After breast cancer, talking with your partner about sex may be hard. Here today to talk about how to navigate sex through cancer and all the big feelings that can go along with it is Dr. Chery Hysjulien
About Dr. Hysjulien
Cheryl A Hysjulien RN, PsyD
Licensed Clinical Psychologist specializing in Health Psychology with further specialization in Psycho Oncology at Sanford Health Roger Maris Cancer Center
Chery Hysjulien is a registered nurse and Licensed Clinical Psychologist specializing in Health Psychology with further specialization in Psycho Oncology. Dr. Hysjulien has worked in the area of health care for over 40 years. Initially she was trained as a registered nurse and worked in medical surgical and intensive care units for approximately 12 years. She then went back to train as a clinical psychologist. She completed her pre and post-doctoral training at a hospital based program where she began to specialize her training in health psychology. She first trained in mind body-based medicine approaches by attending Herbert Benson’s Mind Body Institute at Harvard Medical School and has continued to train in mind-body integrative modalities for the use in health psychology. She has spent her 40-year medical career as a champion of holistic integrated approaches for patients and training medical staff about integrative healthcare. She has practiced in a wide range of health psychology including eating disorders, cardiovascular, neurological disorders, genetic disorders and other medical disorders. However, her passion lies in working with oncology patients and teams where she has spent the last 20+ years developing integrative holistic care for oncology patients.
Support for the Real Pink podcast comes from Lilly Oncology. People living with metastatic breast cancer or MBC deserve more Lily oncology aims to bring more awareness of MBC through more education or research and more dedicated solutions to support the women and men living with MBC and the communities that surround them. Learn more at the more for MBC Facebook page from Susan G Komen. This is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room today.
After breast cancer, talking to your partner about sex, maybe hard, you may develop some body image issues that may affect how you view your own sexuality here today, to talk about how to navigate sex through cancer and all the big feelings that can go along with it is Dr. Chery Hysjulien. Welcome to the show.
Hey, thanks. Good job with my name.
Well, I had a good coach, so, uh, so thank you for joining us for talking about this really important issue. Let’s start out. Can you just tell us a little bit about yourself and how you became so passionate about working with breast cancer patients?
So I’m a first trained as a nurse. So I worked for a couple of decades as a regular nurse in the hospitals. And then, um, I sort of veered over into, uh, dabbled in the psychology area and then went back to get my doctorate in clinical psychology. The last year of my training, I got a call in November and my 38 year old sister told me that she had breast cancer. And so she was a young cancer patient. She went through a mastectomy and chemotherapy and radiation and everything you do. And a year later completed that a year later, I moved near her back from Oregon to the Midwest. And then we went about our ways. We, I was the middle of five girls and she was my big sister and we were good friends and, um, and our kids grew up with each other.
And, um, and then about four and a half years later, she got that dreaded call. I went down and she had had a workup of some low back pain and, and it was a ridiculously late time of the night, like 10 30 at night. And she’s got a call from a doctor that said she had metastatic disease to her bone. We laid their own night and she was wide awake and she had three kids in their early to mid-teens and she would be okay and we have almost drift off to sleep. And then she would just like have this overwhelming panic and anxiety about leaving her children and dying. And so at the time I didn’t make a decision, you know what I want to work with breast cancer patients. But a few years later was involved in some training at, um, st cloud hospital in st. Cloud, Minnesota. And I linked up with them. And from there I’ve done pretty much nothing but cancer. It just was like, when I met this breast navigator with everything going on, I just veered off into there. And I guess kind of in a simple sort of way, I don’t want people to be alone going through those terrifying difficult times.
That’s great. That’s great. I’m glad that you’re doing this it’s important work. So, so thank you for the way you’re serving this community. Uh, so, so let’s, let’s talk about sex. So talking about sex is important for healthy relationship, you know, the breast cancer diagnosis treatment, it’s even more critical I’d imagine. So what advice do you have for our listeners about how to best communicate with their partners related to sex?
