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SEXY EVER AFTER: INTIMACY POST-CANCER Copyright © 2011 by Patty Brisben & Keri Peterson, MD All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, please address: Good in Bed LLC, PMB 409, 22 Prince Street, New York, NY 10012 Cover design by Angela Goddard, eBook design by Emily Blair ISBN 978-0-9838437-0-2 (e-book) Disclaimer: This book contains advice and information relating to sexual health and interpersonal well-being. It is not intended to replace medical or psychotherapeutic advice and should be used to supplement rather than replace regular care by your doctor or mental health professional. While all efforts have been made to ensure the accuracy of the information contained in this book as of the date of publication, the publisher and the author are not responsible for any adverse effects or consequences that may occur as a result of applying the methods suggested in this book.

Our mission is to revolutionize the way the people learn about sex. We know that it isn't easy to walk into a bookstore and buy a book about sex, much less read one on your lunch break. That's why all of our Good in Bed Guides are "blush-free" and downloadable in an instant to your computer, smart phone or other digital device. They are private, printable and portable. And always up to date with the latest information. All of our e-Guides are written by credentialed experts who are passionate about their subjects and respected in their fields. And because Good in Bed is a digital publisher, we can bring you their expertise at a fraction of the cost of a traditional paperback. When it comes to your sex life, we know we can't guarantee satisfaction. That part is up to you. But we can help. In addition to publishing our premium e-Guides, we offer a library of free content and a respectful community in which individuals and experts can interact. Talking about sex isn't easy, but, in the end, not talking about sex is even harder. You only have one sex life, and we want to help you live it to the fullest. Please visit us at GoodinBed.com

To all the brave men and women who have fought cancer and inspire us to live and love to the fullest

About the Authors

Patty Brisben is the CEO and founder of Pure RomanceTM, the nation's fastest-growing in-home direct sales company specializing in relationship enhancement products, intimacy education, and sexual health awareness. With over twenty-five years of experience working with women, she now leads tens of thousands of consultants who are touching the lives of women and couples nationwide. Through Pure Romance's Sexual Health Education Department, Patty assists women in recapturing their sensual and sexual selves following cancer diagnosis and treatment. The Department also engages in collaborative research studies with Indiana University's Center for Sexual Health Promotion, which is affiliated with the prestigious Kinsey Institute. In 2006 Patty created the Patty Brisben Foundation for Women's Sexual Health, which serves to strengthen, support, and enhance health services provided for women through education, research, and community outreach. Her notable work has put her in the national spotlight, with appearances on "The View" and CNN amongst others and profiles in leading business publications, including Forbes and Entrepreneur.

Dr. Keri Peterson obtained her bachelor degree from Cornell University and received her medical degree from Mount Sinai School of Medicine. She completed post-graduate training in Internal Medicine at Mount Sinai Medical Center in New York City and is board certified in Internal Medicine. Dr. Peterson has been in private practice with a prominent medical group on the Upper East Side of Manhattan since 1999. She holds appointments at Lenox Hill Hospital and Mount Sinai Medical Center. She is a member of the American College of Physicians and the American Medical Association. With a demonstrated commitment to the advancement of medicine, Dr. Peterson has several publications in leading medical and scientific journals and has presented at distinguished medical symposiums. Dr. Peterson is a medical contributor and columnist for Women's Health Magazine and also appears frequently on the TODAY Show amongst others.

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Table of Contents

Introduction Part 1: What Does Your Cancer Diagnosis Mean For You and Your Partner? Chapter 1: The Most Common Cancers For Men and Women Chapter 2: How You and Your Partner Can Deal with a Cancer Diagnosis Part 2: Men and Women -- How Can Your Cancer Diagnosis Affect Your Sex Life? Chapter 3: Fatigue Chapter 4: Shortness of Breath Chapter 5: Urinary Incontinence Chapter 6: Infertility Chapter 7: Low Libido Chapter 8: Low Self-Esteem Chapter 9: Low Body Image Due to Presence of Tracheostomy, Stoma, or Colostomy 76 47 50 54 59 62 66 73 34 20 15 10

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Part 3: Women -- How Can Your Cancer Diagnosis Affect Your Sex Life? Chapter 10: Breast Removal Chapter 11: Issues with Arousal and Orgasm Chapter 12: Hot Flashes Chapter 13: Vaginal Tightness Chapter 14: Vaginal Dryness Part 4: Men -- How Can Your Cancer Diagnosis Affect Your Sex Life? Chapter 15: Dry Orgasms and Retrograde Ejaculation Chapter 16: Erectile Dysfunction Chapter 17: Premature Ejaculation Part 5: Best Practices for Your Love Life Chapter 18: Top 10 Rules for Your Best Sex Life 122 124 137 143 146 119 83 86 93 107 112 116

Chapter 19: Top 10 Rules for Your Best Love Life 159 Conclusion 174

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Resources Bibliographic Essay Acknowledgments

177 186 190

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Introduction

We're so glad you're reading this. It means that -- despite the myriad ways in which cancer has affected you -- you're ready to take back control of your life, and make intimacy a priority. We're thrilled. Everyone -- and we mean everyone -- deserves mindblowing, so-good-you-wanna-do-it-again sex. And sadly, not enough people are having it. In fact, you may not realize this but, as an individual impacted by cancer who's frustrated with his or her sex life, you're actually in the majority. It's true. Based upon the results of a study conducted by the Patty Brisben Foundation, 95 percent of women with breast cancer have indicated that cancer has adversely affected their sexuality. And additional studies that looked at the effects of other types of cancer among both men and women indicated that 40 to 100 percent of those who have been treated for cancer have experienced some level of sexual dysfunction. Luckily, you don't have to accept this as your new, sexual norm. That's why we wrote Sexy Ever After. We were seeing too many people in our lives suffering needlessly, and

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giving up on great sex lives. We wanted them to know it was possible to enjoy sex again, despite the obstacles. And we wanted to be the ones to tell them how. Of course, before we dive in, you should know that reinvigorating your sex life after a cancer diagnosis can require a redefinition of what sex is. Why? Cancer treatments can change your body, and can even change the way your body experiences pleasurable sensations. This shouldn't worry you, though. Just because sex is different for you post-treatment doesn't mean it can't be good. In fact, in some cases, making the extra effort in the bedroom might even make things better! Just remember that redefining sex requires an open mind, constant communication, a little bit of effort, and some creativity. That last bit is where we come in. In Section 1 of this book, we'll go over the most common types of cancer that both men and women experience, and will also go into detail on how these particular cancers -- and their treatments -- can affect your intimate life. In addition, we'll give you tips on how you and your partner can go about handling a cancer diagnosis together, from how to communicate

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your fears and concerns to each other to how to choose the best oncologist to how to maintain a healthy lifestyle in general. Section 2 delves into the common symptoms experienced by both men and women, from fatigue to infertility to low self-esteem. Not only that, but we give step-by-step instructions on how to manage these symptoms and, in some cases, how to work toward eliminating them. Similarly, Section 3 focuses on the common symptoms experienced by women, while Section 4 is all about the men. Finally, in Section 5, we pull back and take a more general look at your love and sex life. This particular section is rich with the top 20 tips for living your best life with your partner, both in and out of the bedroom. What makes us qualified to give you advice? CEO and founder of Pure Romance, Patty Brisben is an advocate for women's sexual health whose company goal is to raise awareness about the challenges women face regarding their sexuality. As the CEO of Pure Romance, Patty has overseen the training of more than 75,000 Pure Romance Consultants who learn how to educate women by providing a safe, fun, and

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informative platform on which they can ask questions and learn more about their intimate lives. Sensuality, Sexuality, Survival!, a foundation which helps women recapture their sensual and sexual selves following a cancer diagnosis or treatment, was created as a way to help Pure Romance Consultants get involved in philanthropic activities in their communities.

"This book will hold your hand and give you step by step answers. It will show you that there is life after cancer. It's a fight and it's a battle and you can have an even stronger relationship than you had before."

-- Patty Brisben Keri Peterson, MD is board certified in Internal Medicine, and has a private practice with a prominent medical group on the Upper East Side of Manhattan. She holds appointments at Lenox Hill Hospital and Mount Sinai Medical Center. She is a member of the American College of Physicians and the American Medical Association. With a demonstrated commitment to the advancement of medicine, Dr. Peterson has several publications in leading medical and scientific journals and has presented at distinguished medical symposiums.

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"I see after chemo how tired my patients are... how much they're suffering. To be able to offer advice in this book is very appealing to me."

-- Keri Peterson, MD We have written this book for people who have undergone cancer treatments and who are living with problems they think only they have. We have written this book for people who feel isolated. This book can even act as a guide for partners, as they often feel helpless, without an understanding or insight into what their partner is going through. Your sexuality is a vital part of your health and sense of well-being. To put it under the carpet because you've been sick is shutting off an area of your life that is a source of vitality. We hope that the information throughout this book helps you attain an active and fulfilling love life. We hope that you find yourself able to turn to it again and again as a valuable resource. Because our love lives are important, and sex is an important part of that. No one reading this should go without.

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What Does Your Cancer Diagnosis Mean For You and Your Partner?

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A quick stroll through your local bookstore or library will show that, when it comes to difficulty attaining intimacy after a cancer diagnosis, most people think immediately of breast cancer. We suppose it's understandable. After all, the padded bras and plunging necklines associated with women's boobage do scream sex, and their cleavage is probably the most visible sign of their womanhood and sexuality. But the truth is, any type of cancer diagnosis can affect your sex life -- man or woman -- in ways both obvious and quietly insidious. Cancer is the second leading cause of death in the United States. In 2008, it was estimated that there were over 1.4 million new cases of cancer in the United States and, in 2004, it was determined that there were over 10.8 million Americans with a history of cancer living in the U.S. That number is terrifying. Survival rates vary depending upon the type of cancer one is diagnosed with, of which there are many. In fact, though 25 types of cancer account for about 95 percent of diagnoses, cancer can encompass as many as 200 related yet distinct diseases. Not to make light of the health issues that can arise due to both cancer and the treatments used to manage and eradicate it,

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but that's a lot of different ways in which one can lose their bedroom mojo. And that's what we'll be covering in Sexy Ever After. Because, while there are plenty of books out there that could teach you the ins and outs of cancer diagnoses, treatments, and symptom management, there are not nearly enough resources for those looking to do more than just survive. And having great sex is part of that. Not only does maintaining an active sex live keep the intimate connection between you and your partner strong (and a cancer diagnosis can sometimes cause a rift between you and your loved ones at a time when you need them most), but the toe-curling orgasms don't hurt, either. So yes, learning to love one's body all over again after a cancer diagnosis is important, even if a change is required in the bedroom in order to accommodate for new sexual needs. In this section of Sexy Ever After, we'll give a quick primer on the various types of cancer diagnoses: what the symptoms are, how they can be treated, and how they might affect your sex life.

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We'll also go into the ways in which you can handle a cancer diagnosis in a way that preserves your physical, mental, and emotional health -- all of which affect your "relationship health." Finally, for those readers who are romantically involved with someone who has received a cancer diagnosis, we'll give you an inside look at what your partner is going through, and also teach you how to communicate with your partner about their diagnosis and symptoms, and about your intimate life together.

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Anne Thompson,* Cancer Survivor

"I remember making love to my husband hours after hearing the radiologist tell me I had cancer. It was New Year's Eve of 2007, and we were staying at the Heartbreak Hotel in Memphis, TN, where we were vacationing with our 9-month-old daughter. I actually received the call from my doctor while drinking a milkshake in a little ice cream shop at Graceland. When we returned to the Heartbreak Hotel, I spoke to a team of doctors at my hospital and arranged for my bilateral mastectomy, and my husband put our daughter down for a nap. Then, as if to break some kind of ruinous spell, we came together and made love. We feverishly tore at clothes and at one another's bodies, knowing that the sex we currently knew would be no more."

*pseudonym

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Chapter 1: The Most Common Cancers For Men and Women

Some types of cancer are more prominent in the public consciousness than others, due to charity walks, merchandising, and media campaigns. Everyone knows what those pink ribbons signify, and everyone has seen those horrifying (and perhaps, as a result, effective) anti-smoking commercials that speak out about lung cancer and other tobacco-related diseases. But there are so many other ways in which cancer can strike down a person, and in ways you don't expect. In this chapter, we'll touch upon the more common forms of cancer that affect both men and women, and give you the lowdown on what to expect with each diagnosis. After that? We'll move forward with looking your diagnosis in the eye and perhaps giving it the middle finger. Trust us. It'll feel good. Without further ado ... Cancers that Affect Both Men and Women Lung Cancer Lung cancer is defined as a rapid, abnormal cell growth in the lungs and bronchial tubes, and is the leading

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cause of death from cancer. In 2008, close to 100,000 women and 114,000 men were estimated to have been diagnosed with it. So we urge you to be vigilant about any symptoms that pop up. If you've been suffering from a chronic cough, wheezing, or other breathing difficulties, you should get yourself checked out. If you're experiencing increased mucus production (ick), you should get yourself checked out. And while these symptoms can often be confused for side effects of the common cold, more serious symptoms include the coughing up of blood, chest pains, and recurrent pneumonia or bronchitis. In some cases, someone with lung cancer will also experience persistent hoarseness, difficulty swallowing, and back pain. There are several different types of lung cancer. Treatment is based on the stage at which it is found. Non-small cell cancer is more common and is often treated with surgery in earlier stages. Small-cell lung cancer is a more aggressive cancer, and is typically treated with a combination of radiation therapy and chemotherapy. While the sexual side effects are less obvious, lung cancer can affect your intimate life. The breathing difficulties associated with lung cancer can make exerting

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yourself in the bedroom especially demanding. And you know it gets your partner's motor running when you scream out their name! Weakly panting out your special nickname for him or her (Muffin? Hot Rod?) just doesn't have the same effect. The pain associated with lung cancer can also affect your sex life (in addition to your day-to-day). And, post-cancer treatment, the use of a tracheostomy (breathing tube in the neck) or oxygen tank can affect one's self-esteem and interfere with attempts at intimacy. Colorectal Cancer Colon cancer shows up in the tissues of the colon, while rectal cancer shows up in the tissues of the rectum. Worried you might have it? Symptoms to look out for include bloody stools; cramping, bloating, and gas pains; abdominal pain; diarrhea or constipation; chronic fatigue; and other symptoms of anemia (due to intestinal bleeding) ... all total mood killers, thanks to both the ick factor and the resulting discomfort. There are a variety of surgeries that can be employed if you've been diagnosed with colorectal cancer. Endoscopic surgery can be used to remove the smallest

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of polyps. A colectomy -- the most common operation for colon cancer -- involves the removal of both the cancer and the surrounding colon. If the tumor is in the rectum, a proctectomy may be required, which will eventually necessitate the use of a colostomy bag for the removal of solid waste. This is only required, however, in a small number of cases. Radiation therapy, meanwhile, is not used in the case of colon cancer, but is used with rectal cancer. More often, chemotherapy is used as a treatment for colon cancer, and for rectal cancer as well. Based on its proximity to one's nether regions, it's no surprise that colorectal cancer can easily affect one's intimate life. Both a tumor, and the cancer treatment itself, can put pressure on the vaginal walls, making penetration painful. Treatment may also damage the nerves in the pelvic area, making it more difficult to experience pleasure. This could -- in turn -- lead to erectile dysfunction or ejaculation issues in men. In addition, the presence of a stoma and colostomy bag could affect one's body image, and also make sexual activity challenging. Luckily, these are all things you can work around, and we'll discuss those sex-boosting strategies in later chapters.

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Cancers that Affect Women Breast Cancer Breast cancer is the most common form of cancer among females (and also affects a small percentage of males). It typically manifests with a tumor in the breast. Symptoms to look out for include a lump or thickening in the breast or armpit, a change in the size of the breast, a change in the color of the breast or areola, change in skin texture, nipple discharge, or even a retraction of the nipple. Once a diagnosis has been made, there are a number of treatments available. As about two in three breast cancer patients are diagnosed with a tumor limited to the breast, doctors usually recommend a lumpectomy (removal of the tumor) or mastectomy (removal of the entire breast), so as to eradicate the disease before it spreads. These surgeries are typically accompanied by a form of radiation therapy. If one's breast cancer has spread to the lymph nodes, chemotherapy or hormonal therapy may also be necessary. Breast cancer can affect your sex life in a number of ways. The loss of a breast (and the ensuing surgery

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scar) can adversely affect your self-esteem, destroying your ability to feel sexy (let alone aroused). And if breast play was part of your pre-sex routine, you'll need to seek out other ways to get your motor running. (An erotic massage? A caressing of the inner thighs? Slow, sensuous smooching?) In addition, the stress and anxiety surrounding both a diagnosis and the ensuing treatment options can also lower your libido, strike a blow to your body image, and cause depression. Of course, this is the case with any type of cancer diagnosis. On top of all this, radiation treatments can make touching certain areas uncomfortable, or even painful. And as if is that wasn't enough, both chemotherapy and hormone therapies can affect the amount of estrogen your body produces, leading to menopausal symptoms such as vaginal dryness and, as a result, painful penetration. And while this section is all about the ladies, as we mentioned above, a small percentage of men are also affected by breast cancer. Men: When your breast cancer is managed with radiation treatment, there can be a decrease in the amount of testosterone your body produces, leading to low libido and erection problems.

