Woman Cancer Sex and Prostate Cancer and the Man You Love by Canadian sexual-health nurse, educator and author Anne Katz.

– Share your experience with other prostate-cancer survivors in a support group. Gay men and MSM tend to be underrepresented in prostate-cancer support groups.

– Participate in a survey aimed at developing a measure of sexual function in MSM prostate-cancer survivors.

– If you are in a relationship, try to let go of trying to get back to "the way things were" sexually and be open-minded to the idea of cultivating a "new normal" sexually.

Lori Brotto is an associate professor of gynecology at the University of British Columbia and a registered psychologist. You can find her at brottolab.com and follow her on Twitter @DrLoriBrotto.