On today’s show we welcome Dr. Saketh R. Guntupalli who is the Vice Chairman for Clinical Affairs and Quality in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine in Denver. He is also the author of the book Sex and Cancer: Intimacy, Romance, and Love after Diagnosis and Treatment, and in this episode we chat about exactly that. Dr Guntupalli gives us some background into what inspired him to write the book and then goes onto some great anecdotes and information on the ways that cancer can influence intimacy and sexual relationships.
He stresses the key points that partners should always remember in trying to combat these potentially negative effects as well as focusing on some of the beautiful and surprising situations that arise out of something as scary as a cancer diagnosis. For all this and much more, be sure to tune in!
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- The patient that inspired Dr. Guntupalli to research and write his book.
- A particular story from the book about reimagining intimate life.
- The connection between cancer, hair, breasts and sexuality.
- The gender disparity around anatomical procedures in medicine.
- A three-pronged approach to overcoming the sexual challenges of a cancer diagnosis.
- Some pointers for being a helpful partner to someone in treatment.
- The emotional repercussions that a cancer diagnosis can have on a relationship.
- And much more!
“So what I would suggest is not to think about sex as intercourse and orgasm. It is a platter of different things that you choose from.” — Dr. Saketh Guntupalli [0:19:53.9]
Resources, extended show notes and Dr. Guntupalli’s details can be accessed by clicking here.
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Sean Jameson: Today, I’m talking to Dr. Saketh Guntupalli. Saketh is Vice Chairman for Clinical Affairs and Quality in the Department of Obstetrics and Gynecology at the University of Colorado School of Medicine in Denver.
Saketh is on the Bad Girls Bible Podcast today to talk about how a cancer diagnosis can affect your sex life, intimacy with your partner and your relationship. He’s also written a book on the topic, Sex and Cancer – Intimacy, Romance and Love After Diagnosis and Treatment.
Saketh, thanks so much for coming on the show.
Dr. Saketh Guntupalli Thank you for having me, I’m really excited to be here and I followed some of your other podcasts. So I’m really honored to be here with you today.
Sean Jameson: Great. I love to start off with your book and how you came to write up, if that’s okay with you.
Dr. Saketh Guntupalli Sure. I’m a surgeon by training and I also give chemotherapy but you know, I was in my office about four, four and a half years ago and I had a patient that came in who basically wanted to transfer her care to me. She had been in diagnosed with advanced stage ovarian cancer about a year prior, so had gotten surgery, chemotherapy and come in because her other doctor had moved out of Denver. She wanted to establish care.
In my book, this is the first story that I write about and she basically came in, we did an exam, her tumor markers were totally normal. Her physical examination was normal and by all accounts, she was now a year cancer free and in remission and as I was talking to her after the exam, I said, you know, you’re good to go, I’ll see you back in three months. She started to cry and was quite devastated by something that happened in her life.
And she started to cry and was very sad. I asked her what was wrong and she told me that her husband had left her as a result of her diagnosis of ovarian cancer. She said to me, “You know, I never thought ovarian cancer would destroy my marriage and I just want to die.” I thought that was incredibly sad that a woman who was in her early 40s who had clearly beaten her ovarian cancer and was in a clinical remission was so depressed and so sad and so devastated. This is the time of her life she should be kind of the happiest.
That really stuck with me for the rest of the day and I try to think about it, I tried to not think about it. I got home and I did a literature review to see how does gynecologic cancer or how does cancer in general affect an intimate relationship and someone to merit, someone’s intimate partner relationships and their sex life and I was astonished that I could really not find very much written about this topic.
I started to do some research and we started to look at things and we designed this very nice survey about 181 items and we basically gave it to about 400 women and we were astonished to find that sexual dysfunction after diagnosis of cancer, whether it was breast cancer, leukemia, gynecologic cancer was very prevalent. And that’s kind of what got me to write the book and how I got interested in this topic, was really that one patient who kind of went through her life and how her life was quite good, she had a very active sex life, very fulfilling sex life with her husband. But when she was diagnosed with her cancer that all fell apart.
Sean Jameson: Does sound very tragic. Exactly like you said when you’re supposed to be – when you think you’re supposed to be celebrating, actually, you know, there’s not a lot to celebrate perhaps.
I’m wondering for our listeners if you have any stories about, that someone beating cancer, what about maybe someone’s had an organ removed, you know, would you have any stories that maybe listeners that have had that happen to them and that affect their sex life?
