Last week, Dr Debbie Owies was speaking by telephone to a woman whose husband was being treated for advanced brain malignancy. The steroids he was taken had so greatly transformed his body that she barely recognised him. It was like lying next to a different man entirely.
"He'd put on an enormous amount of weight and wasn't physically recognisable," says Dr Owies, a specialist in psychosexual medicine. "She'd really been unable to think about them as a couple ... She hadn't given herself permission, in the space of her own mind, to have these thoughts, because it felt disloyal. It was a relief to be able to speak to someone about it."
The emotional and psychological fallout from when cancer invades a marriage is complex, with layers that are difficult to identify or put a name to. The impact of the disease and treatment on a cancer victim's sexuality, and sexual relationship, is often put aside as trivial in the grand scheme of things – no matter it touches on questions of identity, confidence and the richness of life.
"But it seems that sexuality is something a lot of people, even counsellors and psychotherapists, are not comfortable speaking about," says Dr Owies, who is one of four counsellors running a telephone psychosexual counselling service, supported by the Cancer Council.
"We speak to women who have undergone the trauma of mastectomies and suffer body-image issues. There are men who lose erectile function after treatment for prostate cancer. For some people, how they feel about themselves is bound up with their sexuality. Some relationships have had a wonderful sexual life and the loss of it leaves them bereft and becomes a huge issue."
The phone service is an extension of clinics run out of Monash and the Women's Hospital in Parkville. The in-house clinics have a long waiting list and aren't convenient for country people.
"To discuss anything emotional, I would normally think it was necessary to be face to face with someone," says Owies. "But much to our surprise the telephone counselling has worked. There are some advantages it seems."
The anonymity has had a liberating effect for some callers; others are relieved to avoid attending the hospital yet again. "People who have been through treatment for malignancy or having ongoing treatment spend so much time in hospital, they are very pleased if they can get help by not going there."
The psychosexual counselling program can be accessed via the Cancer Council's confidential Helpline: 131120