Yeah, well, in our culture, we don’t communicate about sex very well in the first place. So we’re starting at kind of a deficit with, uh, any kind of couple that is trying to negotiate post cancer, diagnosis and treatment and negotiating all of that. If people do talk about sex, um, women, especially, they don’t talk to their partners about sex in general, they talk to other friends about sex. So, you know, I think that, I just tell people that from the get go, you’re not abnormal, that it’s hard to talk about sex with your partner and you have cancer, then you gotta deal with that on top of it. But especially the young cancer patients, you know, they’re, um, maybe newly in a relationship or not in a relationship. So they have a number of really hard things to negotiate. Communicating is critically important for both sides of it because otherwise there’s these rejected, difficult, hard feelings that would be, um, could be avoided if you were clearly communicating with people about it.
So, um, you know, initially when you have a diagnosis, you’re dealing with the panic and uncertainty of even being alive, let alone being an active sexual partner. So, um, it kind of takes a back seat, but again, commuting paying that to the partners saying, you know, I’m really overwhelmed and, and I even educate them and tell the partner when you’re a synthetic stress, nervous system is highly activated. Sex is pretty far down on the ladder in terms of things to have to deal with. It’s nothing to do with you. So, and then as, as treatment progresses, all kinds of things come up that you have to deal with, whether it’s from a pain and or treatment regimens that affect your hormone therapies, other recommendations for surgical interventions, all of those can be impacting. So I think all along the way, checking in, but how do you do that with someone you’ve really never talked about?
So I I’ll, I’ll assign people to set times, not in the bedroom, not when people are feeling like they want to have intimacy, but at another time to say, I really need to talk to you about this. You haven’t done anything wrong. I just got an update you about where I’m at emotionally, physically, and how that’s affecting us in our relationship. Set that time up, then sort of monitor yourself. If you start getting panicky and overwhelmed and they get defensive and use targeting defensive timeout, let’s come back to this at another time. If people are feeling defensive, they start getting into blaming language. Well, you know, I’m just trying to be helpful. Well, you’re not helpful. It’s not what I need. There’s a lot of just feelings of people wanting to be helpful and wanting to survive and do the best they can. People don’t generally want to end a relationship.
On the other hand, speaking of communicating, there are times when cancer can shift your relationship in a way that is not necessarily wanted by both people, but I’ve had women say either male or female, um, say, you know, I’m done with this relationship and the cancer is kind of the impetus for change and, and ending a relationship too, which then, you know, you just try to help them negotiate that as well, but it’s, it’s not easy. And then just teaching people basic communication skills would, which I know it sounds really trite, but setting that time up listening, reflecting, being open, non-defensive try to get at what they’re saying, try to maintain eye contact, just those basic communication skills that are really helpful in any relationship. But when you’re dealing with a super difficult subject, it can be really, really important if they can’t negotiate on their own oftentimes, bring them in and try to facilitate that conversation with them.
Yeah, that’s excellent. And a couple of things you mentioned in there, just the stress of cancer, right. Cancer is just stressful in so many ways. Can you, can you talk a little bit more about the mood changes that someone might expect during cancer treatment? Like what should someone expect there?
Well, I tell people if you’ve never had a day of depression or anxiety in your life that people with that are diagnosed with cancer, again, even kind of the best of cancers, um, are much more prone to having depression and anxiety and people who have preexisting anxiety and depression are really at risk for developing increased anxiety, depression. You know, the general public gets pressured at a rate of 5% well cancer patients have a rate of 20%. We see from 30 to 50% of our cancer patients, um, developing anxiety and depression, and they S they can really go together as well. But again, those symptoms that I just mentioned are really telltale symptoms, panic, panic attacks as well, but sleeplessness appetite, and a lot of the symptoms of depression and anxiety can be made worse or can be like the side effects of some of the cancer treatments like fatigue. Fatigue is extremely common in depression, and it’s very common in cancer and they can lead to a lot of depression. So actively treating fatigue has become a focus in a camp in my area of treating cancer patients with depression and anxiety.
Hmm. That’s great. That’s great.
Medications can cause a lot of anxiety. So you, you know, you educate them, you know, you’re on steroids and steroids can cause lack of sleep that can be directly related to high levels of anxiety and get very depressing. Yeah.
Wow. Right. So let’s, let’s talk for just a minute about body image. Um, I know that body image is something that a lot of women struggle with in general. I’m sure it’s even worse after a breast cancer diagnosis. I mean, it is that true? And if so, what do we need to know about that?
