The phone rang in my office one morning last week.

Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.”

(The opening statement could just as easily be from a man, and often is.)

I quickly looked up her notes in the electronic medical record and saw that she is a breast cancer survivor who, at her last appointment, reported vaginal dryness and loss of libido secondary to endocrine treatment.

I explained that I prefer to see couples, as solutions to these sorts of problems are usually only resolved when both members of the couple are seen.

“But he doesn’t even know that this is a problem …” was her reply.

This is also not an unusual response. I once saw a couple for counseling and the woman, a breast cancer survivor on adjuvant aromatase inhibitor therapy, said that she was comforted by the fact that her husband did not know how much sex hurt because her tears flowed backwards into the pillow. A quick glance at her husband’s face told me that he knew how much it hurt and how awful he felt that something that should be an expression of love caused her pain. It is not unusual for the male partner to develop his own sexual problems as a result of this; rapid ejaculation (“let’s just get this over quickly”) and erectile difficulties (“I feel guilty about hurting her”) are not uncommon in these couples.

I explained to the woman on the phone that unless her sexual activity was restricted to solo endeavors, her partner needs to be part of any potential solution. I didn’t say it at the time, but I am pretty sure that he is aware that the vaginal dryness, in particular, is a problem. She can perhaps hide her loss of libido, and many women do, but any sexual activity that they have had must have suggested to him that she was in discomfort or frank pain. Most survivors try to muddle through the sexual changes after treatment and it often takes a long time for them to ask for help. And she asked for help and was referred to me.

I often see men who have erectile difficulties after surgery for prostate or colorectal cancer. Their partners are very well aware of the problem, but the men think that this is their problem to solve. They are often willing to go to great lengths to have erections, and some even try to hide erectile aids from their partner. This usually results in failure; if they don’t talk to their partner about their interest in sexual activity, they take a pill and then find that they have wasted their money because their partner goes out or starts watching a movie on TV. I have even had one or two patients who have tried to hide the needles and vial of medication for intracavernosal injections.

The subterfuge and taking on the “problem” to be “fixed” reflects essentially on our difficulties in communicating about sexuality with the person we are sexual with. And if we can’t talk to that person, how can they know what feels good, what doesn’t, what one likes or prefers, and what we would rather avoid? Yes, we have facial expressions, and we can swat a hand away, grunt or moan, but wouldn’t it be more efficient to use our words? That is where counseling plays a vital role in solving problems and finding solutions. In counseling, our patients have to talk, and from that talk comes understanding and sharing and empathy and, eventually, solutions and resolution.

I really hope that the woman on the phone at the very least tells her husband about the appointment with me. And perhaps he will come with her. Without the two of them participating, nothing will change, and their sexual relationship will continue in pain or will cease. The choice is hers to make.

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

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