The Unreal World: ‘The Big C’

‘The Big C’

10 p.m. July 13, Showtime

Episode: “Sexual Healing”

The premise

Cathy Jamison (Laura Linney) is a 42-year-old schoolteacher with Stage IV melanoma that has spread throughout her body. She enrolls in a clinical trial that includes the administration of steroid shots, which her husband, Paul (Oliver Platt), gives her. The disease and treatment have affected Cathy’s libido. She doesn’t feel attractive or in the mood, and she and her husband haven’t slept together in two months. When Paul’s frustration becomes clear, Cathy decides to give herself the steroid shots to make Paul feel less like a caretaker and takes steps to spice up their sex life. Matters appear to improve, but it isn’t clear whether Cathy is truly enjoying herself or is just accommodating her partner.

The medical questions

To what extent do cancer and its treatments interfere with a woman’s sex life? How does it affect her partner? Is asking a spouse to help with treatment an automatic turnoff? Can the problem be overcome?

The reality

Cancer and its treatments can have a profound effect on a female patient’s sexuality, says Dr. Stacy Tessler Lindau, director of the Program in Integrative Sexual Medicine for Women With Cancer at the University of Chicago. A cancer diagnosis is often seen as a life-threatening situation, causing the patient to focus on her survival rather than pleasure, adds Lillie Shockney, a nurse who is the administrative director of the Johns Hopkins Breast Center as well as a breast cancer survivor.

Most chemotherapy works by “targeting rapidly growing cells,” Lindau says, and that can directly affect the ovaries, leading to a drop-off in testosterone (a factor in sexual arousal) and estrogen (which is responsible for vaginal lubrication). Steroids, on the other hand, are somewhat unpredictable but may give a boost of energy or reduce side effects such as nausea, thereby aiding romance, she says.

Lindau commends the show’s depiction of role issues in sex. Among her patients, she has found that placing the man in the role of caregiver rather than lover may “change sexual dynamics in a negative way.” Many couples find that after they take on caretaking roles, it’s difficult to switch back to feeling like lovers, adds Leslie Schover, a professor of behavioral science at M.D. Anderson Cancer Center in Houston.

In terms of treatment, Lindau believes in a holistic approach, combining gynecological treatments with physical therapy and psychological-sex therapy. Many women with cancer can still achieve orgasm, though Lindau says it’s not unusual for a cancer patient experiencing pain or low libido to instead focus on her partner. Schover believes that the show does a sensitive and accurate job of portraying a couple coping with the difficult issue of sexuality and cancer and learning to “understand each other’s needs.”

Siegel is an associate professor of medicine at New York University Langone Medical Center. His new book is “The Inner Pulse: Unlocking the Secret Code of Sickness and Health.”

marc@doctorsiegel.com