Dr. Saketh Guntupalli In chapter five of the book that I wrote, we really kind of discuss a very big case that we did, this was done about five and a half years ago, a patient, we obviously changed her name, her name is Alice and her husband Craig. Very normal, healthy couple, high school sweethearts got married Right out of high school, 18, 19 and been married for almost 25, 30 years.
And you know, Alice talks about how she is a third grade teacher and she was in her classroom and she had this chronic back ache, nonspecific abdominal pain, almost feeling full very early and she basically went to the doctor and the doctor told her well, “You probably have fibroids or you probably have something. Let’s get an ultra sound,” got an ultra sound, found an enlarged uterus and they took her to the operating room to remove that and they found cancer all over her abdomen and I think what that highlights is you know, ovarian cancer has very nonspecific symptoms so if you’re having any of these symptoms, please discuss that with your doctor.
She underwent multiple surgeries, had it removed, got chemo, went into remission and throughout all of this, had a very active and healthy sex life with her husband. He got transferred to Denver, Colorado, she came to me and unfortunately, she had a recurrence on her rectum and basically, required another surgery. When we went in and did her surgery about five and a half years ago, her tumor on on her back and her rectum and we had to make a decision about removing all of that cancer and rendering her cancer free.
However, that would render her basically not able to have sex in the normal way. Because she ended up having a colostomy or a bag that collects her stool on her skin and a urostomy which collects the urine. So she has two bags and I talked to her husband, we talk a lot about what that decision making process was and the long and short of it is –
Sean Jameson: How was she during that process? Was she very, you know, able to keep it together or was she incredibly emotional?
Dr. Saketh Guntupalli We talked about the possibility of that, she was very emotional, she talked about what it would be like to lose her vagina and I mean, I think that’s just not something that you hear in everyday conversation, you know? I have to have my vagina removed.
And so, you know, we talked about the possibilities and then when we actually had to do it in the OR, we spoke to her, her husband and her husband said, listen, the most important thing for me is having my wife around for the next 20 years, I didn’t marry her for her vagina, I married her for her and you know, I want you to save her life.
We were able to do that and then afterwards, she had this like six to eight-month struggle of how does she restart her intimate life. She was only 48 years old, her husband’s 48, very healthy, very sexually active and you know, they had to talk a lot about what it meant to be in a situation where they couldn’t have relations in maybe the way that most everybody did.
The story talks a lot about what does intimacy mean, it doesn’t mean just intercourse, it means talking, it means holding hands, it means you know, doing the things that are intimate and are sexual without necessarily just meaning intercourse. She talks a lot about what it was like to reinvent their intimate life.
She talks about how in the story, you know, one of the things that she wanted to do was feel very close to her husband. He went out, kind of this nerdy guy, he goes out and he buys a Harley and gets this thick leather jacket and they go riding through the mountains of Colorado and it’s very sexual and erotic thing that they do and she says, this is a way II feel intimate and close to him.
They would go to adult stores and not really buy anything but they just said that it was kind of a sexy and intimate thing to do. She says that holding hands has a new meaning for them. And she still has an orgasm and so does he and so the different things that they do to reconnect their sex life, to feel intimate, it doesn’t necessarily just mean intercourse.
I think that that story was very telling about how someone rebuilds their life after such immense tragedy. I mean, I mean, I don’t see many women would be able to do that until they read the story and felt like it was possible.
Sean Jameson: Was she able to do that just of her own volition or was she also in therapy, talking to other doctors, getting help with that?
Dr. Saketh Guntupalli She approached me, obviously, we talked about it and I think one of the most telling things that she said and something that was learning for me, she’s like, “You know, when we talked about this surgery, it’s one thing to say it, it’s another thing to do it and experience it.” I thought that was very telling. She was like, “I didn’t really think about how much this was going to affect me until it actually happens.”
I think communication is really important. We talked about things that she could do, we talked about using a good lubricant, we talked about oral sex, we talked about intimacy, touching, cuddling, petting, all those things and those are hard discussions I think for patients and even physicians to have, you know? We did have a lot of communication,
I think they did see a therapist. but I will tell you, interestingly enough, one of the things that she told me that was so telling was her faith and how much her faith and her faith based approach to this got her through. You don’t really think of maybe sex and faith going hand and hand but she said that that’s what got her through and God gave her the strength to rebuild that part of her life.
Sean Jameson: That’s fantastic. I mean, maybe you hear faith and procreation. Yeah, all those other intimate aspects are just as important to living –
Dr. Saketh Guntupalli We don’t think of like going to church or mosque or temple or whatever it is, your religious affiliation is, being associated with intimacy or sexual activity. I mean, those are just seem like two very separate things but she was pretty clear that her faith is what got her through it and gave her the strength to approach sex in a different way.