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Hormone therapies, meanwhile, can cause a decrease in sexual desire, plus erection and/or ejaculation problems. And taking either hormone replacement therapy or chemotherapy may cause you to produce less semen. For both men and women, chemotherapy can cause a loss of sexual desire and a lowering of self-esteem. This is caused partially by the resulting fatigue, hair loss, nausea, and mouth sores. This laundry list of negative symptoms may seem overwhelming. And dealing with all of them is definitely not a walk in the park. But with a bit of creativity (and some optimism, you guys!), you can keep them from holding you back ... in bed or otherwise. Cervical Cancer Cervical cancer is caused by the humanpapilloma virus (HPV), a common STD, and appears in the cervix (part of a woman's reproductive system). Symptoms to look out for include abnormal vaginal discharge, unusual vaginal bleeding or spotting, pelvic pain, and pain during intercourse. Happily, the cure rate for cervical cancer is 95 percent and, oftentimes, the cancerous cells disappear on their own. But if they don't

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disappear, the treatment required can still adversely affect one's quality of life. One option for those who must undergo treatment is surgery -- either a cone biopsy or a hysterectomy (the removal of the uterus or womb and, sometimes, the fallopian tubes and ovaries). For those who go through with a hysterectomy, you're not necessarily out of the woods. Complications such as bleeding or infection can occur. And obviously, your fertility will be affected. If the ovaries are not removed, menopause may occur sooner in life. If they are removed, you'll enter menopause immediately, and experience menopausal symptoms like hot flashes and vaginal dryness. (Delightful!) Radiation therapy can also be employed, though it will destroy the ovaries and induce immediate menopause. And if you end up taking hormone replacement therapy to counteract the fact that estrogen production has halted, side effects can include breast tenderness, bloating, and depression. Then there's chemoradiation (combined chemotherapy and radiation therapy), employed if the cancer has spread. This will not cure one's cancer, but will only shrink it, or slow it down.

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Uterine Cancer Uterine cancer -- cancer of the uterus -- typically occurs post-menopause. Symptoms to look out for include vaginal bleeding and lower abdominal and back pain. Once you've been diagnosed with uterine cancer, you can be treated with surgery (usually a hysterectomy), radiation therapy, or hormone therapy. As previously mentioned, such procedures can affect your fertility, and your ability to enjoy intercourse, though we'll be teaching you workarounds for the latter later on in this book. Ovarian Cancer Ovarian cancer typically appears in the outer lining of the ovaries. Symptoms to look out for include indigestion, flatulence, nausea or vomiting, abdominal discomfort or pain, swelling, or bloating, diarrhea, constipation, loss of appetite, unexplained weight loss, frequent urination, abnormal bleeding from the vagina, and shortness of breath. (Most of these symptoms also paint a picture of your typical college student, but we'll assume -- for the moment -- that you haven't been living on a diet of beer, pizza, and all-nighters.)

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This cancer can be treated with an oophorectomy (the surgical removal of one or both ovaries) or chemotherapy. Removing both ovaries will, however, induce immediate menopause. As a result, your estrogen levels will drop, which can lead to the vagina becoming very dry and thin. Removal of the ovaries can also lead to infertility, though if only one ovary is removed, fertility can still be preserved. Radiation therapy is a less common treatment for ovarian cancer, because of its high complication rate. Cancers that Affect Men Testicular Cancer Testicular cancer can affect one or both of your testicles. Luckily, it's easily treated ... and also easy to discover on your own, so you should be vigilant in keeping an eye out for the warning signs. The symptoms you should look out for include a lump in either testicle, an enlarged testicle, a heavy sensation in the scrotum, a dull ache in the groin or lower abdomen, a sudden collection of fluid in the scrotum, pain or discomfort in a testicle or in the scrotum, and breast enlargement or tenderness.

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An orchiectomy (surgery to remove one or both testicles) is the most common treatment. If only one testicle is removed, your fertility should not be affected. But there could be scarring or pain at the surgical site, which could affect your body image and self-esteem, and which in turn could adversely affect your interest in sexual activity. With surgery, there is also the risk of retrograde ejaculation, which causes semen to end up in the bladder, instead of traveling through the urethra and out the penis. Radiation therapy and chemotherapy are other options, but radiation therapy that is directed at the testicles can cause sperm counts to decrease, possibly affecting your fertility. And chemotherapy renders patients sterile for about two years following treatment. Sperm banking is usually recommended to men having to undergo treatment for testicular cancer. In addition to the sexual side effects of most cancer treatments, the disease itself can cause you to feel stripped of your masculinity. We still think you're pretty darn sexy, but we understand how you might get trapped into this frame of mind. Later on, we'll talk about how to regain your mojo.

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Prostate Cancer Prostate cancer --the most common cancer among men in the United States -- is located in the prostate gland, where semen production occurs. In its early stages, this type of cancer can have no symptoms, but some men do experience weak or interrupted urine flow (the urethra runs directly through the prostate gland), unusually frequent urination, difficulty starting or holding back urine, pain or burning during urination, blood in the urine or semen, inability to urinate, or painful ejaculation. Treatments include surgery, radiation therapy, and chemotherapy. One type of surgery, employed in an attempt to cure the disease, is a radical prostatectomy, which involves the removal of the entire prostate, and some surrounding tissues. This major operation, however, can cause permanent incontinence, and frequently results in irreversible impotence, or erectile dysfunction. Not what we'd consider a win-win situation. A transurethral resection of the prostate, on the other hand, is used to relieve common symptoms of prostate cancer, but it can also cause retrograde ejaculation.

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Radiation therapy, meanwhile, can cause impotence. In advanced cases of prostate cancer, you could also try hormonal or other drug therapies. Unfortunately, hormonal therapies almost always result in impotence, and can also lower your sex drive. You may also experience symptoms more commonly associated with menopause, such as hot flashes. And while we often joke that men should experience the agita that all women are forced to live with (menstruation, childbirth, and menopause), in reality, we wouldn't wish it upon our worst male enemy. Orchiectomies (the removal of one or both testicles) are also sometimes employed in advanced cases of prostate cancer, but this form of surgical castration is -- to put it mildly -- an unattractive prospect for most men. In the end, all of these treatments can cause depression, and low self-esteem and body image. These, in turn, can cause a general lack of interest in sexual activities. Penile Cancer Penile cancer is rare in the United States and Europe, but you should still look out for any odd changes in the look and/or feel of your penis. The most common

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forms of treatment for penile cancer are surgery and radiation therapy. The longer one's penile cancer goes undiscovered, the greater chance there is that all or part of the penis will be lost during treatment. (If that's not a call to action, we don't know what is.) And radiation treatment can also cause erectile dysfunction, and a decrease in sexual arousal and desire.

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Chapter 2: How You and Your Partner Can Deal with a Cancer Diagnosis

How to Deal with a Cancer Diagnosis You may feel overwhelmed seeing all of the preceding information laid out so matter-of-factly. The truth of the matter is, cancer -- and its treatment -- can also lead to many other ailments which, in turn, can lead to even more symptoms, and the need for further treatment. It's like an endless cycle, and it can be crushing, on so many levels. There are healthy and unhealthy ways to deal with a cancer diagnosis. Because we'd like to spare you months of self-isolation, depression, and the repeated playing of your most emo playlist (a brief period of sadness and anger is allowed ...), we're going to help you by laying out the healthiest means of managing the aftermath of your diagnosis. 1. Choose an oncologist who will take a proactive approach to symptom management. The more dedicated your physician is to managing and minimizing your symptoms, the less likely it is that your symptoms will snowball, leading you to even more illness and infection.

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When your immune system is so thoroughly compromised, it can be easy to contract a severe infection or illness, like pneumonia or anemia. It's actually not uncommon for a patient to lose their life to something separate from the cancer they were originally diagnosed with. If your oncologist is aggressive about managing your symptoms, you will remain strong enough to fight off other infections.

Keri Says

Questions to Ask Your Prospective Oncologist

Are you board certified in your specialty? How much experience do you have in treating my type of cancer? What are the privileges gained from using your hospital?

Questions to Ask Yourself

Did he or she listen and address my concerns in a way I understood? Did I feel rushed?

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Was the staff helpful and compassionate? Are the office hours compatible with my schedule?

2. Be honest about your symptoms. You may feel tempted to downplay your symptoms so as not to be a bother (silly you), but your oncologist will be able to do a better job of keeping you healthy if you're up-front with him or her about how you're feeling. So try to be as specific as you can about what you're experiencing, and how it's affected your life both in and out of the bedroom. 3. Be smart and safe. Don't do things that will weaken your immunity. Another good way to remain healthy is to live healthy. A lot of the precautions recommended for those who are undergoing various forms of cancer treatment are common sense.

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Keri Says

Take These Steps To Stay Healthy

If you're going through chemotherapy, stay away from crowds, and away from those who are suffering from communicable diseases. Do not share personal items that can carry germs. Wash your hands a lot, and maintain the highest standards of personal hygiene, so as to combat the risk of infection. Make sure you're up to date on vaccinations. Above all, be practical, be careful, and be cautious.

4. Don't forget about your loved ones. Communicate about all desires, insecurities, and concerns. It can be difficult for your friends, family, and loved ones to understand what you're going through. After all, they're not clairvoyant. Most likely, they feel paralyzed by uncertainty right now, unsure whether to keep you company or leave you alone ... entertain you or have the tough conversations ... remain

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upbeat or keep their minds open to more serious and potentially upsetting conversations. While you have enough on your plate without worrying about their comfort levels, it can be personally beneficial to help them help you. Let's face it: When you're busy working through treatment and taking care of kids and careers, it's easy to simply run out of steam before finding the time and space to tend to your relationship on a regular basis. Even couples who love each other and want their relationships to be lively, sexy, and full of affection still find themselves feeling out of sync and out of practice. A sure sign that not much is going on inside the bedroom is when there's a lack of communication outside the bedroom. Communicate as much as you can. 5. Nip depression and anxiety in the bud. It can be natural to experience varying levels of depression and anxiety (and anger and frustration) after receiving a cancer diagnosis. Don't downplay what you're feeling by telling yourself that the emotions you're experiencing are inevitable, and not cause for worry. Seeking out a regimen of both talk therapy and behavioral medication can be

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helpful, especially if you can find yourself a mental health professional that has previously treated patients with life-threatening illnesses, such as a psycho-oncologist. 6. Look for ways to manage your depression on your own. Talk therapy and the right meds can be a godsend, but throwing yourself into alternative therapies -- such as meditation or yoga -- or seeking comfort in spirituality and/or faith can radically improve your quality of life. Don't let negativity hijack your life.

Keri Says

Natural Ways to Manage Depression

go outdoors and enjoy some fresh air connect with friends practice cardio, to boost your mood practice yoga, to settle your mind try therapy

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seek out a support group, so you can talk to other people who have been through what you've been through go to blogs and websites if you don't have access to people in the flesh. Reading other people's experiences can give you comfort. go back to old hobbies develop new hobbies

7. Reclaim your life. Throw yourself back into your old routines, as much as you possibly can. This will help you see that your diagnosis doesn't have to derail your life. And take a second look at your long-term goals. Ask yourself: Where do I want to be six months from now? One year? Five years? Ten? Use the answers to these questions to reprioritize and focus on your short-term goals. Throwing renewed energy into accomplishing these goals will afford you a sense of achievement, and underscore the fact that your life is still your own.

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Krissi B., Cancer Survivor

"I had a mastectomy in December on my left breast, and then six rounds of chemo. My last round was on Cinco de Mayo, and I celebrated with sombreros and margarita mixes. A lot of dealing with cancer is about mindset. You need to tell yourself: I'm not sick, or I'm not going to stay sick. It's all about not playing the victim."

8. Have some fantastic sex. Even if that means redefining what sex is. We've already shown you the numerous ways in which a cancer diagnosis can adversely affect your intimate life. But you shouldn't allow these complications to sabotage your romantic life. Take the time to get to know your bodies again, exploring how your hot buttons have changed, and what you can do to change your routine for the better. Rewrite your sexual script and take this opportunity to make your sex life even better than before! 9. Ask for help. We've already mentioned therapists and loved ones, but this bears repeating. While, a lot of the time, you may not be in the mood to talk

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things out, you should take the time to share your feelings with someone. So do some research on psychotherapists, or even marital counselors and/or sex therapists. Talk about your feelings with friends and family members. Or, if you'd rather talk to someone who has a better chance of understanding where you're coming from, seek out a peer support group in your area. 10. Be a social butterfly. Don't isolate yourself. Such behavior will only put you on the fast track to succumbing to your depression and anxiety. And we don't allow that.

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How to Help Your Partner Deal with a Cancer Diagnosis Perhaps you're reading this because your partner has been diagnosed with cancer. For that, we salute you. It's admirable that you're taking the time to educate yourself about your partner's diagnosis, and about the physical and emotional fallout they will inevitably experience. But what's even more important is asking yourself: What can I do? It's understandable to feel hesitant, confused, frustrated, angry, helpless ... Your partner is going through something that it's impossible to fully understand, and you're just not sure how you can be there for him or her. Hopefully, this chapter will help to demystify what's going on in your partner's head, and what you can do to help. Before you do anything, of course, you should pause and try to understand what your partner is feeling. When someone is presented with a cancer diagnosis, they often run through a gamut of conflicting feelings. One feeling is the fear of death. A cancer diagnosis can -- understandably -- feel like a death sentence, no

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matter what the survival rate. Another feeling is frustration, stemming from the belief that they are losing control ... over both their health and their life. Finally, depending upon the type of cancer, your partner may feel betrayed by his or her body, and may even feel that they have lost their femininity (especially common with breast cancer) or masculinity (testicular cancer, penile cancer, etc.). Knowing all of this, you should seek to control your own anger, frustration, and sadness, have patience, and just try to be there for your partner. How? Help your partner regain a feeling of normalcy. Because of the loss of control they're experiencing, it can be beneficial to let them do as much for themselves as they can. They'll appreciate knowing that their cancer diagnosis has not robbed them of their independence. Also, don't force them to talk about their feelings before they're ready, tell them to "cheer up!" (so annoying), or jump through hoops to entertain them. Just be there for them, and follow their cues. If they want to talk, listen. If they crave alone time, do restrain yourself from hovering. Eventually, they will be ready to talk about their diagnosis and their symptoms, their feelings and -- in

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due time -- your sex life! When they are, don't guide the conversation too much. Ask lots of questions, and listen, listen, listen! And don't let your relationship fall by the wayside. Show your partner continued affection. They may be feeling insecure about their body, and wondering whether or not you're still attracted to them. You're probably worried about pushing them toward intimacy too soon. They're probably wondering why you haven't made a pass at them in weeks. There's nothing wrong with a good, old-fashioned seduction at a time like this, especially if it ends in full-body orgasms for the both of you. It's so important to maintain intimacy. As soon as you can, go back to having sex regularly, and aim to eventually have it at least once a week. Engaging in sex this regularly increases the production of testosterone in your system, which in turn will increase your libido levels. It's a win-win! And in addition to straight-up affection, start dating again. Spend some fun, quality time together, and keep the conversation cancer-free. If you find that the two of you are struggling with your romantic connection, or with your sex life, be open to seeking out the help of a marriage counselor or sex therapist. Organizations

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like the American Association for Marriage and Family Therapy (aamft.org) and the American Association of Sexuality Educators Counselors and Therapists (aasect.org) have hotlines and online directories you can use to locate a professional in your area. You'll also find additional resources for seeking out mental health professionals at the end of this book. As far as the cancer-related logistics go, do be hands on and participative when it comes to doctor appointments, treatments, and maintaining a healthy lifestyle. Take the lead in finding the best physicians -- and treatment -- for your partner, doing research, asking all the right questions, and helping to make and keep track of appointments. Encourage your partner to be honest about their symptoms and, if they won't, talk to their physician yourself. Maintain patience, no matter how confused or helpless you feel. And above all, become an active participant in their care.

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Men and Women -- How Can Your Cancer Diagnosis Affect Your Sex Life?

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A cancer diagnosis can be a lot to take in. You worry about your chances of survival. You're forced to choose from a variety of treatment options, all of them somewhat horrifying on their own. Your health suffers, both physically and mentally. While we've already touched upon the things you can do to handle the gravity of a cancer diagnosis, you can check out the books and websites in our resource-rich appendix in order to really get into the nitty-gritty of treatment options, maintaining a sense of positivity, communicating with your loved ones, finding support, and more. What we'd like to do for you here is much more specific (and, we'd like to think, a lot more fun). In short, we want to bestow upon you a renewed, revitalized, fantastic sex life. Cancer -- and the treatments that go along with it -- can adversely affect your sex life in so many ways. While most symptoms can't be avoided, all of them can be managed, to some degree or another. Using the tips throughout this book, you'll be able to fight back against the symptoms that are messing with your sexy time ... and perhaps even enjoy yourself a bit more than you did before!

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We're just sayin' ... we know a thing or two about smokin' hot sex. In this section of Sexy Ever After, we'll touch upon the intimacy-related issues that can affect both men and women ... symptoms like fatigue, low libido levels, and poor body image. We'll explain what these issues stem from, and then tell you exactly what you can do to keep it from ruining your sex life. Trust us. You'll thank us. And so will your partner. Loved ones? You guys and gals should use these tips in order to romance your partner right back beneath those sheets. Chances are, they're feeling a bit selfconscious about their body right now, and they could use a good old, red hot seduction. If they're feeling a bit wary, talk to them about their fears, and let them know that you've been doing your homework. Then, wow them with your newfound knowledge and show them that -- even if your bedroom romps need to be a little bit different now -- they're still worth staying in bed for. We hope that you'll find the tips throughout this book to be not only helpful, but also inspiring. If anyone can use an enjoyable roll in the hay, it's probably you.

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Chapter 3: Fatigue

One of the most common excuses people use when turning down sex from their partner? Aside from the latest episode of Army Wives? "Sorry, honey. I'm feeling too tired to exert myself with some strenuous bumping and grinding." We know. So trite. But it's tough to prioritize sex if you've had a long day at work, a tough couple of hours with the kids, or an hour or so of cooking dinner for the family, followed by too many loads of laundry and a little bit of vacuuming. Unfortunately, issues with fatigue are only exacerbated by cancer, and also by the treatments used to cure it. For one thing, a cancer diagnosis can lead to both physical and emotional distress, which can -- in turn -- lead to exhaustion. Fatigue is also a common side effect of depression, anxiety, and sleeplessness, three symptoms that are obviously common when you've been diagnosed with cancer. Add to that treatments such as radiation therapy, chemotherapy, immunotherapy, and the other medications used to treat secondary symptoms, and you have all the ingredients (or perhaps too many) for a complete lack of energy.

