Until five years ago, Deltra James led a very different life. She was 33, married, and happily homeschooling her five daughters in their three-bedroom home in Waterbury, Conn. But within a year of her Stage 4 breast cancer diagnosis, her marriage crumbled, which meant she had to return to the workforce and move into the spare room of her mother's house with all of her kids. There was much to grieve.
"I was really angry that I had to start over – especially at a time where I got a diagnosis like mine, where it felt like starting over at the end," James says.
But on the backside of that horrible year, she also felt empowered, liberated, and eager to make the most of her life. She yearned for escape, pleasure and connection through dating — but also worried, as many cancer patients do, whether sex after surgery and chemotherapy might hurt. James's oncologist seemed embarrassed and dodged her questions, which left her feeling both frivolous and ignored.
"I just felt like: 'When would be a good time to talk about certain things? Because I don't want to just be existing.'"
As cancer survivorship grows, so do the number of people living with sexual side effects of treatment — from joint pain to erectile dysfunction to early menopause. After treatment, patients are often left to navigate lives fundamentally reshaped by the disease, without advice from doctors about things like counseling, vaginal moisturizers or therapeutic sexual devices that might help.
Medicine has made giant leaps in recent years, helping many more people outlive cancer, even as incidence of the disease spikes. With that, the population of survivors is also growing rapidly. Around 1970, only 1.4% of the population lived with cancer in their past. Today, there are over 18 million survivors who make up 5.4% of the population, and their ranks are expected to reach 26 million by 2040. Cancer rates are also spiking among younger people in their dating and sexual prime.
For a large majority of them, sexual side effects are a reality, says Janeane Anderson, a researcher and assistant professor at the University of Tennessee, who estimates about 80% of patients struggle with sex after treatment. "Sexual health is one of the greatest unmet needs," she says. "Dating and relationships and sex and sexuality have been ignored."
Anderson says many also crave advice about related matters, like: "When do I disclose I'm a cancer survivor? When do I share my body? When do I share my scars?"
Patients frequently internalize the grief about their altered bodies, or the new vulnerabilities in their relationships.
Men, especially, are often reluctant to talk about erectile dysfunction that can result from treatment, says Lorraine Drapek, a nurse practitioner at the Massachusetts General Cancer Center Sexual Health Clinic. Yet Drapek says sex lives and relationships are a very important part of returning to normalcy for patients and their partners. So she says some return to her office months later, asking, "Remember you said we could talk about this?"
What to hide? What to reveal? When?
Deltra James says her ongoing treatments have not affected her libido, but left her bald, tired and sore. Still, when she first began dating, she didn't always want to share her diagnosis with partners, which meant she had to learn to use new products or make-up techniques to make her look "healthy-presenting," she says. She affixed fake hair, eyebrows and eyelashes to replace the ones she'd lost with chemotherapy. "I'd try and do things like use all of the wig glue that I could," and she thought through managing the mechanics of sex. "You being on top is less likely for your hair to come off."
For many patients like Abigail Glavy, disguising the effects of cancer isn't an option.
Glavy was 31, and only a month out of her double mastectomy, when she posted her profile on dating apps with a mix of both curiosity and fear. Where her breasts and nipples once were, she had incisions, stitches, and expanders to help stretch the skin on her chest to create space for implants. She still grieved her old body, and in particular her nipples, which were now replaced by tight skin grafts. "It was something that was difficult for me to let go of."
Glavy, who has a broad smile and flowing red hair, had grown up seeing her beloved grandmother's mastectomy scars, and felt they'd done nothing to diminish her beauty. But when it came to herself, Glavy wondered, "Would somebody see me as whole?" Glavy felt both protective of her new body and terrified men would reject it. But she forged ahead, telling herself: "It can't be scarier than beating cancer."
At first, it felt better to exchange messages from a safe distance, before she got emotionally invested. A few men she shared her cancer diagnosis with stopped texting; others responded with compassion. One, named Dave Luke, responded: "I'm more of a butt guy, anyway." She laughed, and felt her anxiety dissipate.
She agreed to meet Luke for a date at a pumpkin patch in Dallas, where she lives. Still nervous about starting a physical relationship, she waited two more dates before kissing him.
"He was really patient when it came to sex and intimacy," Glavy says. "He asked if it was OK to touch my chest," and he checked in to make sure she felt comfortable, she says. "I don't want to do anything to hurt you or hurt your incisions," she recalls Luke saying.
"I felt safe," says Glavy. In that safety, she found healing and confidence in her new body.
Just before this past Christmas, Luke proposed. In a photo taken moments later, Glavy – now 34 – beams over her new sun-shaped diamond ring.
A disclosure met with compassion
Deltra James, the single mother with Stage 4 cancer, also got to a point where it was difficult to conceal the fact of her cancer from her dates.
A lumpectomy three years ago left a c-shaped scar on her left breast. "That's very, very noticeable," she says, "and so that's when dating got a little scary."
In particular, James was nervous about telling a man named Mike Carbone, someone she'd been seeing for 7 months, without broaching the topic of cancer. She braced for his reaction, but he surprised her: "He actually felt kind of relieved because I had canceled dates enough that he questioned how much I was into him," she says. "But the real reason was I had just had chemo and was feeling like garbage."
The disclosure opened the door to more intimacy. His compassion, she says, became its own turn-on. "I certainly leaned more into our relationship, because I could share a lot more."
Three years later, they're in a committed relationship, and he is a part of her daughters' lives.
Still, James says some topics remain delicate, like when Carbone recently dreamt aloud about a future life in retirement with her. She felt the need to remind him that her disease is incurable, and "to check in and make sure he understood what I'm dealing with and the realistic odds of a future." Carbone started to apologize for getting carried away. It's a difficult balance, James admitted to him: "I don't want you to talk in a way that totally writes me off, either."
Even with its various challenges, James says dating after cancer has been both an act of courage and a life-affirming gift. It allowed her to live life more fully, she says, because sharing life — with all its joys, messiness and uncertainties — is what the human experience is all about.
Visuals design by Katie Hayes Luke
Photography by Michelle McLoughlin
Editing by Diane Webber and Carmel Wroth
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