Yeah, it is extremely true that in our culture, body image is a huge issue for women, especially, although unfortunately it’s become more of an issue for men as well. And it’s affected, you know, basically what it is. It’s how we see ourselves, our image that we have of ourselves. And it can be affected by probably you all know lots of factors, experiences that you’ve had in your life, cultural factors, media factors, but over 30% of women who get cancer struggle with increased body image issues. Now that’s not all just related to like surgical intervention. It can be effected by the way you feel about your body. Like even the portrayal, you had this thing coming in your body and your body, not being able to take care of it. Like it’s taken care of other things that affect your body and like a bacteria or virus.
It’s really important that people know that this is a common outcome with cancer. And it’s laid on top of what already is existing in our culture today. Oftentimes it’s an unspoken part of cancer treatment. It’s like, there’s so many priorities about other than how I feel about my body that take precedence over it, that it gets neglected. And then two years later, they have been a distance, not just from a partner in intimacy, but from themselves. Like I have many women who won’t unclothed themselves in front of themselves. They don’t, can’t stand looking at parts of their body. They feel betrayed by their body. And that’s sad because really it is your body. That’s kind of seeing this through this. So one message I tell people is it’s common and try to intervene early. You know, it’s not, I know it’s not the priority, but make it a part of the treatment program.
That body image is critical because it’s so much a part of how we see ourselves and can feed that depression and anxiety and their personal relationships significantly and dealing with that can be pretty tricky because it’s about acceptance of your body. Again, mindfulness, which is just being present in this moment and intentionally doing that without judgment. Well, if we could all do that all the time, we wouldn’t have opinions about our body. We wouldn’t be judging our bodies, right? We wouldn’t be saying, Oh, we’re ugly. I wouldn’t want anybody. See me. This scar is ugly in treating it, moving to that acceptance and nonjudgmental place with your body, which again, hasn’t been bred and in our culture judgment of our body in a comparative relative way is almost second nature. So I do talk to people about being kind of corny. Like I want you to take your clothes off and I want you to sit in front of the mirror or sit in front of the mirror with your clothes on at first.
And I want you to look at yourself and I want to give you, I want you to give yourself different messages than you have given yourself. And you know what cancer is providing the opportunities for you to stop the negativity that flows through your brain about your body. If you can only get to neutral, that’s better than negative. If you can get to positive of gratitude and thanks to your body, that is awesome. I say, whether you like it or not, your body has seen you through your body has had the strength to get through this. And your body is, is, is the embodiment of you try to treat it nice. Yeah.
I love that. That’s that’s a great exercise. So, um, doctor dr. Halen, this is amazing. I do have one last question and I want to go back to an earlier question regarding communication with your partner. Cause that seems really important. So in addition to just talking verbally, what are some other ways that a cancer patient or a patient with diagnosis can reconnect with their partner following that diagnosis?
Yeah. So one of the things that I talk a lot about with couples is doing exercises again together that are not necessarily verbal. I mean, like I’m a Midwesterner. We don’t need to talk about a lot of stuff. It’s funny, I’m a psychologist because you know, we just know a lot of things without we don’t get Blab about it, unless it’s saying good bye. Then we take an inordinately long period of time to say goodbye. So the exercises I give people in terms of nonverbal communication is based on masters and Johnson, sensate focus exercises that go back decades and decades. So really what it is, is it’s series of exercises that also people like this step one, step two, step three. So they like to do that. But in each of the stages, you move to a more intimate level with each other. But initially like in step one, you both have your clothes on and you both just touch and explore each other.
You don’t have to talk about it. You can giggle with you want to, not if want to, but it’s an interesting exercise to communicate in a nonverbal way, but in a safe way where you’re not feeling too vulnerable or risky, right? So one person does that for whatever they can tolerate. I recommend 20 minutes oftentimes make it five. And then the other one. So then you go on to the next step where you become increasingly more intimate, what you might take, turns touching each other, but you might touch the sexual areas. So genitals or breasts or things like that. And they agree upon this. And then it just continues on. So there’s this beautiful thing that can happen. Where sometimes when we talk, we say things that we use our thinking minds to then react to. And this is just a very gentle, instructed, structured way of getting to know each other without a lot of talk. And it can be really beautiful.
Wow. That sounds like a great exercise This has been really fantastic. I appreciate you coming on and talking about this really important, but difficult to talk about issue and thank you for taking the time to do that.
Thank you for making this a part of Susan G Komen mission too. I attended my first walk the year after my sister was diagnosed. My family’s done it for years and it’s a good organization. So thank you.
About This Episode
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