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In addition, some of the other health problems you're likely to experience due to your cancer, or to its treatment, include chronic pain, nausea and vomiting, appetite loss, dehydration, and more ... all things that can easily wear you out and leave you weak. None of this is any fun -- for you or your nether regions -- but we have some tips on boosting your energy. Right now, you'd probably like to close the blinds, bury yourself in five blankets, and sleep well into tomorrow afternoon. But if your sex life is important to you (again, think of your nether regions ... and maybe even your partner), it's worth it to give these a try. Eat Well We know. You may be experiencing a loss of appetite. But when else are you going to have people urging you to eat more? Of course, we're not suggesting you load up on cupcakes, milkshakes, and Peppermint Patties (though feel free to indulge ... in moderation). Rather, consider what your body may be lacking.

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Keri Says

What You Should Be Eating

Eat liver, red meats, and green, leafy vegetables to get more iron. Prepare chicken or fish to get some much-needed protein. And -- most important of all -- scarf down pastas, breads, fruits, and potatoes to load up on those carbs.

Exercise Regularly Your energy is low. You're feeling weak. Upping your speed on the treadmill is probably the last thing you feel like doing. But if you push yourself to remain active -- all while listening to your body, so as not to push yourself too hard -- your energy levels will reap the benefits. Consider workouts that won't be too highimpact. Do the alternate poses on your yoga DVD. Nix that fast-paced Zumba class in favor of the more sensuous belly dancing (we assure you: it'll still make you sweat ... and your partner may be interested in a

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private showing). Take a brisk walk. Or pair up with your partner and try something that will raise both your heart rates, like a salsa or tango class. Not only will exercise boost your energy, but it will also cause a rush of endorphins ... which will have the happy side effect of a racing libido. Get Plenty of Sleep Right. Insomnia is common when you have cancer. But you can improve your odds. Close the blinds to block out disturbing light sources. Adjust the temperature in the room so that you don't wake up boiling. Make sure your bedding is clean, and the bed freshly made, because a newly made bed feels especially delicious. Throw on some soothing music if you think it will help, or beg for an erotic back rub. And you know what else can help you sleep well? A rousing round of vigorous sex. (Yes. We're telling you that more sleep leads to more sex, and that more sex leads to more sleep. Isn't that an endless cycle you'd like to hop in on?) Some of these suggestions are sexier than others, but all of them will lead to a win-win situation ... in your bedroom.

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Chapter 4: Shortness of Breath

We mentioned earlier that a bout with cancer could cause shortness of breath, an unfortunate side effect when you want to get extra lively -- and extra vocal -- in bed. This symptom -- also known as dyspnea -- can be caused by lung cancer and its treatments, chemotherapy, anxiety and stress, and other illnesses that sometimes crop up when your immune system is compromised. In fact, as many as half of all cancer patients experience shortness of breath at some point. How can you fight back against the wheezes and reclaim your screamer status? In addition to medical treatments (surgery in the case of an obstructed air passage, a blood transfusion in the case of anemia, a portable oxygen tank, or other forms of medication), there are some DIY options. Invest in a Love Wedge Okay. Perhaps you don't really need a high-end piece of sex furniture, but a thriftier soft-foam wedge, or even a pile of pillows, will help keep your body at a 45-degree angle, which will in turn allow your lungs to expand enough to breathe comfortably (or whisper

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sweet nothings ... or tell him to move a little to the left and ... right there. No. Right there. YES!). Relax Already! You know what we love most about yoga? The delightfully meditative deep relaxation at the end, wherein participants lie stretched out on the ground -- all of their limbs and muscles relaxed -- and concentrate on their breathing. You can skip the sweating and the trembling and just go straight to the relaxing. Stretch out on your back and concentrate on your inhalations and exhalations. Watch your chest rise as you inhale. When you exhale, imagine all of your limbs going limp. Bliss! Allowing yourself to slip into deep relaxation can ease your breathing problems and any other pain you happen to be experiencing. Ask Your Loved One For a Massage. Tell Him or Her It's Medicinal When you're feeling the ultimate calm that comes from a good massage, it's easier for you to catch your breath. Not only that, but massage boosts your immune system, which can be a major plus when you're struggling

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with the side effects of cancer and its treatments. An erotic massage? Even better. And your partner doesn't need letters behind his or her name to give a good one. As humans, we like to be touched. All your partner has to do is listen to you, and pay attention to how you're responding to their touch. Partners: Offering a massage lets your partner know you recognize his or her need for a little attention. Your partner will appreciate your thoughtfulness, and this gesture will help improve your intimate relationship in the long run, both emotionally and physically. The power of touch is not to be underestimated. How can you give a massage to remember? To make massage night truly special, set the mood. Dim the lights and use a linen spray infused with pheromones to enhance your sexual scent. Don't be afraid to be dramatic -- throw rose petals on your bed! Light candles to create a soft glow. Now on to the main event! Light a soy candle and let some of it melt. Blow out the flame and then pour the melted wax directly onto your lover. Soy melts at a very low temperature, so there is no risk of being burned by hot wax. You can then rub the warm oil into your

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partner's skin. It only takes a few drops to do a whole body massage! Need a little twist? Try giving your massage with a personal massager, which will add stimulation and relieve you of some of the work. Enjoy!

Patty Says

A List of Products for the Aspiring, At-Home Masseuse

massage oils massage candles heart massager warming lubricant

Drink Lots of Water You've heard this one before, but what you may not know is that water thins out secretions that could have become lodged in your respiratory tract, exacerbating your breathing issues. Have you always had trouble getting in those eight glasses a day? Just remember that

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drinking lots of water has also been known to help one maintain a bootylicious bod. Maintain Optimal Temperature Levels Cool air on your face can help you breathe more easily, so use a fan or air conditioner instead of sweating it out ... especially when you're sweating it out with a partner. A humidifier in the winter will also prevent dryness and mucus.

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Chapter 5: Urinary Incontinence

This symptom -- the involuntary leakage of urine -- is particularly dispiriting, as it can lead to moments of very public embarrassment. So of course, experiencing urinary incontinence can only heighten the feeling that you've been betrayed by your own body, causing extreme self-consciousness and poor body image. We'd like to fix that. But first, what can cause it? Urinary incontinence can be the result of chemotherapy; radiation therapy to the bladder, prostate, uterus, or cervix; or other infections. And while there are medicines and surgical procedures that can be employed to deal with it, depending upon the severity of your condition, there are a few other things you can try at home, sans anesthesia. Keep it Regular You'll find yourself visiting the restroom a bit more often than you'd like, but if you instate a pee schedule, you may be able to avoid accidental leakage between bathroom breaks. So drink lots of liquids, and take care to visit the bathroom every hour or so.

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Wear Protection This isn't going to sound sexy, but it would probably behoove you to wear some protection, such as an absorbent pad or urinary catheter. The pads aren't as terrible as you'd think. In fact, these days, they typically come in the form of close-fitting underwear, with an extra liner. And for men (if you'd rather forego the special panties), there are small urine collectors that can be worn around the penis. Do Your Kegels We know. We promised that we wouldn't give you too strenuous of an exercise regimen. But exercising your pelvic floor muscles regularly can be one of the few things standing between you and an impromptu golden shower. Maybe you guys are into that sorta thing. In which case ... fabulous! Perhaps this could work in your favor! But if you're not, Kegels will help you strengthen your pubococcygeus muscles, making it easier to hold it in.

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Not only that, but PC exercises are also known to give orgasms an extra power boost. We'd count that as a win! Ladies: You could even use Ben Wa balls in order to ensure that you're Kegeling correctly. These exercisers help tone and strengthen your PC muscles. All you have to do is insert one or both into the vagina and flex those muscles in an attempt to hold them in.

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Chapter 6: Infertility

About half of all people diagnosed with cancer in their reproductive years receive treatments that can impair fertility. Radiation treatment, for example, can make men produce less semen, and give them erection issues. Chemotherapy and hormone therapies can lower women's estrogen levels, causing them to enter early menopause. Some men experience impotence or retrograde ejaculation due to cancer treatments. Some women have their ovaries or womb completely removed. Even cancer itself can impair your fertility. There's not a lot that can be done to wipe away the pain one feels when they learn they may not be able to conceive (or even get it up, for that matter). What you should do is keep an open mind to the other options out there. Plan Ahead If you have been diagnosed with cancer, are about to undergo treatment, and hope to one day conceive, you should probably take some precautions. Ladies: You can research embryo freezing or egg freezing, or

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even consider ovarian tissue freezing, with an eventual transplant. Another option is ovarian transposition, in which the ovaries are moved higher up into your abdomen, so as to spare them the brunt of any radiation treatment to your pelvic area. Men: You can do sperm banking, or even testicular sperm extraction. We know that it can already be overwhelming to decide upon the best cancer treatment, but these are things you have to consider if you're at all worried about having children in the future. Work with What You Have If you didn't take precautionary action, you still have options. Ladies: If your ovaries are no longer functioning, you can try egg or embryo donation. If your uterus is the problem, you can find a surrogate. There are even various forms of surrogacy (an arrangement in which a woman carries and delivers a child for another person). In cases of traditional surrogacy, the surrogate may be the child's genetic mother, and the child may be conceived via artificial insemination using fresh or frozen sperm, IUI (intrauterine

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insemination), or ICI (intracervical insemination). In cases of gestational surrogacy, you may carry the pregnancy to delivery after having an embryo transferred to your uterus. Men: If you're experiencing erectile dysfunction, it may only be temporary. But, in the meantime, if you'd rather not wait and see, you can try drug therapy (something like Viagra); surgery (penile implant surgery or vascular surgery); or even a penis pump. In the case of retrograde ejaculation, however, drugs may reverse it, but it's usually permanent. Adopt While just as pricey as most fertility treatments -- if not more so -- adoption is certainly less invasive. In fact, adoption is a fantastic option for those who have exhausted all scientific possibilities, and who still hope to experience parenthood, or complete their family. Not only that, but adoption provides the birth mother with the peace of mind that her child will be raised within a safe and stable family environment, and provides the adoptee with stability he or she needs.

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Be Optimistic The younger you are when you receive fertility-busting treatments, the greater chance there is that your fertility will return. Even chemopause (premature menopause brought on by chemotherapy) can be temporary.

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Chapter 7: Low Libido

Of course, one of the biggest roadblocks to a healthy sex life after cancer is plain old lack of desire. Libido is a complex thing, and the sexual response cycle detailed in Chapter 11 explains why. What we will tell you now is that libido can be affected by so many things. Hormonal therapy and chemotherapy can cause low libido. But the issue could very well be psychological, too. Your sense of sexual identity may have been compromised, or your body image damaged, due to treatment symptoms like hair loss, infertility, or disfigurement. Or maybe ... just maybe ... you're feeling like crap. But you can't allow your intimate life to fall victim to the health issues you're struggling with. It's not fair to you or your partner. Being proactive about fighting your low libido is important and, if you work hard enough at it, sex will become fun again. So what should you try? Enjoy sensual pleasures Take the time to explore the various types of touch, taste, and smell that can bring you pleasure, and reawaken your more sensuous self. Take a bubble bath or

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get a deep tissue massage. Light some scented candles. Roll around in some clean, silk sheets. Take a long, hot shower. Whatever you choose to do, be extra mindful of what feels good ... and revel in it. It's only one small step from enjoying the feel of your sheets to enjoying the touch of your lover. Touch yourself Allow things to take a turn for the sexual. Find a time and a place where you can enjoy some extended privacy. Then, touch yourself with the aim of exploring what feels especially arousing. What you enjoy now may be different from what you enjoyed before going through cancer treatments, especially if you had to undergo surgery, or are experiencing pain or numbness. So, using an item like a feather or silk scarf -- or even the light touch of your hand -- caress yourself from head to toe. Don't neglect the backs of your knees, the space behind your ears, or your inner thighs. You may discover an erogenous zone you never knew you had! Masturbate as well, using either your hands or a bullet vibrator to give yourself a greater range of pleasurable sensations. Knowing how to bring yourself back to orgasmic levels is good information to have. Later on,

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when you're in bed with your partner, you can share what you've learned! And don't forget to use a lubricant, even though you're going it alone. For women especially, vaginal dryness is a frequent side effect of most cancer treatments, and it can affect your ability to enjoy yourself down there, even when it's just you and your own two hands. An arousal cream can help as well. They help to enhance pleasurable sensations and, as the name says, increase arousal. Communicate If you've been in a sexual rut lately, have a chat with your partner about what's been holding you back from feeling sexy, what you miss about your intimate life together, and what you've been daydreaming about that really turns you on. Tell your partner about how you touched yourself, and how good it felt. Swap stories of sexual fantasies. If you're having trouble getting the conversation going, try journaling first. Engaging in some free writing -- about what you've experienced, how it's affected your life both in and out of the bedroom, and how you want things to change -- can help you clarify

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and eventually verbalize the thoughts that have been swirling around your head. Or you can turn the conversation into a game. One we like to play is To Tell the Truth. It's similar to the game Two Truths and a Lie, in which players present to a group of people two true things they've done in the past, plus one outrageous lie. The more difficult it is to distinguish between the truths and the lie, the more fun it is! In this case, however, you're only sharing with your partner, and the point is to be more open about your sexual desires, and about what you've been feeling lately. You could also play a sexy game of Truth or Dare, or pick up an actual, sex-specific board game, to facilitate your discussion. Once you get going, talking can easily lead to doing. Practice Practice not only improves sex but, the more you have sex, the more you want to have it. The converse is also true. The more you allow yourself to succumb to your low libido, the harder it becomes to get in the mood. So get busy getting busy! This is an opportunity to make your sex life a bigger priority. While it may seem like

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a bit of a chore right now, it will go back to being fun. You just can't expect it to happen right away. So start slow. Shoot for once a week. This is a good frequency to aspire to as a means of maintaining your intimate connection. After that? You may find yourself wanting it every darn day! Can your partner keep up? Mix it up Of course, you're not going to want to get your sex on if you found your previous routine boring anyway. And even if you didn't, trying new things can revitalize what you so recently lost. There are so many ways to mix things up, and we're not going to list them all here. But here are a few suggestions: *Go shopping for a sex toy together and then introduce it into your sex play. You could go to a sex shop, or even peruse the offerings online, at sites like babeland.com, goodvibes.com, or pureromance. com. Another fun option is the sex toy party ... like a Tupperware party, but with a bit of spice. *Play show and tell. Ladies: Show your partner that new lingerie you picked out. Men: Tell her how hot she looks.

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*Watch a sexy film or read erotica together. Take the fiction and make it come alive. *Reveal your sexual fantasies to each other. Pick some that you're both willing to try. *Try a new kink, a new position, or a new role playing scenario. Try therapy If, after all this, you're still not feeling it, it may be worth it to seek out a sex therapist. He or she will be able to objectively evaluate the roadblocks you've been throwing up, and give you step-by-step instructions on how to bust them. Sex therapists also have specific training about sexual issues that sabotage sexual satisfaction. As mentioned earlier in this book, organizations like AASECT can help you find a therapist near you, and the resource section at this end of this book contains even more suggestions. In fact, it is important to find a counselor or therapist who is certified by AASECT, as experts with this certification have had training related to both relationship issues and sexual concerns. A sex coach can also help individuals and couples. They tend to work on issues in the present and, through

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communication and home activities, help get to the root of the issue by providing education, support, and guidance as a means of helping clients set and reach their goals. Since many people can call themselves a "coach," it is best to find one who has a graduate or doctoral degree in human sexuality and certification from AASECT as a sexuality educator, counselor, or therapist. Following is a quick reference guide for the various academic degrees and licenses a mental health professional might obtain: *Psychologist: Usually has a PhD, PsyD or EdD in psychology or other mental health specialty. *Social Worker: An MSW or PhD in social work. *Counselor/Therapist: An MA or MS in clinical psychology, counseling, mental health, or sexology. *Psychiatrist: An MD in psychiatry, generally licensed to prescribe medication. Some, not all, psychiatrists are trained to provide therapy, in addition to prescribing medication. Many people see a psychiatrist in conjunction with a therapist. *Sex coach: Ideally has a MA, MS, or PhD in human sexuality.

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Chapter 8: Low Self-Esteem

Most likely, you experienced a rush of conflicting feelings upon hearing your cancer diagnosis: fear, anger, sorrow ... These eventually made way for anxiety and depression, and a sense of betrayal. Your body had turned traitor, and you were helpless to stop it. Feelings like this inevitably affect your self-esteem. You start to feel worthless, and that innate instinct to take care of yourself withers away. Sex? Ha! You can't even bring yourself to enjoy your old hobbies and passions. Or your favorite foods. Or even fresh air. We don't want to browbeat you, but you have to snap out of it. You deserve to squeeze every last ounce of joy out of your life that you can. And that includes orgasms (one of the most joyful experiences we know). How? Develop a Mantra Okay. This sounds woo-woo even to us. But it can work. Here's the thing. You've just returned from a war. A war on cancer. And your return requires an adjustment period... time in which you can relax and celebrate the fact that you've whipped cancer in the butt. But after that time has passed, you need to return to life. You

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need to allow cancer to stop holding you back. Sex is a big part of that. If you haven't regained your sexual self, the cancer has won. Your sex life has to be a priority right now, as does your self-esteem. That's why we recommend positive mantras. Just remember the little train that could, telling itself, "I think I can ... I think I can ... I think I can ..." The more you tell yourself "I deserve to live life fully" or "I am pretty darn awesome" or "I have earned at least five earthshattering orgasms this week," the more you'll start to believe it. Throw Yourself into the Things You Love and Care About Sometimes, nothing peps us up more than being productive. Those daily accomplishments -- both big and small -- make us giddy. And sometimes, we're even inspired to do a happy dance to our latest guilty pleasure song. Talk about a mood booster! What do you love to do? What do you care about the most? Is it work? Throw yourself into it. Is it spending time with family? Throw yourself into that. Is it an active sex life? Throw yourself into your partner's arms. They've been waiting for you.