Sean Jameson: Now, what about breast cancer? It’s very prevalent and it might not be as psychologically tough to get over but do you have any stories of that on how a breast cancer diagnosis and treatment can affect someone’s intimate life?
Dr. Saketh Guntupalli I would actually respectfully disagree with a little bit of that and I would say that a breast cancer diagnosis is in some ways even more devastating for women and here’s why. We talk a lot about this in the book. We talk about a lot about one of the things that I learned from my patients is that cancer for women robbed them of their femininity, it robbed them of the things that make them feel like a woman.
I’ll give you two examples. In the book, we talked a little bit about this. The first is, when a woman gets chemotherapy for breast cancer or really any cancer, oftentimes she loses her hair and for women, hair is a very defining feature of their womanhood. If you ask most of our female friends, colleagues, significant others, they say, what do they say they spend the most time doing in the morning, they spend it on their hair.
Men are attracted, we know that long hair, thick hair is a sexual attractant for men, we know that women spend a lot of time on it because it is something that makes them feel like a woman and feel very sexy. When cancer robs you of that because the chemo makes you lose your hair, it desexualizes a woman. And I had a patient who talked about this in the book, she said she was walking to the airport in Denver and she said that she had lost her hair and she wasn’t wearing her wig because it was very itchy, she said, it was like wearing a scarlet letter on her chest that everybody knew she had cancer.
It’s different for women than it is for men. When a man loses his hair, there are a lot of women that find that attractive, it’s distinguished, it’s stately, there are a lot of – like I said, women that find that bald men attractive.
Sean Jameson: Bruce Willis is a good example.
Dr. Saketh Guntupalli It’s an expected part of aging for many men, it is not an expected part of aging for most women and when a woman walks through a public place with no hair, what is the first thing that you think of? You think that she’s got cancer and if she’s got cancer, she’s sick, she’s uninterested, she’s not attractive and that’s really was very telling to me, you know?
Wow, there’s this part of cancer care that we haven’t explored. The other thing I will say is, the most outward physical sign of femininity for women are their breasts, I mean, women are very proud of their breasts, they enhance them, they want to feel proud that it’s an outward sign of female femininity.
Breast cancer and you have to – we remove the breast and you get chemotherapy to lose your hair. Many patients feel like they have lost the two things that make them feel like a woman. That can be very devastating for women and I think it’s something really important for partners to understand and for physicians to understand.
One of the patients I interviewed in the book. She’s a really interesting story. She is a physician actually, lost her mother to breast cancer and at age 35, while she was trying to get pregnant, she basically found a lump in her breast and went to the doctor, they did an incision and she ended up having a breast cancer at age 35.
She really thought about it, what she wanted to do and she said, “Listen, I’m trying to have a baby, I just got married,” proceeded with a double mastectomy and she talks a lot in the book and really talks about what led to have a mastectomy and have her breast removed at age 35. She was very proud of the way she looked, she worked out every day, she said that her breasts were kind of her pride and joy, she was very proud of her figure.
When she had them removed, how incredibly devastating it was, we interviewed her husband as well. It was interesting because she was devastated because she felt like he would feel like she was less attractive and he was very clear, “Listen, that is important and did I enjoy that part of her, yes but it wasn’t the most important. I just wanted her to be healthy.”
It is very heartwarming actually and so she got breast reconstruction. She says it is not exactly the same but that was very telling to me that this physician, very accomplished, smart woman was still brought back to that very basic feeling of femininity.
That she felt like she was going to lose as a result of her breast cancer. So I thought that was very telling. I thought that was very interesting that hair and breasts are these very, very important, obviously, things to women but I didn’t realize how important it was until I heard these stories.
Sean Jameson: Yeah, I don’t think I realized either until you just told me right there.
Dr. Saketh Guntupalli Right, the other thing I will say really quickly is one of the health disparities we have that I see walking around the hospital is we treat men and women very differently. I feel like we are very willy nilly like we’ll do, “Oh well vasectomy is not a big deal,” or taking out a woman’s ovaries are not a big deal but let me tell you if we were removing a man’s testicles, we would do everything we could to spare it, give a prosthesis –
Sean Jameson: Oh absolutely, I agree.
Dr. Saketh Guntupalli If you tell a guy, “Listen, I am going to take out one of your testicles.” He is going to run for the door. He is never going to come back to your office. You better have a really good reason but sadly in medicine, we’re very less likely to have that kind of and you know – I think that that’s sad. I think we need to do a better job of that.
