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Psychosexual therapy after a bone marrow transplant

Krystal Woodbridge is a qualified psychosexual and relationship therapist, offering support to individuals and couples. In today’s blog, she discusses the potential impact of a stem cell or bone marrow transplant on sex and relationships, and how therapy can help.

Photography by www.richardmunn.com

What made you decide to be a psychosexual therapist?          

I started out my working life as a registered nurse in the NHS; I worked on a urology ward with male and female patients.

Many were affected by cancer, and I found that sexuality wasn’t discussed at all. Or if it was touched on, it was it was very much in the physical sense – ‘we can prescribe you some Viagra’. Relationships weren’t mentioned!

Then I had couples therapy myself and I found it massively helpful. So I decided to change tact and train as a psychosexual therapist. I’ve been doing it ever since and I absolutely love it!

There are quite a lot of myths about psychosexual therapy – can you explain what it actually involves?

People ask me that all the time – they  have all sorts of ideas about what I do or the types of people I must see.  But most of what I do is working with ‘everyday’ people who just happen to have sexual or relationship issues. Which could be any one of us at some point in our lives.

Psychosexual therapy is a type of talking therapy, a specialist form of counselling. We can deal with anything to do with sex and relationships – from erection problems, to low sexual desire or avoidance of sex, or general relationship issues. And it’s for individuals and for couples.

Other types of counselling are often ‘non-directive’ – about talking and understanding. Psychosexual therapy does this as well, but the therapist may give you specific exercises to do outside of the therapy sessions that will help you, whether you’re in a couple or single.

How can psychosexual therapy help someone who is recovering from a treatment like a stem cell transplant?

Treatment for cancer like a stem cell transplant can have a huge impact on your body, and people can feel different about themselves before and after treatment.

Men and women may have changed sensitivity in their genitals: what was arousing before treatment may have changed, there may be a sense of loss around this. I find that people can feel less connected to themselves sexually, as well – they might have just been focused on surviving and getting through their treatment.

Psychosexual therapy can help people understand and come to terms with themselves physically – relearning how to connect with their body and sexuality. We can help you explore what is different, and how you can accept the changes.

An important element of psychosexual training is thinking about the medical and physical aspects of sexuality – there’s no point doing weeks of emotional work in therapy without also addressing physical difficulties! So if you’re dealing with side effects like pain or hormone changes that are affecting your sex life, we can also liaise with GPs and help get treatment prescribed.

What about changes to relationships?

I have found that after treatment like a transplant, communication about relationships gets buried. Often the partner takes on the role of being the strong one. They are managing everything and reassuring the patient and the family, being everything to everybody and protecting her partner.

But they don’t always feel they can be honest and say – ‘I thought I was going to lose you.’

Bottling these feelings up might be helpful in some ways, but at the same time the patient is left with all the emotions and fears and can feel isolated. They start making assumptions – ‘Maybe my partner doesn’t find me attractive any more?’

And because they’ve been through all this treatment, their partner might also feel like they need to be very careful with them physically and stop initiating sex.

But it can be so hard to talk about sex – even if you are in a close relationship. Do you have any suggestions about how to broach the subject?

You could try starting by talking more generally – about how you’re feeling about treatment and your relationships – before diving straight into talking about your sex life.

Try and talk about how you feel, rather than making any assumptions about how your partner might be feeling. Sit down with them and say, ‘I’m feeling this about my body, I wonder how this is affecting you?’ Or ‘This is what I am thinking...what are your thoughts?’

This might give their partner permission to talk about themselves.

What about single people who’ve had a transplant? Can psychosexual therapy help them as well?

Yes, definitely – it’s an equal split in my caseload at the moment between single people and those in relationships.

I find that single people are often worried about the ‘disclosure’ aspect; at what point do you tell someone you’ve had cancer or a transplant? I think it is very personal and individual, and something you must judge for yourself.

There also seems to be more of an expectation in our dating culture nowadays that you should have sex early on – perhaps before you’re ready. A good rule of thumb is if you don’t feel comfortable enough to be open and authentic with the person, then you might need to question whether you are ready to have sex with them.

What are the first steps in getting support for sex and relationship issues?

Acknowledge to yourself that it is bothering you, and that this is normal – everyone will have had some kind of relationship or sex issue at some point in their lives.

Be kind to yourself – you don’t have to battle on alone! Sometimes you just need a bit of guidance. If you’re not sure that therapy is right for you, then no decent counsellor is going to mind you having an initial chat with them about what is involved and whether they might be able to help.

Just know that you can be completely open with them, and you won’t shock them – we’ve heard it all before!

It can be tricky to get therapy through the NHS in some areas, but you could ask your GP if they can refer you, and some sexual health clinics can also refer people on. There might not always be a long waiting list.

You can also look for private, qualified and accredited psychosexual and relationship therapists in your area, using the College of Sexual and Relationship Therapists website. The important thing is to know that they have had specific psychosexual training, and are members of and/or accredited by COSRT. There are some low-cost schemes out there, too; your GP might know of them.

What about talking to health professionals about sexual problems - do you have any tips about how to raise the issue?

Unfortunately, sometimes the patient feels that they have to raise the issue, if their treating practitioner doesn’t address sexuality. With time limits and pressure in the NHS, the focus is usually on saving lives and sexual issues can get forgotten – it’s not that health professionals feel that it is wrong to talk about them. So most doctors and nurses should be willing and happy to discuss your concerns with you.

Just try saying, ‘I’m having this issue...’ Even if your doctor or nurse can’t deal with it themselves they should be able to refer you on. Don’t be afraid to ask!

What would be your one ‘take home’ message about sex and relationships during and after a stem cell transplant?

Don’t bottle things up! Don’t leave things until you’re really struggling. Find someone you trust who can be open with. Right from diagnosis, it’s important to know that cancer and treatment can affect relationships!

Find out more:

Read about treatment for sexual problems after a transplant in our booklet The Seven Steps: The Next Steps.

For more help and support, you can visit the College of Sex and Relationships website, the Relate website, or Krystal’s own therapy website.

DISCLAIMER: At Anthony Nolan we take great care to provide up-to-date and accurate facts about stem cell transplant. We hope the information here will help you to look after yourself. Each transplant centre will do things differently, so this blog is just a general guide and it’s not intended to replace advice from your doctor. Please speak to your transplant team for more details about your own situation.

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