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Try Therapy Here we go with the therapy recommendation again. That's because we're huge believers in the powers of talk therapy and, in some cases, talk therapy supplemented with behavioral medication. Why? Because it's always helpful to have an objective listener, someone who can see the patterns in your thinking and behavior, or who can call you out on your unproductive attitude. If you're having problems in or out of the bedroom, consider seeing a therapist by yourself, or a couples counselor with your partner, or a sex therapist, or some combination of all three. And consider joining a support group so that you can hear the stories of those who are going through what you're going through. You can find a group near you on sites like cancer.org or cancercare.org.

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Chapter 9: Low Body Image Due to Presence of Tracheostomy, Stoma, or Colostomy

A large number of cancers require surgery, which can leave pain, scarring, or -- in some cases -- the necessity for permanent hardware. One example of this is a tracheostomy. This is when a surgeon creates an opening in your windpipe in order to facilitate breathing. Another example is the stoma, often paired with a colostomy bag. The stoma is the opening surgically created in one's large intestine in order to facilitate the removal of feces from the body. When you experience such a radical change to your body, it's natural to suffer from issues of low body image. You may feel less manly ... less feminine ... less sexy. Not only that, but the anxiety surrounding your body issues can keep you from letting go to a degree in which you can actually enjoy sex. This anxiety can even lead to temporary impotence. We think this is truly a shame. You're so hot. We can see it. Your partner can see it. Why can't you? Maybe you just need a little bit of help. Fortunately, that's what we're here for.

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Talk to Someone About What You're Feeling At this point, you're feeling pretty down on yourself. Your partner can sense that. He or she can sense the negative feelings you're projecting. But your partner may not understand it. Not only that, but your partner is probably also feeling hesitant to push you to have sex too soon, and is waiting for some cues from you. We get it. Cancer is exhausting. But being the partner of someone struggling with cancer is exhausting, too. That's why you have to open up to your partner about what you've been feeling, and experience the glow that comes from having him or her tell you what a sex machine you still are. Or at least try to project some feelings of positivity. If you're not yet comfortable talking to your partner, have a chat with a positive and supportive friend or family member, a therapist, or the members of a peer support group.

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Anne Thompson,* Cancer Survivor

"My husband told me he really doesn't know what to do. He doesn't know whether to come on to me or leave me alone. He struggles with himself as well. Life since cancer has been difficult, and when he's stressed, he tends to eat--a lot. Now, three years after my diagnosis, he is still struggling with body image. He said, `When I feel worse about myself, I have lower libido, and I think part of it is definitely physical, and part of it is psychological. But also, I don't know where I stand with you sometimes."

*pseudonym

Embrace the Changes in Your Voice or Body So your voice has changed due to that tracheostomy. So what!? Play up your new, throaty, sexy tone with some dirty talk. As for that stoma, let it inspire you to try new and alluring silhouettes in the clothing you buy.

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And ladies: There is nothing sexier than a confident woman. It can be hard to feel sexy when you're going through the cancer trenches, but have it within yourself to increase your confidence and body image. One of the best ways to do this is to pamper yourself. You have been through procedures that take a toll on your body and mind -- you deserve at least a 30-minute bubble bath! Lather up in a wonderfully luxurious bath and clear your mind of everything. Focus on the warmth of the water and the aroma of the bubbles. Focus on all of the amazing things you still adore about your body. The curve of your hips, the shape of your nails, or the piercing blue of your eyes--whatever you love, acknowledge it. Then honor the strength of that body and its capability to conquer anything that stands in its way. When you take time to pamper yourself, you're taking time to celebrate your soul. If you concentrate on all you do have, rather than what you don't, your confidence can begin the rebuilding process. Accentuate Your Other Assets While you've been busy stressing out over your scars or your throat or your stoma, you've completely forgotten about the curve of your hips and the small of your back and the delicate arch of your foot. Wear crotchless

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panties or a slinky nighty to cover up the areas that make you insecure, and concentrate on baring those sexy shoulders of yours, or indulging his foot fetish with a pair of sky-high heels. And pick up some beauty products! Investing in products that enhance your inherent beauty will help you think positively about your image. When you look good, you feel confident. The feeling of limitless confidence is priceless. You can't argue with that. Be Prepared Stay on top of any maintenance required for your trach or stoma, so as to avoid complications. And empty that colostomy bag before having sex. Do all you can to avoid the accidents you worry about the most. Try Different Positions Sometimes, the surgery required to create a stoma can leave a woman's vagina temporarily sore. If this is the case, experiment with different positions. Have sex while lying on your side, or get on top, so that you have total control of the thrusting. Another position that often helps if you're experiencing painful intercourse is a variation of the missionary position, in which the male

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puts his legs on the outside of the female's legs, which she then closes. Not only does this ease the pain, but it also ups the chance that he'll stimulate your clitoris during intercourse. Man or woman, if you're worried about damaging the stoma or colostomy, stick to positions that keep weight off the stoma, or cushion it with a pillow. Redefine Sex Traditional intercourse is not the only option you have when it comes to intimacy. Which is especially good news if you've been experiencing temporary impotence. Make love with your hands, your mouth, or your tongue (or all three!). Consider it a personal challenge to find all the ways in which you can bring each other to orgasm ... without having intercourse. And achieving orgasm isn't the be-all, end-all either. Bring each other to extreme heights of pleasure, all without ever coming. Playing around with this can extend and intensify your lovemaking. You have to consider this as an opportunity ... one that not many people have. It's an opportunity to take your relationship to the next level. It's going to be hard work, but anything worth having is worth working for.

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Maintain a Sense of Humor No matter how much you prepare, mistakes can still happen. Above all, you should maintain a sense of humor when it comes to sex. Even without the complications that come from cancer treatment, sex can be messy, awkward, or accidentally painful. If you have the ability to laugh it all off, you'll find yourself enjoying sex way more.

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Women-- How Can Your Cancer Diagnosis Affect Your Sex Life?

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In the preceding section, we touched upon the various ways in which cancer -- and its treatment options -- can affect the sex lives of both men and women. We also chatted a bit about what you can do to manage intimacy-related symptoms and, in the process (we hope), inspired you to have some pretty awesome sex. But breathing issues, low body image, and fatigue aren't the only problems you're up against in bed. Ladies -- there are some additional symptoms that affect just you ... and your ladybits. In this section of Sexy Ever After, we'll explore the intimacy-related issues that affect only women ... symptoms like hot flashes, vaginal tightness and dryness, and the possible absence of your breasts. We'll explain what can cause these particular symptoms, and then tell you exactly what you can do to keep it from ruining your sex life. We'll also include some hot sex strategies to help you put your best foot (not to mention other body parts) forward. Also? Take what you learn in this section and share the information with your partner. Chances are, even before your cancer diagnosis, your lover may have occasionally grappled with the best ways to turn you on,

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or wasn't necessarily aware of the no-fail ways in which to bring you to a lip-biting, full-body orgasm. That's because your partner isn't clairvoyant, and can't read your mind, and it's important to show him your top hot spots. You have to own your orgasm. This concept is even more important now.

Because -- just when he thought he had it down -- your body has changed. Some of the positions in your regular sex repertoire are now uncomfortable, and perhaps even painful. Some of your former erogenous zones are now numb. The nips he loved to lick and suck on? Potentially gone. What's a well-meaning man to do? Tell him what he has to do. Show him what he has to do. Sex may have to change, but that doesn't mean it has to be any less hot.

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Chapter 10: Breast Removal

This particular symptom only applies in the case of breast cancer (and only if you opt for a mastectomy rather than a lumpectomy) but, because it can affect your body image, self-esteem, and sense of femininity and sexuality so severely, it's worth addressing on its own.

Keri Says

"The biggest issue I've seen is with women with breast cancer who have needed a mastectomy. What I experience is the range of emotions women feel. They feel embarrassed with their new breasts...uncomfortable having their partners touch the area. They lack sensation. It's frustrating. That's where I see it the most when it comes to intimacy. The breasts."

If one or both of your breasts have been removed, you're probably feeling self-conscious about the drastic change in your body. Because, while you appreciate the fact that men now look at your face when you're

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conversing (up here, boys), your collection of deep V-necks now leaves you feeling flat and slightly sexless. What good is a halter top, after all, without the cleavage?

Krissi B., Cancer Survivor

Regarding sex after cancer treatments: "You don't want to have it. You don't feel sexy. You don't feel pretty. You don't have the energy. I also had an open incision on my chest for seven months because my mastectomy wound did not heal. The very first time I looked at my mastectomy wound, I was in the shower. I said to myself, It is so ugly. My husband came into the shower fully dressed and kissed that area. Cancer's ugly, honey, he said. You can never be. When you get a mastectomy, you don't have the same body you had, because you're missing a breast. You don't have that muscle tone, because of the chemotherapy. You don't have your hair. You just don't feel sexy. But then you realize that true love is about your inner beauty, and not your external beauty."

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How will he react to the changed landscape of your body? How will foreplay change now that you don't have boobs to caress, or nipples to nuzzle? Will he still be attracted to you? And were all those cardio striptease classes a complete waste of time now that you're missing one (or both) of your boobs? We wouldn't give up on that cardio striptease routine if we were you. Chances are, your man would still enjoy a private showing, and we guarantee that he's still wowed by the curve of your hips, your thighs, your butt, and even your remaining breast if one survived. In fact, we're pretty sure that men are blind to all of your perceived imperfections ... especially once the clothes come off. Still, what you're feeling is valid, and undeniable. So what are your options? Request Breast Reconstruction Surgery You can go one of two routes here. You can choose saline or silicone implants, which would be inserted under your chest muscle in order to create a mound. Or you could opt for breast reconstruction using your own skin tissue, usually taken from the lower abdomen. Because -- while we think you look fantastic no

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matter what -- having even faux breasts can make you feel better about body. Just remember that the sensations you experience in that area will be different from what you were used to. Those old nerve endings are gone. Your new nipples will be tattooed on. You'll have to go looking elsewhere for that jolt of erotic pleasure. Which could be a good thing. What better excuse for experimenting with new forms of touch? Obtain a Prosthesis Prostheses usually come in silicone or foam rubber, and they're available in a variety of sizes, shapes, weights, and colors. And if you're willing to pony up the extra cash, you can even have one custom-made to match your remaining breast. Your prosthesis can be attached to your body with an adhesive glue, or you can get one that slips into a bra-like contraption. In fact, there are a number of manufacturers out there who design clothing made with hidden pockets for prostheses, including bathing suits and sexy lingerie. Check out sites like makemeheal.com and wearease. com for just a glimpse at all the options you have.

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Touch Each Other ... All Over Because of the lack of sensation in your breast area, you guys will need to go looking for new erogenous zones that can get you all hot and bothered. In fact, even without cancer, everything changes on our body as we grow. We constantly have to explore and be explored. In many cases, the pleasure zones relocate slightly above where they were before. So the crook of your neck or that spot behind your ear has the potential to make you go wild. But don't neglect the rest of your body. Demand a foot rub. An erotic massage. A full-body rub-down. You could even use a toy, like a bullet vibrator or other massager. If you use a blindfold, sensitivity will be heightened, too, which will make it easier for the two of you to watch each other's responses to various types of touch.

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Patty Says

Product Suggestions for Your Hot Spot Explorations

An easy way to introduce vibration into the bedroom is by using an unintimidating bath toy, such as the Pulsa Bath Ball. You and your partner can give each other a massage by gently guiding the Pulsa Bath Ball all over each other's bodies. Or use a great bubble bath, like PureRomance. com's Excape. Add the Super Deluxe Love Mitten for a stimulating in-the-bath massage. And next time, take it up a steamy notch and insert a vaginal vibrator like Phillip into the mitt for a stimulating bath time experience. You could also add an additional element of excitement to foreplay by utilizing Dust Me Pink, an edible body powder. Trace it over your body, turning those parts into edible areas that make it even more fun to pinpoint new erogenous zones.

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Here are some step-by-step instructions for a thorough, feel-good, erotic massage: First, lie down on your stomach, with your arms at your side. Ask your partner to run his hands firmly down the length of your body, all the way from your upper back down to the tips of your toes, first without and then with a pleasantly-scented massage oil. Have him massage your back and shoulders, your spine and the sides of your torso, eventually moving to your legs and arms. Don't let him neglect your hands and feet! As he's doing this, pay attention to which forms of touch feel best. Then, have him heat things up. Your breasts may no longer have sensation in them, but you still have your vajayjay. Have him massage the area around the head of your clitoris, and then swipe his finger from the bottom of your vulva all the way to the top, over and past the clitoris, several times. If you're up for it, let him insert a finger or two. He can also massage your genitals while simultaneously massaging another part of your body. This will make it easier for you to associate various parts of your body with erotic stimulation. Now ... what felt good?

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Chapter 11: Issues with Arousal and Orgasm

Following treatment, you may experience numbness and a lack of sensation in areas that were previously hot spots. This can be caused by surgery, or even by the nerve damage that can occur as a result of chemotherapy treatments. And while this numbness may lessen over time, in some cases, it can be irreversible. This can be disorienting. Forms of foreplay that were previously earth-shattering may now feel meh. You may struggle with arousal. You may struggle with achieving orgasm. You may wonder to yourself: Will I ever enjoy sex again!? These feelings will be especially overpowering the first time you have sex following your cancer treatment ... or even the first few times. You'll most likely feel nervous and self-conscious, and so will your partner. He won't know how to turn you on anymore. He won't know how far you're willing to push yourself. He doesn't want to be the one to push you past your comfort level. At Patty's very first Pure Romance party, she was inundated by questions from women wanting to know: Do you have anything that will put me in the mood?

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Unfortunately, there's no such thing as a magic pill, especially when it comes to women. You have to, as a person, take responsibility in knowing what stimulates you, what arouses you. Arousal should not be a responsibility just for him. It needs to be a responsibility for both partners. So how can you become comfortable in the bedroom again, and eventually come to experience new heights of pleasure? The pioneering sex researchers Masters and Johnson first developed a four-stage model for understanding sexual response back in the 1960s, and it still holds true today: Excitement. Excitement starts with stimulation, whether physical (a partner's touch, masturbation, etc.) or mental and emotional (fantasy, thoughts about your partner, etc.). Whatever the cause, for ladies, stimulation causes the blood vessels in the vagina and clitoris to relax and fill with blood. In guys, the spongy tissues in the penis expand and fill with blood, and he gets hard. In both men and women, the nipples, earlobes, lips, and even nostrils also swell and darken, and both heart rate and breathing quickens and blood pressure rises.

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Plateau. Excitement tends to plateau or level off before a person gets even more aroused. As you approach orgasm, your abdomen and thighs get tense, your hands and feet clench, and your breathing becomes even quicker and more uneven. At this point, a guy will also have a full erection. Orgasm. For many people, this third stage is the best part of sex. During orgasm, all the tension that's been building up is finally released. The physical signs that started in the plateau phase -- higher blood pressure, rapid breathing, muscle contractions -- kick into overdrive. Resolution. The final phase of sexual response occurs after an orgasm. For most men, this is a time to relax: The tension seeps out of his muscles, his blood pressure sinks, and his excitement dissipates. For some women, meanwhile, the first orgasm is just the start. There's also a new theory of arousal, developed at the Kinsey Institute by Erick Janssen and John Bancroft. Called the Dual Control Model of Sexual Response, it shows that how sexually aroused you get depends on how much or little stimulation you've received.

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So how can you ensure you're getting the stimulation you need? Pinpoint New Pleasure Zones with Solo Sex You're going to need to look for new ways to turn yourself -- and each other -- on. Schedule some alone time in which you can explore your body. Experiment with new forms of touch, and engage in some solo sex. It's so important to know how to turn yourself on and, if you can achieve orgasm, all the better! Not only will it feel good, but it will help you relax.

Patty Says

"Studies show that up to 75 percent of women can only climax from clitoral stimulation, so try using a clitoral vibrator as you refamiliarize yourself with your body. Other products, like the Pleasure Puff, are discreet and unintimidating, and act as both an exfoliating bath sponge and a sensual, all-over massager."

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Then, schedule some alone time with your partner. Take turns touching each other. And don't focus immediately on the genitals. A light stroke behind the knees may be the new thing that makes you immediately moist. Or perhaps you're now turned on when he runs his fingernails lightly down your back. In fact, why don't you put that erotic massage we described in the last chapter into practice? Take the time to learn about your new erogenous zones. This little homework assignment (which doesn't sound much like work to us) will help you crave sex again. Prepare Your Love Nest Set the scene for your (second) first time. Things have been stressful lately, and the mess in your bedroom only adds to the stress. Which isn't very conducive to good, in-the-moment sex. So before getting busy in there, clean and de-clutter. Then, once you've given yourself a blank slate with which to work with, pause to consider how you can sex up your space. Look at the décor first. How can you play around with the color palette to make it more conducive to slow, sensuous lovemaking? Shades of light blue and green can be relaxing, while pops of red and pink can heat things up. How about the bed itself? Consider upping the thread count

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on your sheets, making them softer and more durable. How about lighting and scent? Forget the glare of your lamp and pick out some scented candles. Cinnamon and vanilla scents have been known to increase arousal and attraction, and other libido-boosting scents include frankincense, ginger, lavender, lime, orange, patchouli, and rose. Finally, create a toy box that's all about sexy time. Fill it with form-flattering lingerie. Massage oils and massage candles. Lube. Toys. We'll touch upon the best ways to fill your toy box later in this and other chapters, but here is ...