Sean Jameson: Then perhaps some surgeon sort of see nails and they are the hammer almost.
Dr. Saketh Guntupalli Well that is a very good point. You know if you are a hammer everything is the nail. So we got to be less hammer, maybe hammer, wrench and screwdriver and not just the hammer.
Sean Jameson: I like it, I like that analogy. So what advice then would you have to women to rebuild their life. Maybe they have cancer, maybe they get a mastectomy, a hysterectomy or maybe something else but they want to rebuild their intimate life after such a devastating diagnosis and treatment, what kind of steps can they take?
Dr. Saketh Guntupalli So I’d say it is a three-pronged approach. This is the approach I take in my practice in Colorado. The first is, first and foremost is communication, communication, communication. And I think that that is might be trite and it might be overused but I cannot emphasize how important communicating with your partner is.
When you get a diagnosis of cancer I feel like many women and men as well as so concentrated on curing the cancer and getting rid of the cancer and treating the cancer, they forget to communicate with their partners about what their fears and expectations are.
So I think communicating with your partner about how your body is going to be different, desire might be less, it may take a while to come back. It might feel a little bit different. It might be a little bit more painful is incredibly important because I think if the expectation is at least outlined as early as possible, then people can adjust and can decide what it is on how they want to approach it.
But you know oftentimes people just get thrown in – physicians are guilty of this as well. We just concentrate on the cure, we don’t think about the person that there is a person behind that disease. So that is the first thing. The second thing I would say is use a good lubricant. I cannot emphasize that enough. I have told that and it seems like a very simple solution and I’ve had patients say that using a good lubricant saved their marriage or their intimate partner relationship.
And I am not talking about the two dollar lubricant that you get at the local grocery store by a high end lubricant that feels good, try them out. Make sure that you don’t feel gross after using it. A lot of people use this thick goopy lubricants and they’ll feel gross after use. Use a nice swab of soft lubricant for your partner or for you. Put it inside you, put it on if you are with a man, you put it on the man’s penis. You have to use a good lubricant.
Not using a good lubricant is the difference between good and bad sex, plain and simple. So that’s the next thing. I’ve had patient literarily that have come and told me that this $22 bottle of lubricant X saved their marriage. So that’s the second thing. The third thing and I think this is probably the most important thing, we talk about in the book a little bit about managing expectations and I think that it is very important.
For your average 25 year old, what is sex? It is foreplay, intercourse slash orgasm, done. Sex is more complicated than that as we get older and sex is certainly more complicated than that with a cancer diagnosis. So what I would suggest is not to think about sex as intercourse and orgasm. It is a platter of different things that you choose from. Maybe just petting or taking a shower with your partner, maybe it is oral sex, maybe it is orgasm and intercourse but having a different variety and kind of a cornucopia of sexual proclivity, I think is very important.
And I think that if you try different things and not think that orgasm is the end-all-be-all that that is really important. We talk a lot about that in the book as to other things that you can do to have a fulfilling sexual life.
Sean Jameson: Yeah, I think a lot of people get hung up with like you said, penetration and orgasm and maybe a bit of foreplay beforehand and some sleeping afterwards.
Dr. Saketh Guntupalli And men are very guilty of that. They think that that without that there’s no sex and I would argue that sex and intimacy, because men want intimacy too, there is a difference with intercourse and intimacy is more than just intercourse. It is so many other things and I actually think men feel that way.
They are just conditioned by our society to not think that way but in their heart of hearts they really do think that way because we interviewed a lot of men in the course of this. And they say, listen – I was so pleasantly surprised to see here that sex is important but she is much more important. And that was actually very heartwarming to hear.
Sean Jameson: So what advice then would you have for a partner that’s maybe listening and they’re spouse has got a cancer diagnosis and they want to be supportive as possible and try to get through this together.
Dr. Saketh Guntupalli So again it is very similar to what I said before is first just communicate for a lot of partners particularly men. They feel like they have to be nothing but a rock and they have to be strong, 99, 100% of the time. It is okay to cry in front of your partner. It is okay to say that you are scared. It is okay to verbalize that. If you verbalize that and you’ve acknowledged it and then you can address it. Understand that cancer treatment is very devastating for a lot of women for a multitude of reasons that I talked about before.
It desexualizes a woman, it makes her feel tired, it makes her feel scarred. It makes her feel scared so the understanding of that. And when you want to have relations and the interesting I discovered is I had a couple that came in where she really wanted to have sex even throughout her chemotherapy. She’s like, “You know, I drop all these hints and he would just ignore them.” He wanted to sex but he didn’t want to seem like that jerk guy whose mind is just on one thing.
