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Table 4 Perception of causes of changes to sexual activities after cancer

From: Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study

Material changes to the body I am still recovering from my operation 3 months ago. Also, I am still mildly incontinent and have erectile dysfunction (M, 54, hetero, prostate)
  Lack of interest on my part; tiredness; no feeling of arousal; no orgasm; vaginal dryness (W, 37, hetero, breast)
  Removal of clitoris due to a radical vulvectomy (W, 61, hetero, gynecologic)
  As a result of radiation treatment no erections, no fluid, plus even using Viagra. My penis is now quite small (M, 69, hetero, prostate)
  I didn’t really realize the radiation would affect my sexuality until it happened. I don’t think anyone can tell you what the pain discomfort and exhaustion will do to you (W, 61, hetero, digestive/gastrointestinal)
  A lack of testosterone and the natural aging process together, particularly the hormones, yeah, it does mean less sex (M, 77, hetero, prostate)
  We still hug each other and have a sort of intimacy. But –we have sex about once a year I would think, it’s barely a part of our relationship anymore. I mean, that may have something to do with getting older, I am 60 (M, 60, gay, prostate)
Intrapsychic factors No erection. FEAR (M, 59, hetero, prostate)
  Confidence and self-esteem (W, 35, hetero, breast)
  I just don’t want to have her touch me because I don’t feel I deserve it or feel worthwhile (W, 45, lesbian, breast)
  I think there is a fear. I feel uncertain about sex (W, 50, hetero, gynecologic)
  Too stressed – I would rather sleep/read a book and be on my own for ‘me’ time. Now sex is a chore/duty (W, 44, hetero, skin)
  Prior to cancer and that we had good sex I think and a lot of digital pre-sex with lubricant and that, which did arouse her because otherwise she was slow to arouse… but of recent times, no. It was depression and lack of confidence and to a lesser extent, a lack of libido (M, 77, hetero, prostate).
  When I went through chemotherapy and a lot of the treatments I was a bit depressed as well, so that depression also turns you off wanting sex (W, 49, hetero, ovarian)
Body image concerns Due to the lack of body parts I feel less like a sexual being and more like a breathing blob and that contributes to the fact that I have no inclination to have sex. (W, 48, hetero, gynecologic)
  My body is grotesque so I do not want anyone to see or touch me (W, 50, hetero, breast)
  I am hideous, my body is offensive and repulses me (W, 42, hetero, breast)
  I’m too embarrassed to let my partner put his fingers inside me in case the surgical scars/changes disgust him; I also worry that it will be uncomfortable (W, 30, hetero, gynecologic)
  you lose drive, you put on body fat, you lose muscle tone. Sexually you’re finished (M, 69, hetero, prostate)
Relationship context  
Absence of partner support I just don’t look forward to it and would rather go without these days. Some if this has to do with my feelings for my partner. I don’t feel looked after or supported by him (W, 45, hetero, digestive/gastrointestinal)
  I find since my wife has been reluctant to provide physical support as and when I would like it, this in its self has put a great strain on our sexual relationship. (M, 57, hetero, prostate)
  I am stressed and therefore sex is the very last thing on my mind and the least thing I feel like - I would get more pleasure if my husband actually let me put my feet up - the last time I relaxed was when I was in bed for 3 days after my operation (W, 44, hetero, skin)
Absence of partner sexual interest My partner won’t look at me or touch me (W, 46, hetero, breast)
  My husband has no interest in sex (W, 53, hetero, breast)
  My partner considered that following surgery our sex life was finished and she does not wish to resume (M, 73, hetero, prostate)
  1. Key to abbreviations: gender (W = woman; M = man); age; sexual orientation (hetero = heterosexual, gay or lesbian); cancer type.