Patty Says

An Erotic Toybox for Beginners Checklist

The bullet can give you the stimulation you desire during intercourse...use it on your cheek while giving oral favors... the possibilities are endless! Another vibrator... perhaps one that provides penetration, g-spot stimulation, etc. A good, water-based lubricant. An arousal cream. If you're going to participate in sex, you might as well enjoy every moment of it.

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Talk It All Out Your room may be ready, but are you? Before stripping down to your birthday suit, have a talk: about your sex-related worries ... about the things that make you feel self-conscious ... about the reasons you've held off for so long. Talk about the solo explorations you've been taking upon your body, and about what does and does not turn you on post-treatment. Engage in some two-way, shameless flattery. It will make you feel less self-conscious about your bod, and will reassure him that you're ready for this. And as you're shedding your layers and getting to know each other's bodies all over again, remember to take your time.

Patty Says

I once went out with a dear friend of mine to celebrate her fifth year in remission. We enjoyed champagne and a nice dinner, and were so happy to have that moment together...to have a girl's night out. After dinner, we got back the in car, and my friend started crying. "He just doesn't understand!" she sobbed, referring to her husband of about 30 years. It turns out, her husband had been sleeping in another room when she most needed him to be

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there for her. Because they never spoke about it, there was a resentment building up in my friend. I urged her to have a talk with him. The result of that chat? It turns out that her husband was afraid his snoring would keep her awake at a time when her health was already draining her energy. He was so afraid of losing her, and thought she'd tell him when she needed him. The moral of this story? Do not ever think your partner is clairvoyant. Tell your partner about your needs and wants. They love you and don't want to lose you. They're looking out for your best interests. Tell them what you need.

Try Different Sex Positions Those positions you rocked in bed before your cancer diagnosis and subsequent treatment probably don't feel quite the same. In fact, you're probably feeling a little bit lost, unsure of where to put your legs, your bum, his hand ... Consider this a good reason to pick up a book of Kama Sutra positions. Trying out the ones that look most intriguing could make sex fun again. Also, depending upon what you're feeling

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down there, certain positions may up your chance at achieving orgasm. One of our faves is a variation of the missionary position, in which your partner should enter you and then rock his body in order to assist you in bringing your legs pressed together within his. This position makes it possible for your outer lips and clitoris to be stimulated during penetration. Another one we love requires your partner to sit in a chair with his legs relaxed. You can then straddle him and slowly lower yourself onto his erect penis. This one is great, because it offers a maximum of upper body -- and eye -- contact. Not only that, but this position allows you to have total control over both the speed and depth of your partner's thrusting. Don't want to leave your bed? Have your partner spoon you, and then slowly enter you from behind. You can then grab ahold of your partner's hand and aid him in stimulating your clitoris. But it's not all about the clitoris. If you'd like to stimulate your G-spot, have your partner insert his index finger into your vagina, turn it so that it's facing your front vaginal wall, and wiggle it in a come hither gesture. He can then massage the area above your pelvic bone and tap the inside of your vaginal wall.

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Some women experience discomfort when their G-spot is stimulated, and even feel a sensation akin to the need to urinate. This sensation is normal. To ease your mind, however, you can just pee before experimenting with this form of stimulation. And if there is a clear fluid that leaks out upon orgasm, congratulations! You've just experienced female ejaculation. Practice Intercourse Plus What does this mean? Even without cancer to contend with, the majority of women out there are unable to orgasm through vaginal stimulation alone. In fact, Patty likens men and women to microwaves and crock pots: While men can become aroused almost instantly, it takes women about 20 minutes before their brain is really in the game. Which is why we always recommend pairing plain old intercourse with one or two other forms of stimulation: clitoral stimulation ... g-spot stimulation ... butt play ... All of those pleasurable sensations thrown together could prove to be more than enough to push you over the brink.

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Do Your Kegels We've already mentioned these when discussing urinary incontinence, but exercising your PC muscles can also intensify your orgasms. So practice your kegels regularly. Three times a day, flex and relax your PC muscles 25 times. Squeeze the muscles, hold for a few seconds, and then relax. And push yourself to have a more productive workout by using Ben-Wa balls. Like a personal trainer, Ben-Wa Balls -- which you insert into your vagina -- help ensure that you're doing your exercises correctly. In fact, the more frequently you use them, the more frequent and intense your orgasms become. How else will this improve sex? If you flex your PC muscles during intercourse, you could end up stimulating your G-spot. It will also increase friction, which can feel pretty darn good, too. What better motivation can there be to exercise!?

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Krissi B., Cancer Survivor

"When I was ready to have sex again, I kind of felt I had to go into training. I was already lifting weights for my arms. Then I was given kegel balls, and I thought Okay. I'll use them. I'm going into training to get my sex life back."

Raid Your Toy Box That smoothie vibrator sitting in your naughty drawer doesn't have to be relegated to solo sex alone. If your lover is having trouble poking your clitoris out of its deep slumber, give yourself a head start orgasm using your favorite vibe. Or find other ways to incorporate toys into your sex play. You and your partner can even go shopping for toys together! A double-ended dildo? A vibrating cock ring? Handcuffs and blindfolds? Mixing things up in bed can definitely lead to surprising new heights of pleasure. Get a Lube Job We'll be discussing personal lubricants later on in this section, in the chapter on vaginal dryness, but it's

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worth mentioning here. If painful sex is keeping you from that ever-elusive orgasm, achieving success could be as simple as lubing up. In fact, you should always use lube during sex (partnered or solo). Lubricants don't just help remedy dryness and discomfort; they vastly enhance the sensations of intercourse and other types of sexual play, including self-stimulation. According to a nationally represented study by Indiana University concerning lubricant use, nearly 70 percent of women described sexual activity with a lubricant as "very satisfying" and "very pleasurable." And most women who used lubricants found that they made sexual activity more comfortable and pleasurable. Consider Arousal Creams Using an arousal cream can help those of you who are feeling especially frustrated by providing a jump start to your sexual engine. In fact, through her work with Pure Romance, Patty has devoted much of her time to championing the development of products like this for women who are cancer survivors ... products that significantly improve the quality of their intimate life. Arousal creams in particular work by drawing blood to the genitals, and can also enhance pleasurable sensations

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on your other erogenous zones. PureRomance.com offers three different arousal creams: w"O"w is a mint oil-based heightening cream meant to be used on the female erogenous zones. It contains special sensitizers that intensify and heighten pleasurable feelings. Nympho Niagra is a menthol-based cream developed to stimulate and sensitize the female erogenous zones in order to enhance pleasure. And X-Scream is a menthol-based unisex cream meant to be used on the genitals in order to help enhance pleasurable sensations and increase arousal. Work Toward Regaining Sensation Of course, after all this, you may still be experiencing numbness, and this can still be frustrating But this numbness may not last forever. We urge you to consider massage and other relaxation exercises as a means of managing this side effect, and to ask your doctor about medications that can also help.

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Chapter 12: Hot Flashes

If you've received cancer treatments that have thrust you prematurely into menopause, hot flashes are just one of the delightful symptoms you'll experience. And contrary to what the name implies, the intense heat you'll feel on your face and upper body can also be accompanied by a rapid heartbeat, sweating, nausea, dizziness, anxiety, headaches, weakness, and a feeling of suffocation. Delightful! So with this horrifying confluence of symptoms, why would you want to get sweaty together in bed? Because -- despite what you have to deal with these day -- sex is supposed to be fun, and feel good! How can you minimize the hot flashes? Avoid Hot Flash Triggers Their arrival may often feel random, but hot flashes can actually be trigged by other things going on in your life. Stress is one such trigger. Others are alcohol, spicy food, hot tubs, and hot showers. So resist the urge to get buzzed before heading to the bedroom. And avoid those spicy dishes, even though you've been told they're aphrodisiacs. Hot tub and shower sex? Also out.

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Luckily, you can still have sex all over the place while avoiding these high-temp triggers. Give Him a Strip Tease The common suggestion is to dress in layers so that you can peel them off when you're feeling hot. But we like to interpret this advice as an invitation to put on a sexy show. Either way, when you're layering up, avoid synthetic materials and stick to cotton. Also, avoid turtlenecks. Not only will your open-neck shirts show off your décolletage, but they'll also keep you cool. Employ Temperature Control Speaking of keeping cool, before you get busy, do the smart thing and turn up the air conditioner, or install a ceiling fan. Do as much as you can to optimize your comfort level. Roll Around on Cotton Sheets Like your clothing, cotton sheets will keep you cooler, which will be extra important if the two of you are working up a sweat. And as we mentioned in the previous chapter, investing in new sheets (with a higher

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thread count) can improve your sex life in other ways, too. So consider this a worthwhile indulgence. Exercise Regularly Although it may seem counterintuitive, exercise can reduce both the frequency and intensity of hot flashes, as well as other symptoms of menopause and aging. The intensity at which you exercise is vital to symptom reduction, with moderate exertion delivering the best results. Cardiovascular exercise performed at an intensity of 65 to 75 percent of your maximal heart rate (220 minus your age, multiplied by 65 or 75 percent) will increase the production of the neurotransmitter serotonin, which positively affects mood and the ability to establish restful sleep patterns. Exercise also increases endorphin levels, which can in turn increase your pain threshold. And because the brain and the body learn through repetition, repeating these exercises is crucial. Listen to your body and progress slowly. When exercise is performed at a high intensity (you are huffing and puffing), stress -- a major trigger of hot flashes -- can be increased. Moderate exercise repeated three to five times per week will bring better results than intense exercise. Relax!

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As stress is one of the main triggers of hot flashes, it stands to reason that taking things down a notch will decrease their frequency. So try relaxation exercises, meditation, breathing exercises, massage, and/or yoga. Heck, try all of them, and make them a regular part of your routine. Eliminating those hot flashes seems like an excellent reason to chase your bliss. Not only that, but some yoga poses can actually improve your sex life, stretching your muscles and joints in ways that can help make you more ... um ... acrobatic in bed. Practice Cobbler's Pose to help give yourself a wider range of motion in your hips. (While seated, bend your knees and bring the soles of your feet together, letting your knees drop open to the sides. Keep your spine long and press the outer edges of your feet together strongly.) Practice some breathing meditations in order to regain mindfulness in the bedroom. Work your way to touching your toes and then see where else your legs can go during sex. Talk To Your Doctor Of course, if you'd like to go beyond the DIY (doit-yourself) route, your doctor may have some suggestions. Alternative therapies like vitamins,

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acupuncture, or herbology can help. There are also other medications that can help with hot flashes, including hormone replacement therapy.

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Chapter 13: Vaginal Tightness

Immediately following your cancer treatment, you may feel tighter than you ever have before. You aren't imagining things. This is a common side effect of treatment, and radiation therapy to the pelvic region in particular can cause scar tissue to form in your vagina, and can also cause your vagina to narrow. And while this can improve that delicious feeling of friction you experience during the ol' in-and-out, it can also make sex painful. And no one wants to have sex if they're anticipating an ouch feeling instead of an ooh ... In fact, this expectation of pain can also adversely affect your libido. So what can you do in order to make sex revert from painful back to pleasurable? Invest in a Vaginal Dilator A vaginal dilator is a tapered device that is used to slowly stretch the walls of the vagina. You should make a regular date with your dilator if you're experiencing tightness down there. Venue? Your bedroom. Outfit? Your birthday suit. Lock the door, undress, and lie down on your bed. After lying back with your legs spread apart, gently separate your labia and insert the dilator into your vagina, holding it in place for several

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minutes before removing it. Then? Do it again. Keep doing it until sex feels less painful. If you're feeling wary, it could be helpful to get some tips from your health care provider. Make Sure You're Getting Regular Stimulation ... Down There Your vaginal muscles are like any other muscle. The more you work them, the stronger they'll become. And the stronger they become, the more you'll be able to stretch them out. Yes, we're writing you a prescription for regular masturbation. You're welcome. How should you go about it? While we know that you know how to masturbate, we'd like to urge you to start small. Begin with your hands and, in addition to stimulating your clitoris, work at stretching your vaginal muscles by inserting a finger or two (or maybe even three?). From there, upgrade to vibrators, and maybe even dildos. Ben-Wa Balls can also improve vaginal elasticity. Take the time to achieve arousal, and then, slowly, penetrate yourself with your toy of choice. Aim at working your way to larger and larger toys, until your partner's penis or fist is no longer an issue.

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Patty Says

Vaginal Dilators vs. Vaginal Vibrators

Vaginal dilators are tapered devices used to slowly stretch the vaginal walls of the vagina so penetration is more comfortable. Dilator sets typically come in a wide variety of sizes so that a woman can start at a size that is most comfortable for her. Often, women experience pain during penetration during and after cancer treatment. A vaginal dilator can help a woman progress back to comfortable and satisfying vaginal penetration. Vaginal vibrators are used to stimulate the vaginal for sexual pleasure. If a woman does not have an issue with painful penetration, a vaginal vibrator can help her experience sensations that will help her progress through the sexual response cycle. A vaginal vibrator can also be used on the outside of the vagina to stimulate the clitoris.

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Ask Your Doctor About Topical Creams Vaginal estrogen creams or other topical creams can provide you with relief from vaginal atrophying. When your body is in short supply of estrogen, replacing it can ease any discomfort you're experiencing in the vagina, vulva, and urethra. In fact, using an estrogen cream can relieve or lessen dryness and soreness in the vagina; itching, redness, or soreness of the vulva; pain during intercourse; and more.

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Chapter 14: Vaginal Dryness

Surgery, chemotherapy, and radiation can all dry out the vagina, making sex painful. And again, if you're anticipating painful sex, you're going to want it less. It's only logical. Which is why vaginal dryness -- such a seemingly simple problem -- can have such a huge impact on your sex life. Luckily, this particular side effect is easy enough to counteract. Purchase a Water-Based Personal Lubricant ... in Bulk Forget diamonds. Lube is easily a girl's best friend, whether or not you have cancer. If your body isn't providing enough moisture to make intercourse comfortable and pleasurable, there's no shame in using lube to make your sexy slipping and sliding that much more slippery. We suggest a water-based lubricant, as they're less likely to cause vaginal irritation, and also won't break down latex condoms or silicone toys in the same way other lubricants can. PureRomance.com's water-based lubricants even have a re-wetting quality, which means they work with a woman's body to produce even more lubrication. You could also try a silicone-based lube, like Pure Silk. They

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last longer, and can even be used in water without immediately washing away. PureRomance.com's products include safe and effective products for women before, during, and after cancer treatments. With the color, odor, and flavoring removed from most of the top selling lubricants, lotions, and arousal creams, the Original formulas provide women a safe alternative when they are most sensitive.

Patty Says

"Everyone should have a good lubricant. Period. Yes, you can have sex without one, but why should you? Would you brush your teeth without toothpaste? Would you skip conditioner if your hair were dry and brittle? Lubricants enhance the pleasure. If you truly want to be a good lover and maximize your experience in the bedroom, then lubricants, in all forms, are the answer."

Seek Out Additional Relief Vaginal moisturizers can also provide relief from vaginal dryness, soothing sore or irritated genitalia. In fact, you should make vaginal moisturizer use a

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regular part of your daily routine. When you first start using a vaginal moisturizer, apply it seven days in a row, right before bed. After that, you can move into a maintenance schedule, applying it two to three times a week, before bed. Cancer or no cancer, using a vaginal moisturizer is important for good vaginal health. Just remember: Vaginal moisturizers are not a replacement for lube (which is actually used specifically during sexual activity). This particular item should be used in addition to your lubricant of choice. Try a Vaginal Estrogen Cream And, as already mentioned in the previous chapter, vaginal estrogen creams can replace the hormones you've been lacking, which in turn will ease any dryness or soreness you've been experiencing in the vagina.

4

Men -- How Can Your Cancer Diagnosis Affect Your Sex Life?

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In the preceding sections, we touched upon the various ways in which cancer -- and its treatment options -- can affect the sex lives of men and women alike, and women in particular. We touched upon love nests, lube, and erotic massages. We tackled numbness, dryness, and low body image. Unfortunately, guys, you're not immune to having your own very specific side effects to cancer and its treatment. In this section of Sexy Ever After, we explore the intimacy-related issues that affect only men ... symptoms that can affect your erections, and your ability to ejaculate. We explain what can cause these particular symptoms, and then tell you exactly what you can do to keep them from ruining your sex life. The symptoms we touch upon in this section are symptoms that can be tied directly to your feelings of masculinity. We already touched upon issues with low self-esteem and poor body image in Section 2 of this book, but those tips are worth keeping in mind as you go through this section. It's important not to let the effects of your cancer define who you are, either in or out of the bedroom.

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Though you may be worried that your sex life will never be normal again, this just isn't true. Sexual touching between you and your partner will always be possible, and "normal" should be defined as whatever gives the two of you pleasure together. Remind yourself -- if you have to -- that you're still you, and that you still have many downright sexy qualities. And if you can, share your grief with someone close to you, or with a mental health professional. Just as it is important to take care of your physical health, your mental and emotional health is also important. Hopefully, armed with the tips in the section, you'll be able to reclaim a good amount of the control you feel you lost when you were forced to choose between cancer and its treatment. After all, there's more than one way to enjoy your sex life.

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Chapter 15: Dry Orgasms and Retrograde Ejaculation

Cancer and its treatments can easily affect your most prized possessions, and this is especially true of prostate cancer. Removal of the prostate can cause dry orgasms (orgasms without ejaculation), and other operations related to prostate cancer treatment can cause retrograde ejaculation. This is when your semen swims in the opposite direction it's supposed to, landing in your bladder instead of in her vagina. Luckily, this symptom doesn't affect your ability to have good sex. And if that's all you're worried about, you can go along on your merry way, sexing her up to your heart's content. What this does affect is your fertility. What can you do if you'd still like to expand your family? Plan Ahead We mentioned this in an earlier chapter, but it's worth repeating. If you know that you're about to undergo treatment that can affect your fertility, consider options like sperm banking or testicular sperm

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extraction. Or ... keep your mind open to adoption, or other sperm donors. Talk To Your Doctor There are drugs available that may be able to reverse the effects of retrograde ejaculation but, as mentioned in the chapter on infertility, it's often permanent. Still, it doesn't hurt to try!