So they weren’t communicating with each other. They both want to have sex with each other and they weren’t because they thought that the other person didn’t want to. So that communication is important. So I would say communication, being understanding and again, trying out things that are a little bit different and outside the box is really, really important.
Sean Jameson: I especially as a guy not been focused with that angle of orgasm and perhaps focusing on things that might not be as crazy intense but is still incredibly intimate.
Dr. Saketh Guntupalli Absolutely, yeah.
Sean Jameson: So do you have any other stories that maybe a listener could relate to about a diagnosis and getting through it?
Dr. Saketh Guntupalli Sure, I have a couple who we talk a lot in the book, they had an interesting relationship. I think probably before the cancer diagnosis they were a little bit on the rocks. They were in their early 50s but still sexually active and you know the patient had an early stage uterine cancer. She had surgery, got some chemo and was cured and basically every time I would see her in the office she would tell me how horrible her husband was and she would do it with him in the room.
And how he was not understanding, how he didn’t care, how he couldn’t understand what she was going through because he didn’t have cancer and he would just sit there and not say anything.
And you know I kind of ran into him in the hall, “Look how are you doing?” And he said, “Well I am miserable but I would never tell her how miserable I am because she’s the one that had cancer and she’s the one that has suffered.” And then I said – but he was clearly miserable on this toxic relationship.
And what I realize was is she was using him as a Dammit Doll, I don’t know if you know what a Dammit Doll is but it is a cotton doll that you just hit when you get angry so you don’t take your problems out on another person except she was using him as that.
Sean Jameson: Sort of like a human stress ball, almost.
Dr. Saketh Guntupalli Exactly and she was using him as basically a Dammit Doll and I brought the two of them in the room and I said, “I think you guys need to talk. I am not a sex therapist or a counselor but you guys really need to talk because this is not healthy. What is happening here.” And we sent them to a counselor and I think they worked through it and I think what they found was she was so scared of her cancer coming back that she couldn’t live her life.
And he wasn’t communicating with her about how abused he felt and I think what came out of it is that no person no matter their diagnosis can use another person as a Dammit Doll or as their focus of their abuse. Because they are scared about something else. But he’s at fault as well because he did not set those boundaries and I think that that’s a really, really important. It is one of the things that we see with cancer patient’s reoccurrence.
The patients are so afraid of their cancer coming back that they don’t know how to live their lives and what I tell patients is you’ve got to live your life every day. You’ve got to look at it as my cancer hasn’t come back today I am going to enjoy life out to the fullest and just taking it one day at a time and if you tell yourself that every morning I think you will live a happier life.
Sean Jameson: I think so. I feel in a lot of ways your book is about the second and third order of consequences of a cancer diagnosis.
Dr. Saketh Guntupalli Absolutely, yeah.
Sean Jameson: Great, so we’re nearly out of time unless you have any other interesting patient stories you would like to tell?
Dr. Saketh Guntupalli Well what I would say is globally, you know like I said, communication is everything and effectively communicating is something very few people I think do well. But I think that cancer humbles you and humanizes you and it makes you rely on your own mortality and I think that it is important for people to really use something that is very, very scary and very – an adverse outcome to try and turn it around into something positive.
The adage when life gives you lemons, you can be sour or you can make lemonade and I have had so many patients that have made lemonade out of their cancer diagnosis. Patients who have been on the brink of divorce where their cancer diagnose actually saved their marriage.
Where patients have really become so much closer to their partner because the cancer diagnose is brought up to think their good in them. Actually that happens much more often than the first story in the book where somebody left their partner as a result of their diagnosis. So I think these are all really interesting parts of the human condition and then we’ll see how it evolves.
Sean Jameson: I think that is a lovely place to end this episode. If people want to get in touch with you, where will be the best place for them to do that?
Dr. Saketh Guntupalli Sure. So I think the book is a great read. It is a very nice set of nine stories which each teach a lesson. So we talked about this woman that had all of her pelvic organs removed in and how she built her intimate life without having her vagina, we talked about the breast cancer patient. We talk about this patient whose marriage disintegrated. So I think that is a good starting point. But anybody that wants to reach me can always reach me at my email.
Which is my first, dot, last name, at UC Denver, dot EDU and I am happy to answer specific questions or talk about how to build their intimate lives after a diagnosis of cancer.
Sean Jameson: Awesome. I will include both your email and the link to the book in the show notes.
Saketh, thanks so much for coming on the show.
Dr. Saketh Guntupalli Thank you so much for having me.