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Chapter 16: Erectile Dysfunction

Erectile dysfunction, or impotence, is the inability to attain and maintain and erection for long enough to achieve penetration, and a good amount of in-and-out action. It can be caused by a number of cancer treatments. In the case of prostate cancer, for example, the surgery employed to take out the cancerous gland can injure the nerves that act as your penis's arousal-related puppet strings. Other operations in the abdomen can also cause nerve damage, or do damage to the blood vessels that carry blood to the penis. And the removal of one or both of your testicles -- or even the use of hormonal drugs -- can lower your testosterone levels, making it difficult to become aroused. And these concrete, physical issues aren't the only things that can hamper an erection. The stress from your cancer diagnosis, and the subsequent treatments you've had to suffer through, not to mention their masculinity-damaging side effects, can cause a serious case of performance anxiety, and a poor self-image. Assuming that your erectile dysfunction is a result of physical issues alone, your erections may very well return after six to 12 months. But what can you do if they don't?

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Rebuild Your Sex Life Around Other Forms of Intimacy Being unable to have traditional intercourse is a total bummer. We're not going to deny that. But we've said it before and we'll say it again: part of enjoying sex post-cancer requires redefining what sex is. And there are plenty of ways to have some good, old erotic fun without penile penetration. There's kissing, first of all: that simple, now-soinnocent act that used to get your heart pumping and your blood rushing back in the early days. Soft kisses at the corner of the mouth, or planted lightly on the lips. Deep, urgent kisses coupled with the twisting tango of your tongues, and a light nibble on the lips. Kisses placed firmly on neck, chest, inner thighs, belly, everywhere. There's snuggling and caressing (and, if you'd like to perform some full-on erotic massages, please do revisit the step-by-step instructions that appeared in this book's previous section). There's also dry humping, which we've always been partial to anyway. There's mutual masturbation, which is surprisingly hot in an exhibitionistic sort of way. Never done it

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before? Just start by lying side by side in bed and gently caressing yourselves, watching each other for signs of arousal, or gazing into each other's eyes. (If you'd like, you could remain at this part of the process, reveling in playing the voyeur as she brings herself to earthshattering climax.) Then, take turns touching each other. You can use your index and middle fingers to lightly rub your partner's clitoris in a circular motion. You can insert your fingers into her vagina. If you're using both hands, you can do both at once! Then, ask her to return the favor, telling her that you like it when she runs her fingers over your balls and up and down the sides of your shaft, letting them linger lightly on the glans (the head of the penis) and corona (the base of the glans). Encourage her -- perhaps using your own hand on hers as a guide -- to place her palm over the head of your penis, and move it in a twisting motion, as if she was squeezing juice from a lemon. Ask her to incorporate some firm stroking, too. If she uses both of her hands in a continuous sliding motion, it can actually feel as if you're penetrating her vagina! If you're still worried about her pleasure, you can also make it your mission to become the master of fantastic oral sex. It will probably come as no surprise that we

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have a few tips for you in this department: Before diving in, gently caress her inner thighs, allowing her to feel your breath in her pubic area. This will help build up some anticipation before you get down to business. When you're ready, begin licking her like an ice cream cone, in long, thick strokes that cover the entire area down there. Let your licks gradually build up in intensity before plunging in fully. Once you've reached a certain rhythm, try mixing things up (though god help you if you've brought her to the brink of orgasm and suddenly change tactics). As you're down there, pay attention to how she's reacting to your touch. If she's enjoying herself -- but doesn't appear blown away -- feel free to switch from a firm lick to an eyelash flutter. If she's writhing around in an agony of pleasure, pulling you closer, and so obviously close to release ... please don't stop. So. If you've determined that she's amenable to a new mix of moves, feel free to go ahead and use your lips to kiss her most intimate parts, alternating those particular kisses with smooches on her thighs. Lightly nibble and then suck on entire bits of her skin. The gentle suction will feel fab, especially if you can still simultaneously manage to keep using your tongue. Blow softly across her skin, teasing her with the new sensation. Repeat, repeat, repeat!

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And now ... we're feeling a little flustered. See?? There are so many ways to enjoy intimacy, even with erectile dysfunction. In fact, you could even focus on and eroticize completely different, non-genital body parts. Foot fetishists, for example, worship the feet. Feeling skeptical? Let us know whether this scenario turns you on: Your partner warms up her hands and places your foot in her lap, using her thumbs to knead your aching feet. By massaging different areas of your foot, she's actually stimulating different parts of your body. After this massage, she gets a little closer, licking and kissing your toes and the arch of your foot. After showering your feet with kisses, she sucks your toes, ones by one, and then graces the tip of each tootsie with another smooch. Can you imagine her mouth on other parts of your body? You can return the favor by giving your partner a foot job. Rub your feet against her breasts, pinching her nipples lightly between your toes. Allow the sole of your foot to trail slowly down her torso, eventually arriving between her legs. Use your toes to softly rub her clitoris and, if she seems lubricated enough, try

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slipping a toe or two inside. See if you can bring her to orgasm. No hands -- or penis -- allowed! Try a New Position There are some sex positions that can improve your chance of maintaining an erection. If you let her get on top, you won't have to worry that the muscles in your thighs and glutes are using up blood that could be put to better use in your penis. Having sex while lying on your side will also help you maintain your erection. Mix Up Your Routine If you always have sex in the evening, right before turning in for the night, you may want to consider mixing things up a bit. After all, do you really want to wait around for your package to perform? Instead, be up for jumping into the sack whenever your member is feeling extra frisky, morning, noon, or night. Not only will this provide more opportunity for sexy time, but the added spontaneity could give the both of you an extra libido boost. And morning sex can be such a nice way to start your day. Because androgen levels are highest between 8 a.m. and 12 p.m., your desire should be at its peak.

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Afterward, you can shower together, holding onto that last bit of intimacy while also washing off the slickness of sex, and the grit of a long night's sleep. Don't you wish you spoiled each other more often? Use Some Extra Equipment Of course, if you're dead set on getting your penis into her vagina, you could try a penile pump, paired with a cock ring. PureRomance.com offers a variety of both, plus some thick, creamy lubes that you can use to make the whole operation a lot more comfortable. How does it work? A penile pump is basically just a plastic cylinder attached to a hand-operated pump. You use it to pull the blood into your penis, and then you place the cock ring around the base of your shaft in order to keep the blood in place (for a maximum of 30 minutes). Some cock rings even vibrate, to provide your partner's clitoris with some extra stimulation. She has toys for her hoo-ha. Why can't you? And speaking of toys, experimenting with vibrators, cock rings, handcuffs, and other sex toys could possibly help your erectile issues. For one thing, the new sensations you experience thanks to the items in your (adult) toy box might awaken something within

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you. For another, knowing that a couple toy will help you please your partner will take the pressure off of you ... and sometimes, the added pressure is all that's keeping you (and your winkie) down. Finally, you could consider using a strap-on vibrator or dildo with your partner in order to simulate penetration. Assuming you'd like to enjoy intercourse again, this isn't a permanent solution, but knowing that you have the option could take some of that added stress and pressure away from you, leading to a possible comeback from your penis. Do Movie N ight But don't just watch any old movie. Look. Porn/erotica may be one of those pleasurable pursuits you prefer to enjoy alone. But such films can also be used as a tool to combat problems with arousal. Men are more visual (which is why most porn is aimed at men) and, if your erectile dysfunction is primarily psychological, watching a skin flick right before sex could be just what the doctor ordered. And watching one together could allow you and your partner to open up a fruitful dialogue about fantasy, turn-ons, new positions, and more.

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So dim the lights in your TV room, settle down on the couch, and pop in your favorite DVD. Comstock Films' Matt and Khym is an ideal film for couples, as it depicts sex -- and raw sex talk -- between two real-life lovers. And Candida Royalle's Femme Productions is dedicated to creating porn that gives couples "positive sexual role modeling." But there's always Internet porn, too. While a definite mixed bag, sites like RedTube and YouPorn provide the payoff for free. While you should definitely concentrate on enjoying what you see on-screen, don't hold back in letting your partner know when something is making you hot. These comments may develop into dirty talk and, eventually, the film's bow-chik-a-bow-bow may be background music to your own on-the-couch action. Pretend to Be Someone Else Again, if your struggles with erectile dysfunction are a result of the psychological side effects of your cancer diagnosis and its treatments, it could help to lose yourself in a fantasy. Which is why we suggest role playing. It just might be enough to distract yourself from the insecurities you've been feeling ... and that distraction could be enough to get you out of your own way.

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Role playing scenarios abound. It's really all about what you're into. But some suggestions include: Strangers in the Night. Can you remember the time you first locked eyes? Can you remember the approach, the thrill of the chase, and the pleasure of seduction? Can you remember those heady beginning days, where just a light brush of skin on skin sent lightning rushing through your body? "Bump into each other" at a public place, and pretend you're meeting each other for the very first time. Flirt like hell, while casually touching and teasing each other. Put some effort into publicly seducing your partner. As the night draws to a close, imagine that -- unless you make a move -- this could be the last time you see this enchanting specimen. Invite her back to your place, or pull her into the restroom for a clandestine quickie. Hot for Teacher. There are a number of ways to have fun with the student/teacher dynamic. If you're playing the professor, have your "student" read aloud a bit of naughty prose from a book of erotica. Touch yourself as she's reading. If she stumbles or mispronounces a word, have her stand up and lean over her desk in order to accept a spanking. Or, if you've walked in on your partner masturbating, slip into the teacher role,

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making your disobedient student write down all of her sexual fantasies about you as punishment. When she's done, have her read her fantasies aloud. Afterward, give her a real education in how to please you. Escort for the Evening. Why not let your partner know that you find them so sexy, you'd be willing to pay to sleep with them. Present your partner with a sexy outfit you purchased just for her, and then pile on the flattery when she tries it on for you. Ask her to spin around, so you can admire every inch of her. Then, take your partner out for a night on the town, and flirt like mad the entire time. When the night is about to end, ask if you can get a little something extra for your money. Slip her a few bills and take her home. At this point, she gets to decide how much it will cost you for some steamy foreplay, or full-on sex. An expert hand job? That'll be extra. A top-notch blowjob? That'll be even more. Intercourse? Are we talking basic missionary, backside entry, or something a little kinkier? Renegotiate at every stage. Cops and Robbers. Been pulled aside for questioning because of indecent exposure? Or have you just been very, very bad? You may be able to get out of this ticket if you flirt like hell. Beg your arresting officer to let you

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off easy. Suggest that you can make up for your bad behavior with some community service ... community service that involves sexually servicing her. Get a Prescription Drugs like Viagra, Cialis, and Levitra can also improve your ability to achieve and maintain your erection (though they're not foolproof). There are also other medications (90 percent effective) that can be injected directly into the shaft of your penis, but this can be painful and cause scarring. Beyond this, you could also get a testosterone boost from patches, creams, or injections. Talk to your doctor about your options. Pack an Extra Penis A more extreme option is to undergo penile implant surgery. There are a variety of prostheses, but you should talk to your doctor about possible complications. For example, there are prostheses that have you walking around semi-erect 24/7, which can obviously be uncomfortable. And inflatable prostheses can malfunction. Still, these prostheses are easily concealable under your clothing (even under swimsuits and jeans!), inflation

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can be achieved discreetly, and the psychological and emotional well-being you'll experience due to having the full package can be worth the risks. Talk to a Professional Of course, if the issue you're grappling with is psychological, it can help to talk to a counselor ... especially one who specializes in erectile dysfunctionrelated angst.

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Chapter 17: Premature Ejaculation

Of course, there's also the chance that you could suffer from premature ejaculation if you've had an orchiectomy (removal of one or both testes). This can obviously put a damper on a sex life, shouldering you and your partner with many of the same problems associated with erectile dysfunction. So if you are experiencing PE, we do suggest that you follow many of the tips in the previous chapter. There are some additional things you can try, however. Do Your Kegels (and Other Exercises) Yes. Men do Kegels, too. Not only can they prevent urinary incontinence and improve her chances of orgasming, but working your PC muscles can also make it easier for you to delay ejaculation. You can revisit previous chapters for the lowdown on one of the most important exercise routines out there. Or, ask your partner to spot you, and work on some exercises together. One helpful exercise is known as the stop-start technique. Basically, you -- or your partner -- stimulate your penis until you're close to orgasm. Then, you stop all stimulation and start again.

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Another exercise is the squeeze technique. Have your partner place her hand so that her thumb is on one side of your penis and her index and middle fingers are on the other side. When you feel like you're almost ready to climax, tell her to squeeze. This will quash your desire and prevent orgasm. These exercises should be repeated regularly. Focus on Quality, Not Quantity While you may have previously prided yourself on lasting for extended periods of time in bed, sex isn't necessarily better when it's longer. If you're not hitting all the right spots, she's not going to enjoy it, no matter how long you last. (In fact, she may just wish it was over.) Likewise, your partner won't mind quickie sex if you're making those limited moments together worth her while. So how can you (quickly) guide your partner toward orgasm? First, make sure you're having sex in a spot where you're both relaxed and comfortable. Stimulate her sense of fantasy by telling her something really hot. Enjoy lots (and lots) of foreplay, perhaps even bringing a vibrator into bed. This will ensure that, once you're ready for docking procedures, she'll already be on the

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brink. (And we're telling you now ... if you're worried about making it through foreplay, too, a vibrator will get her closer to orgasm more quickly.) If she's showing signs of imminent release (tension in the hands and feet and throughout her pelvis), keep doing what you're doing, making sure that your body is providing a point of resistance against her clitoris. Her orgasm is right around the corner, and will likely occur right before, or directly after, your own. Try a New Position There are some positions that make it easier for you to hold off your ejaculation, and they take advantage of the fact that the top of your penis is less sensitive than the underside of your penis. When you use your lesssensitive areas to stimulate her most-sensitive spots, you've got a winning formula for longer-lasting, pleasurable sex. How can you pull it off? Hold your erect penis in your hand so that it's at a near-right angle to her body. You can achieve this by lying side-by-side, spooning, or standing. Whichever way you choose, if your penis is somewhat perpendicular to her genitals, you'll be able to easily touch and rub her vulva and clitoris with the top side of your penis. The result? You'll both feel blissful, and you'll stay in control.

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Slow It Down Trying to hot foot it to the finish line could be making things worse. So slow it down in bed, and try to just breathe, and enjoy every moment of what you're feeling with your partner. In fact, the more you concentrate on deep breathing, the less chance there is of your muscles tensing up, and your penis prematurely shooting its load. In fact, let your partner get on top so that you can just concentrate on syncing up with her breathing while she takes charge. Go Tantric That mindful, breath-centric sex we just described is a major part of what tantric sex is all about. And while Tantra is about much more than sex, its teachings can take your bedroom activities to a whole new level. Consider taking a tantric sex workshop together, so you can learn how to experience longer, more intense, and more satisfying sexual sessions. Or just try out the following: First, prepare with some tantric yoga. Exercises like yoga have been shown to help those suffering from sexual dysfunction. In fact, those who practice Tantra recommend Kundalini yoga, because it's been shown

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to have tantric benefits, especially if you perform the poses with a partner. This particular type of yoga can relieve your stress and relax your body. In addition, because it is a yoga of awareness, it will improve your ability to sense and understand your partner's sexual needs. Finally, Kundalini yoga helps to strengthen your pelvic floor muscles, which can be helpful when you're attempting to delay your orgasm. When you're finally ready to test your new knowledge in the bedroom, settle down together (perhaps after a relaxing bath, massage, or glass of Champagne) and attempt to harmonize your breathing. Sit across from each other and gaze into each other's eyes, and try to match your breathing to your partner's. Do this for 5 or 10 minutes. Next, experiment with touch, caressing each other's bodies and discussing what feels good. As you naturally transition into foreplay, maintain eye contact, and continue to harmonize your breathing. Keep it slow, and concentrate on giving your partner pleasure. Move into slow, sensual sex, using mindfulness and the exercising of your PC muscles to keep your orgasm at bay. If you feel yourself heading toward the brink, pause in your lovemaking, relax, tighten your PC muscles, and breathe. Then continue for as long as you can manage. While there's something to

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be said for hot, sweaty, quick and dirty sex, the slow sensuality of tantric sex has the potential to eradicate any issues you may be having with PE. Try a Desensitizing Product There are creams, gels, and sprays on the market that can be used to numb the head of your penis, so that your sensation is dulled and you last longer. They're sold under names like Up All Night, Maintain, Prolong, and Sta-Hard. Condoms, particularly those that are thicker or contain topical numbing creams, are also often used for this purpose. Some guys even wear two or more condoms at once to blunt their arousal. This is only a temporary solution, however, as desensitization doesn't address the underlying causes of PE. Also, some men (or their sexual partners) may be allergic to the ingredients in these products.

5

Best Practices for Your Love Life

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Whew! We've just covered a whole lot of ground. We've reviewed the various types of cancer, and how they can affect your intimate life. We've gone even deeper, exploring the symptoms and side effects both men and women can experience as a result of cancer and its treatment, and have given you what should prove to be helpful tips for managing and -- in some cases -- eliminating these symptoms. We've provided you with a detailed roadmap for making your way back to fantastic sex ... which isn't anything to sneeze at. But sex isn't the only important element of a thriving relationship, no matter how good it may feel to spend the weekend in bed, ignoring all the other stresses and responsibilities of your day-to-day life. The truth of the matter is that relationships are challenging ... even without cancer. And the issues and difficulties that can make any relationship a lot of work only become augmented after a cancer diagnosis. In this section of Sexy Ever After, we'll touch upon the things you should be especially mindful of during this difficult time in your life, such as maintaining good communication, striving for a healthy work/love balance and, yes, making your intimate life a priority.

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It is our hope that, after reading this book, all of the difficulties that come with a cancer diagnosis will cease to act as a damaging influence on your romantic relationships. Read on for our top 10 tips for your best sex life, followed by 10 more tips for your best love life.

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Chapter 18: Top 10 Rules for Your Best Sex Life

Intimacy is such a huge part of keeping your relationship strong. It's why we wrote this book in the first place. With nearly 100 percent of people reporting that cancer had an adverse affect on their intimate lives, we felt that it was time for a resource that allowed people to take back control of their bedroom activities. After all, intimacy brings partners closer, helping them maintain a strong connection even in the worst of times. And sex also has added health benefits that can be extra important when you're fighting cancer. So beyond just having it, what can you do to achieve the best possible sex life? 1. Have Sex Regularly If you're struggling with the intimacy-related symptoms mentioned throughout this book, you may also be having trouble making sex a priority. I have more important things to worry about, you tell yourself. It doesn't even feel good anymore, you insist. Is working on my sex life even worth the effort? From here, things can quickly devolve from infrequent sex to no sex at all. Why? The less you do it, the less you want it.

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So don't just have sex (sometimes / once every other month / when there's a full moon / when your partner begs on their hands and knees). Have it regularly. Put it into your calendar if you have to, as contrived as it might seem. Having sex regularly will rev up your sex drive. How? Having sex increases the production of testosterone in your system, and testosterone is the hormone that's most responsible for your libido levels. Soon enough, if you stick to your schedule, sex won't feel contrived anymore. Rather, you'll want it (all the time, you naughty minx). 2. Have More Non-Sexual Physical Contact, Too While maintaining that physical connection with throughout-the-day butt smacks and soft caresses can leave you more open to sex, it can also combat another issue cancer survivors struggle with: poor body image. You may feel that your body has turned traitor. And, depending upon the type of cancer treatment you opted for, you may be walking around with surgical scars, a stoma, or even missing body parts. This could make you feel self-conscious ... perhaps even ugly. And when you feel that way, you definitely don't feel sexual.

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The truth is, your body can be an incredible agent of change, and what it sacrifices to keep you alive and thriving is simply amazing! This is something that perhaps you need to be reminded of. So partners: Listen up. You may be hesitant to make a move on your love muffin, unsure of whether or not they're ready for intimate contact. But while you're respectfully keeping your distance, they're assuming that you no longer find them attractive. Shower them with hugs and kisses and an unexpected grope or two. Those struggling with cancer: Your partner is at a bit of a loss right now. Provide them with the reassurance they need by initiating sultry smooches, or some extreme cuddling sessions. Some other ways to engage in some non-sexual touching include eye gazing and passionate hugging. Intense eye contact leads to greater intimacy, and something as simple as hugging can also help with your connection. Even a 30-second hug can raise oxytocin levels in women, and increase feelings of attraction. So face each other, look deep into each other's eyes, and allow yourselves to melt into a close embrace. Then, instead of pulling away, keep hugging. Lean into each

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other. Relax into your partner's arms, erasing the space between your two bodies. Hold longer than is comfortable. And then even longer. And then, only after you've felt the tension melt out of your bodies, let go. One of the biggest complaints Patty has heard from women is that their partners don't touch them enough, unless they want something physical in return. So often, we find ourselves going through the motions of being in a relationship, and forget the importance of simple gestures like a hug or an affectionate touch. Certain types of touch, including massage, can help take couples from feeling loved to actually wanting to make love without feeling forced.

Andrea Maria, Cancer Survivor

The night I was diagnosed, my then-husband decided to drink a big bottle of Jack, and was ridiculously drunk in front of our family. He passed out. Meanwhile, I was up all night alone, wondering if I was going to die. This set the tone for the rest of our relationship. After my surgery, we'd be in bed and he'd be looking at Hustler ogling huge healthy breasts, while mine looked like they had been through a

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shark attack. He would not touch me anymore in that area, claiming he didn't want to hurt me. After my divorce, it took me three years to be with someone again. My ex made me feel less than nothing, and I was deathly afraid that the next guy would run out screaming in fright at the sight of my franken-boob. But two and a half years after I left him, my period returned, and so did my libido. When I met my current boyfriend, he didn't run out screaming. He gently kissed my scars and told me I was super sexy. The sex didn't hurt, and hasn't ever with him.

3. Engage in All-Day Foreplay As a continuation of the previous tip, use these affectionate, physical gestures as a means of gearing up for some later-in-the-day nookie. A single, quick arm caress right before you mount your partner doesn't cut it as far as getting her in the mood for full-on intercourse, and lazy foreplay practices come across as even weaker when cancer treatments have messed around with her libido levels. But giving your partner

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the warm fuzzies throughout the day can leave her with sex on the brain, making her all the more likely to respond to your sexual overtures later on. And these nice gestures don't have to be limited to the physical. Other things that can be huge turn-ons: *Help with the housework *Kind words *Pleasant surprises *All of the other items mentioned in Tip #10 of the previous chapter 4. Create Intimate Rituals Another way to get you and your partner in the mood for sex -- aside from those unplanned acts of foreplay -- is to create intimate rituals that you can look forward to every day ... rituals that make you feel closer, and all sorts of lovey dovey. Perhaps you could share a cup of coffee every morning. Give each other foot massages while watching TV in the evening. Hold hands while taking your daily walk. Anything that helps you feel that you're much more than two ships passing in the night.

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You could even start your day off hot by sexing up that intimate ritual ... with bathtub or shower sex. Dim the lights in the bathroom, set up some scented candles, and make sure the water in the shower is steaming hot. Then, undress each other and get cozy beneath the hot spray. Take your time soaping each other up. Allow hands to linger on breasts, inner thighs, genitalia. Give each other scalp massages as you lather up with shampoo. Trade slow, soapy hand jobs or full-body rub-downs. If you prefer a slow soak, spread out together in the tub and just hold each other. Then, begin to rub the stresses of the day away. Gently wash each other with a shower poof. If you'd like to kick things up a notch, bring a waterproof toy into the tub with you. Run the vibe up and down your partner's thighs, or over their nipples, before heading straight to the bull's-eye. 5. Take Care of That Sexy Body How others perceive you -- and how you perceive yourself -- can have a direct effect on your sex life. As mentioned above, many cancer treatments leave you feeling sexless, or just plain ugly. But the more you take

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care of your bod, the sexier you'll feel. What should this self-care regimen entail? For one thing, you should eat mindfully. People tend to binge eat unhealthy and processed foods when they're feeling stressed or depressed. If you pay closer attention to what you're eating, in terms of both nutritional value and portion size, you'll start to feel stronger, slimmer, and generally healthier. Some foods and vitamins (mentioned earlier in the book) can even help replace those vitamins that have been in short supply since your health scare. You should also exercise regularly. It can be tough to gather up the motivation to sweat, but the benefits outweigh the pain-in-the-butt effort. As mentioned throughout this book, exercise can reduce your stress levels, help you relax, strengthen your body, and also combat many of the side effects associated with cancer treatments. Not only that, but exercise releases endorphins that raise libido levels, and maintaining a strong body can make you feel extra sexy. To make it easier on yourself, choose a workout you enjoy, rather than mindlessly throwing yourself at the treadmill every day. There are tons of workouts out there designed to make you smile, such as hoop dancing, belly dancing,

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punk rope, and laughing yoga. Pick one you can look forward to, and reap the myriad benefits. Finally, allow yourself to splurge on some extra-cute outfits and luxe hygiene products. Dressing up can be confidence- and libido-boosting for both men and women, and will cause bereft and confused partners to do a double take.

Karen Sacksteder, Cancer Survivor

"I spent $2,000 on a wig I named Vivacious Vivian. The first day I wore her, it was very, very windy. As I was stepping out of a cab, Vivacious Vivian got sucked off my head, blew to the middle of the intersection, got caught in a wind tunnel, and flew 20 feet up into the air. `You little bitch!' I said. `How could you do this to me!?' But I needed her strength. She made me feel like me. I wasn't the type of person who wanted to run around without my wig on. I wanted to be pretty."

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6. Be Sexually Adventurous A recent survey found that couples willing to engage in new sexual behaviors were more likely to be satisfied with both their relationship and their sex life. Coincidentally, we've already mentioned mixing things up earlier in this book as a means of boosting libido. But here's a bulleted list of things you could consider: *go lingerie shopping together *watch an erotic film together, or read aloud from a book of erotica *have sex in every single room of the house *engage in some mutual masturbation *have a frantic, midday quickie *flip through a book of kama sutra positions and try out your faves *use handcuffs and blindfolds *try anal sex *play strip poker *share your secret sexual fantasies and fetishes, and pick one or two to try out

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*give each other lap dances Revisit our chapter on libido for detailed descriptions of some additional, hot ideas for new things to try in bed. As one of the top libido-boosters, new sexual experiences are one of the cornerstones of fabulous sex. 7. Chase Those Rushing Endorphins And you shouldn't only be adventurous in bed. Those arousal-enabling, rushing endorphins can also be achieved through riskier, outside-of-the-bedroom behavior. Perhaps you've always dreamed of trying out sky diving, or you've thought about going for a ride on a hot air balloon. Both fantastic options! Other options include hang gliding, white water rafting, jet skiing, rock climbing, rollerblading, cliff diving, horseback riding, skiing, bungee jumping, paintballing ... Basically, if you can think of anything that would be new and exciting for the both of you, keeping any limitations due to health in mind, it's fair game. We want you to think outside the box, and throw yourself into new experiences that get the blood flowing, the heart pounding, and the adrenaline pumping. After you've put your lives in each other's hands and lived to tell the

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tale, you'll probably want to celebrate your continued existence with a high-octane romp in the bedroom. 8. Strengthen Your PC Muscles As we've already learned, doing your kegels can help both men and women manage side effects like urinary incontinence, and can also make your orgasms more intense. Revisit Chapters 5 and 11 for step-by-step instructions on how to incorporate these exercises into your day-to-day. 9. Share the Love With each other. Yes. Saying, "I love you" can be more than enough to make one weak in the knees, and tingly in the ... well ... our other below-the-belt parts. And when you're suffering from low self-esteem due to your cancer treatments, or self-doubt due to your inability to fix everything for your partner, those three, little words can make all the difference in the world.

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10. Redefine Sex We've already mentioned this so many times throughout this book and, honestly, if we had to choose one main, overarching theme to define Sexy Ever After, this would be it. When you've been diagnosed with cancer and are forced to grapple with all of the side effects that can negatively affect your intimate life, it becomes necessary to show flexibility in the bedroom (the other kind), and to redefine sex. Many of us have a sexual script that is used with our partner to signal that one or the other of us is interested in sex. For example, some couples start with kissing and caressing the breasts. As you can imagine, sexual scripts can be interrupted by treatments such as a mastectomy or even painful radiation scars. Couples can work together to generate new sexual scripts, and find other areas of the body that work equally as well to signal the beginning of a romantic romp! Every single tip in this book is a way to find your way back to a sex life that works for you. Don't let cancer define who you are, in or out of bed. You deserve a better life than that.

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Chapter 19: Top 10 Rules for Your Best Love Life

There's no foolproof way to keep a relationship from faltering or failing, but you can certainly improve your chances. And when you're grappling with the difficulties of a cancer diagnosis, and all of the life-changing decisions that come along with that, it's more important than ever to maintain that strong network of people who love and support you. During a time like this, your partner should be your best friend, your support beam, your hero. And though you're going through a tough time, you should take care not to neglect him or her either. You may be feeling the desire to retreat and isolate yourself. And though your partner wants to help you in any way he or she can, they may be feeling thrown off balance by this new distance between the two of you. So what can you do to achieve the best possible love life? 1. Maintain an Open Line of Communication If there's anything that can sabotage your love life at this point, it's not being open and honest with each

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other. If you're struggling with the psychological fallout from your experiences with cancer, make the effort to share your thoughts and feelings with your partner. Let them in on the things that are making you stressed or upset, the things that are making you scared and self-conscious and, most of all, the things you need from them in order to get through this. If you're the romantic partner of someone struggling with cancer, make the effort to be open as well. Share the emotions you experienced -- and have since experienced -- when learning about your partner's diagnosis. Share the uncertainty you've surely felt at figuring out the best way to be there for them. Be honest if you've felt distressed by the way your partner has seemed to pull back from you. Be honest about what you need from them. And if you find yourself in the midst of an argument (as you surely will ... these things seem to multiply at times of stress), try to maintain control, and follow some rules for healthy fighting. Yes, fighting can be healthy. In fact, it can be an even bigger problem to never discuss the things you're unhappy with. So how can you keep an argument from getting out of control?

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*Don't let your anger simmer and boil over. Approach your partner about an issue before it becomes a major problem. *Don't use language that will make your partner feel attacked. This will automatically put them on the defensive. Instead, say, "I feel BLANK when BLANK," and confirm that your partner hears and understands you. *Take a moment to consider the root of your anger. Losing your temper over something small -- like the dirty dishes in the sink or your partner's workaholic tendencies -- may actually be indicative of a deeper issue (like your overall feelings of abandonment since cancer led your partner to withdraw). *Don't go off-topic. In the heat of the moment, you may feel tempted to throw out a laundry list of your partner's past offenses. This will only cause the fight to escalate, and it will soon become impossible to resolve the original issue. *Remember that you love each other. Remind yourself why you love each other. This will make the issues you're arguing about seem comparably smaller.

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2. Pay Attention Even when you make every effort to keep the lines of communication open, there may be things that remain unsaid. Don't be surprised. Those who are diagnosed with cancer commonly suffer from depression, anger, and low self-esteem. And their partners often feel helpless, frustrated, and uncertain. You and your partner are likely experiencing a mix of emotions that are difficult to verbalize. So keep your eyes and ears open for signs of unhappiness, frustration, or discontent, and try to remain attuned to your partner's emotional state, good or bad. And when your partner does say something to you, pay attention. There's nothing more frustrating than a partner who seems clueless and insensitive to what we're feeling, especially when we're going through a particularly tough time. 3. Provide Encouragement and Support Cancer or no cancer, we all want to be with someone who believes in and respects us. When we feel that our partner does not support us in all that we do, it can be crushing.

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When we're forced to make the tough decisions that come with a cancer diagnosis, our partner's support means even more. Those with partners who have survived cancer: Realize the magnitude of what your partner is going through, and provide them with the support they need. Help them through the decisions they have to make, and back them up even when you don't fully understand or agree with what they have decided. They need to know that, no matter what happens, you're behind them. Those who have cancer: Realize that your partner is trying hard to be and do all they can for you, and take the time to show your appreciation. And though your health issues may be the biggest thing in your life right now, know that your partner has other things going on in his or her life that are worth cheering about or sympathizing with. Be the support that they are for you. And beyond cancer-related issues, always try to encourage your partner in everything they do, whether a career change, a hobby, or a commitment to some other sort of change.

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4. Maintain a Healthy Work/Love Balance It was tough enough when you were balancing work and life. Now, your health has sprung up as a whole other entity and, when it comes to priorities, love always seems to get the short shrift. You can't allow this to happen. Now more than ever, the relationships you have with your loved ones are incredibly important to maintain. But with all that there is to do, how can you even begin to achieve a healthy work/health/love balance? *In the same way that you schedule in business hours and doctor's appointments, schedule in time for yourself, and time for your partner. These things won't be priorities until you mindfully make them priorities. *Set a monthly or weekly date night that you're not allowed to reschedule ... no matter what. *Leave work at work. And ... well ... leave work. *Do the same with your doctor's appointments and treatment cycles. While it may be tough to think of anything but your health issues, the two of you need

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to regain the connection you had before cancer. Let those cancer-free convos be a frequent treat. *Redefine romance and quality time. A partner who does the dishes without asking can be just as romantic as a partner who surprises you with your favorite flowers. And an evening in eating Chinese takeout and watching Netflix DVDs can be just as fun -- and high-quality -- a date as a night out on the town. 5. Nurture Your Intimate Life Speaking of priorities, your sex life should be up there, too. We know. We've already beat you over the head with the importance of a healthy sex life, and have hopefully provided you with all the tools necessary to rekindle beneath-the-sheets romance, even when you're suffering debilitating side effects from your cancer treatment. But we're going to say it again: Intimacy is important to a long-lasting romantic relationship. Because of this, we believe that you and your partner should be having sex regularly. Why? For one thing, reconnecting with your partner on a physical level helps reaffirm intimacy and rebuild connections. Not only that, but regular sex also reduces stress, boosts

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immunity, and releases endorphins, all things you could use help with when you're struggling with cancer. If you feel it's like pulling teeth to get in the mood for sex, even just once a week, we suggest you revisit Chapter 7, the chapter on low libido levels, and look for new ways to mix up your routine.

Anne Thompson,* Cancer Survivor

"During treatment, sex stopped. Now that I think about it, most forms of intimacy between me and my husband stopped as well. It makes sense to me now; out of fear, we both withdrew from one another. But if I could do it over, I would have paid more attention to sex. I would have tried harder to remain intimate. I thought we could set that aside and come back to it when the diseased storm had passed. I thought we could pick right back up in bed when I was healthier. This wasn't true, though, and we have found it especially difficult to reestablish our sexual relationship."

*pseudonym

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6. Have Patience Monogamy can be an exercise in infinite patience (why are your dirty socks lying next to the hamper!?) and, when you add in the stress of serious health issues, keeping your cool can seem even more daunting. Just as we suggest in Tip #2, look inward before losing your temper. Ask yourself: Why am I really angry and/ or frustrated? Is this something we should sit down and talk about? Is it something I can fix on my own? Is it worth worrying about at all? And, as that last question implies, know how to choose your battles. If your partner's been driving you up a wall lately, give them the benefit of the doubt. You've both been through a lot lately, and your coping mechanisms may be clashing. Instead of thinking downbeat, unconstructive thoughts about your partner, write down a list of all the reasons you love them. Remember the things that made you fall in love, and then remember the reasons you still love them. Look over this list and realize that both you and your partner deserve a bit of leeway.

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7. Be Willing to Compromise Similarly, know that things can't always go your way. It's often said that marriage (and love in general) is all about compromise. Take it from us. It's true. Therefore, know that you and your partner will oftentimes have to meet in the middle, when it comes to major life decisions, when it comes to social plans, and even when it comes to the right way to load a dishwasher. And dealing with a health issue like cancer comes with its own set of compromises. Though it's important to maintain a sense of normalcy when your life has been rocked so far off its axis, know that things will change, in ways both large and small, and that the two of you will have to roll with it. Priorities may shift. Attention spans may shift. Heck, physical capabilities may shift. It's important to always be communicating about what you're feeling, what's looming largest in your mind, and why. And even more important, don't just talk about your feelings. Listen to what your partner has to say in return, and then work together to come up with a solution that will make you both happy.

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8. Maintain a Sense of Humor In the worst of times, a well-placed private joke or silly voice can fix everything. Even awkward sex. But when it comes to cancer, a sense of humor can be even more crucial. How? For one thing, there have been several studies on the mind-body connection, and laughter has been found to have a potential influence on healing, even improving immune function. Not only that, but a good dose of belly laughs can reduce stress ... a common detriment to both physical and mental health. And while it may not definitively improve cancer outcomes, laughter can help you better cope with pain, boost your mood, help you to relax, and give you an improved sense of well-being. That's why humor therapy -- also known as laughter therapy -- is even listed as an alternative, complementary treatment on the American Cancer Association's website! (cancer.org) If you can't laugh at yourself and your situation, you're giving cancer greater control over your life than it deserves. So when things seem especially hopeless, be

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the irrepressible goofballs you always were and find the humor in things. 9. Be Open to Therapy There's still a bit of a stigma surrounding the mental health industry. People are reluctant to admit that they could benefit from therapy, because they feel it indicates that they are in some way deficient. This couldn't be further from the truth. The truth of the matter is that most of us could benefit from some form of therapy, mostly because an objective listener can give us added insight into both the small and large things we struggle with on a daily basis. We haven't failed just because we'd like some outside help, or an empathetic ear. Consequently, no matter how serious your cancer diagnosis is, or how well you think you're handling it, a therapist can help. Individual therapy alone could improve your mental state, and help you work through the complex and conflicting feelings you may be experiencing as a result of your health issues. But you should also keep an open mind in regards to both couple therapy and sex therapy.

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Couple therapy can facilitate the communication of things that, for some reason, you've been struggling to share with your partner. It can help you learn things about what your partner has been feeling that you were previously unaware of. As strong as the two of you are, it can help to make your relationship even stronger. And if you've been struggling with intimacy in particular (a good bet if you're reading this book), you should consider a sex counselor ... someone who can pinpoint the things that have been holding you back in bed, and who can give you homework and pointers that will enable you regain the sizzle in your sex life. You'll find resources for tracking down the best therapist for you and your partner in the resource section of this book. 10. Express Your Love Daily Finally, don't forget to let your partner know that you love them, whether in words or in action. What could you do to express your love? *Slip into the shower with your partner in the morning. *Bring your partner breakfast in bed.

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*Clean the dirty dishes without being asked. *Send your partner a "thinking of you" card via snail mail. *Help with dinner preparations, using the time to catch up. *Write your partner a love letter, similar to the list you drew up in Tip #6. *Surprise your partner with their favorite gourmet food or guilty pleasure candy. *Give your partner an unsolicited foot rub when you're watching TV together. *Don't let him or her leave the house without a goodbye kiss. *Hold hands, or surprise your partner with an out-ofthe-blue hug. *Handle the scheduling of doctor's appointments, or the picking up of prescriptions, without being asked. *Tell your partner how beautiful / sexy / stud muffin-y you think they are.

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*Educate yourself on the ins and outs of your partner's illness, and put the things you learn into practice. *Say, "I love you." Because it's always nice to be reminded. If you followed all of these tips before your cancer diagnosis, we're betting that you're a pretty strong couple. Post-cancer? Keeping up with these tips is even more important.

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Conclusion

Whew! We've certainly been through a lot in the past 166 pages. Hopefully, by this point, you have a healthy understanding of the impact cancer can have on your sex life, and have the details down cold on what may be causing the most persnickety of your sexual side effects. In addition, we hope you're well on your way to turning your waning sex life around. Because, make no mistake, intimacy is important -- to your relationship, to your emotional well-being, and even to your health! If you're still grappling with the volume of information in this book, no worries. We have a few suggestions for putting the tips in this book into action, and want you to know that implementing even a handful of them will make a huge impact: 1. Pinpoint the sexual issue that's been causing you the most angst. No need to tackle all of them at once. 2. Flip to the relevant chapter in this ebook. 3. Keeping an open mind, scan our suggestions and pick the one that seems easiest to implement ... or perhaps even the one that sounds most intriguing.

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4. Talk to your partner about the health issues that have been frustrating you, how they've been affecting your sex life, and why you'd like to prioritize sex again. Your partner isn't clairvoyant -- they need your help! 5. Realize that you're on the same team here, and that your partner will support you no matter what. Confidently present the tips you'd most like to try. 6. Give it a go. No pressure and no deadlines! 7. Feel good knowing that there are plenty of other tips throughout this book you can turn to in the future. 8. Have fun! Because, more than anything else, sex is supposed to be fun. It's supposed to bring you and your partner together, it's supposed to keep your relationship exciting, and it's supposed to feel good. And if you can have some extra fun while adding new and uniquely pleasurable activities to your bedroom repertoire, all the better! Perhaps most important of all, we hope you've come to realize that, even though sex may be different now, it doesn't have to be worse.

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In fact, because you've opened your mind to new possibilities, it can be even better.

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Resources

General Cancer Resources: American Cancer Society. cancer.org. A nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem. American Society of Clinical Oncology. asco.org. A non-profit organization founded in 1964 with the overarching goals of improving cancer care and prevention. CancerCare. cancercare.org. Helps individuals and families better cope with and manage the emotional and practical challenges arising from cancer. Their services include counseling and support groups, educational publications and workshops, and financial assistance. Crazy Sexy Cancer Tips by Kris Carr. This book gathers the lessons learned and advice offered from the author's own journey, as well as the experiences of her cancer posse. Chapters contain advice, warnings, and resources for the cancer patient, and also cover your changing social life, dating, sex, and appearance; essential health tips on how to boost your immune

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system; recipes; medical and holistic resources; and information on young survivor support groups. Cancer Support Community. thewellnesscommunity.org. An international non-profit dedicated to providing support, education, and hope to people affected by cancer. Intercultural Cancer Council. iccnetwork.org.

Promotes policies, programs, partnerships, and research to eliminate the unequal burden of cancer among racial and ethnic minorities and medically underserved populations in the United States and its associated territories. National Cancer Institute at the National Institutes of Health. cancer.gov. The Federal Government's principal agency for cancer research and training. National Coalition for Cancer Survivorship.

canceradvocacy.org. The oldest survivor-led cancer advocacy organization in the country, advocating for quality cancer care for all Americans and empowering cancer survivors. National Comprehensive Cancer Network. nccn.org. A not-for-profit alliance of 21 of the world's leading

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cancer centers, dedicated to improving the quality and effectiveness of care provided to patients with cancer. Out with Cancer. outwithcancer.com. The world's first program for gay, lesbian, bi, and trans men and women who are diagnosed with cancer. Specific Cancers: Breastcancer.org. A nonprofit organization dedicated to providing the most reliable, complete, and up-todate information about breast cancer. The Breast Cancer Research Foundation. bcrfcure.org. An independent 501 (c) (3) not-for-profit organization whose mission is to achieve prevention and a cure for breast cancer in our lifetime by providing critical funding for innovative clinical and translational research at leading medical centers worldwide, and increasing public awareness about good breast health. Colon Cancer Alliance. ccalliance.org. National patient advocacy organization dedicated to ending the suffering caused by colorectal cancer. In order to increase rates of screening and survivorship, the CCA provides patient support, public education, supports research and conducts advocacy work across America.

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Feel Your Boobies. feelyourboobies.com. A breast cancer non-profit organization whose mission is to create an annual reminder campaign so that women will perform breast self-exams. Fight Colorectal Cancer. fightcolorectalcancer.org. The leading colorectal cancer advocacy organization in Washington, DC, empowering survivors to raise their voices, training advocates around the country, and educating lawmakers, pushing them for better policies. They also offer support for patients, family members, and caregivers, and serve as a resource for colorectal cancer advocates, policymakers, medical professionals, and healthcare providers. Additionally, they do everything they can to increase and improve research at all stages of development and for all stages of cancer. F.O.R.C.E. (Facing Our Risk of Cancer Empowered). facingourrisk.org. The only national nonprofit organization devoted to hereditary breast and ovarian cancer. Their mission includes support, education, advocacy, awareness, and research specific to hereditary breast and ovarian cancer. Foundation for Women's Cancer. foundationforwomenscancer.org. Increases awareness and education, supports expanded research and

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training, and provides knowledge and hope for women diagnosed with cancers specific to them. LIVESTRONG. livestrong.org. Provides support to guide people through the cancer experience, bringing them together to fight cancer--and work for a world in which the fight is no longer necessary. Living Beyond Breast Cancer. lbbc.org. A national education and support organization. Lungcancer.org. A source of support and information for our lung cancer patients and their loved ones. Lung Cancer Alliance. lungcanceralliance.org.

The only national non-profit organization devoted solely to support and advocacy for all those living with or at risk for lung cancer. Men Against Breast Cancer. menagainstbreastcancer.org. The first and only national 501 (c)(3) nonprofit organization designed to provide targeted support services that educate and empower men to be effective caregivers when cancer strikes. National Breast Cancer Coalition. breastcancerdeadline2020.org. Their mission is to end breast cancer by January 1, 2020.

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Prostate Cancer Foundation. pcf.org. Firmly committed to curing prostate cancer, the Prostate Cancer Foundation is the leading philanthropic organization funding and accelerating research globally. Sensuality, Sexuality, Survival! pureromance.com/sss. Helps women recapture their sensual and sexual selves through education, empowerment, and safe product offerings designed specifically for women following breast cancer diagnosis and treatment. Sisters Network Inc. sistersnetworkinc.org. Committed to increasing local and national attention to the devastating impact that breast cancer has in the African American community. Susan G. Komen for the Cure. ww5.komen.org. The world's largest grassroots network of breast cancer survivors and activists. Y-ME National Breast Cancer Organization.

y-me.org. At the heart of Y-ME National Breast Cancer OrganizationTM is the YourShoes® 24/7 Breast Cancer Support Center, the only place in the world where someone can call, 24 hours a day, 7 days a week, 365 days a year, talk to a breast cancer survivor, and be understood in 150 languages.

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Young

Survival

Coalition.

youngsurvival.org.

A global organization dedicated to the issues unique to young women who are diagnosed with breast cancer. YSC offers resources, connections, and outreach so women feel supported, empowered, and hopeful. ZERO: The Project to End Prostate Cancer. zerocancer.org. Increases research funds from the federal government to find new treatments, and funds local grants to end prostate cancer through their national event series, the Great Prostate Cancer Challenge. They also conduct free testing through the Drive Against Prostate Cancer mobile testing program, and they educate patients, families, and those at risk. Fertility: 100 Questions & Answers about Infertility by John D. Gordon and Michael DiMattina. This book gives authoritative, practical answers to 100 of the most common questions asked by individuals and couples regarding their infertility. Fertile Hope. Fertilehope.org. Fertile Hope is a LIVESTRONG initiative dedicated to providing reproductive information, support, and hope to cancer patients and survivors whose medical treatments present the risk of infertility.

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The Oncofertility Consortium. myoncofertility.org. A patient education resource for preserving fertility when facing cancer treatment. Impotence: Guides Against Impotence. impotenceworld.org.

An informative website containing both resources and support for those struggling with impotence. Mental Health Professionals: American Psychiatric Association. psych.org.

The world's largest psychiatric organization. It is a medical specialty society representing more than 38,000 psychiatric physicians from the United States and around the world. Contact the APA to find a mental health professional who can help you. American Psychological Association. apa.org.

A scientific and professional organization that represents psychology in the United States. With more than 154,000 members, APA is the largest association of psychologists worldwide. Contact them to find a mental health professional who can help you.

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American Association of Sexuality Educators, Counselors and Therapists. aasect.org. A not-for-profit, interdisciplinary professional organization. In addition to sexuality educators, sexuality counselors and sex therapists, AASECT members include physicians, nurses, social workers, psychologists, allied health professionals, clergy members, lawyers, sociologists, marriage and family counselors and therapists, family planning specialists and researchers, as well as students in relevant professional disciplines.

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Bibliographic Essay For those who are interested in the research behind this book, the major studies, books, articles, and other resources we have used are listed below. For information and statistics on how cancer can affect one's sexuality, see "The Prevalence and Types of Sexual Dysfunction in People with Cancer," an information sheet put together by the National Cancer Institute, updated in 2011 and available online; Leonard R. Derogatis and Suzanne M. Kourlesis's "An Approach to Evaluation of Sexual Problems in the Cancer Patient," which appeared in CA: A Cancer Journal for Clinicians, 1981;31;46-50, and which was updated in 2011; and Richard Sadovsky, MD, Rosemary Basson, MD, Michael Krychman, MD, Antonio Martin Morales, MD, Leslie Schover, PhD, Run Wang, MD, and Luca Incrocci, MD, PhD's "Cancer and Sexual Problems," published in the Journal of Sexual Medicine, 2010;7:349­373. To read more about the basics of cancer, treatment options, and the effects of those treatments, see Peter Teeley and Philip Bashe's The Complete Cancer Survival Guide, Doubleday, New York, 2000. For more tips on supporting your partner through a cancer diagnosis, sexually and otherwise, see John W.

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Anderson's Stand By Her, AMACOM, New York, 2010 and Gina M. Maisano's Intimacy After Breast Cancer, Square One Publishers, Garden City Park, NY, 2010. For more detailed and in-depth information in how cancer affects fertility, and what you can do about it, see Gina M. Shaw's Having Children After Cancer, Celestial Arts, Berkeley, 2011. For information on how sexual fantasy influences arousal levels, see Harold Leitenberg and Kris Henning's "Sexual Fantasy," in Psychological Bulletin, Vol. 117, No. 3, 469-496, 1995. For more information on how personal lubricant can help with arousal issues, and improve your orgasms, see Debby Herbenick and Michael Reece's "Association of Lubricant Use with Women's Sexual Pleasure, Sexual Satisfaction, and Genital Symptoms: A Prospective Daily Diary Study," Journal of Sexual Medicine. For see more info on humor/laughter Society's therapy, page on

the American

Cancer

humor therapy, available online at http://www. cancer.org/Treatment/TreatmentsandSideEffects/ Complementar yandAlternativeMedicine/ MindBodyandSpirit/humor-therapy and Cancer

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Treatment Centers of America's "Laughter Therapy" information sheet, available online at http://www. cancercenter.com/complementary-alternative-medicine/ laughter-therapy.cfm. For more information on how exercise and nutrition can affect your cancer symptoms in a positive way, you can turn to Mary Beth Knight, owner of Revolution Fitness, a certified personal trainer, and the author of Strategies for the C-Section Mom: A Complete Fitness, Nutrition, and Lifestyle Guide, Adams Media, 2010. For more on how yoga can improve sex, see Nora Isaacs's "The Big O in Om: Yoga for Hotter Sex," which appeared in Prevention magazine in 2006. For more facts on vaginal dilators, see the Vaginal Dilator information sheet put together by the James Cancer Hospital & Solove Research Institute, The Ohio State University Medical Center, in 2007. For more information on hot flashes (including what causes them and how you can minimize their effects), see "All About Hot Flashes," an information sheet updated in 2011 by Breastcancer.org, and available online at http://www.breastcancer.org/tips/menopausal/facing/ hot_flashes.jsp.

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For more information on stomas, see "Sexuality for people who have a stoma," an information sheet put out by The Cancer Council, New South Wales, in 1997, available online at http://www.cancercouncil. com.au/html/patientsfamiliesfriends/livingwithcancer/ sexualityforstoma/download/sexuality_stoma.pdf, and L. Manderson's "Boundary breaches: the body, sex and sexuality after stoma surgery," in Social Science & Medicine, 2005 Jul;61(2):405-15. For more information on how to deal with low energy levels, see Alicia Potter's "10 fresh ways to boost your energy now," which ran online at CNN Health on April 9, 2008. For additional in-depth information on hysterectomies, please see the Hysterectomy Fact Sheet, available online at http://www.womenshealth.gov/publications/ our-publications/fact-sheet/hysterectomy.cfm#a. For more information on how cancer and its treatments can affect men both physically and mentally, see the American Cancer Association's fact sheet on Sexuality for the Man with Cancer at http://www.cancer.org/acs/ groups/cid/documents/webcontent/002910-pdf.pdf.

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Acknowledgments

A very special thanks to Steph Auteri for all of her editorial expertise and personal gusto in making this book sing and soar. And for their acumen and insight, much appreciation to Erin Hoschouer, MPH, Director of Training, and Celeste Holbrook, M.S., CHES, Health Education Coordinator, at the Pure Romance Sexual Health Education Department. And infinite gratitude to all of those brave individuals who have contended with cancer and let their voices be heard in these pages.

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