The scans were returned. The operation went well. Your care team is happy with your progress. And yet, months later, something has gone quiet between you and your partner and no one at any of those appointments ever asked about it.
A serious diagnosis or major procedure throws your body, your energy and your sense of yourself out of kilter. Sex and intimacy are often the first to go, and the last anyone talks about.
One of the most common silent concerns for Maryland adults, and one of the most treatable, is reclaiming intimacy after a medical event. If physical closeness has changed since your diagnosis or procedure, you are not doing recovery wrong. You are experiencing a normal part of it that rarely gets named.
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Why Intimacy Changes So Much After a Health Crisis
Intimacy after a medical event shifts on two separate tracks at once, and most care addresses only one of them. The first is physical: fatigue, pain, hormonal changes, changes in erectile function, vaginal dryness, changes in sensation or the impact of medication.
The second track is emotional and it’s the one that tends to go unaddressed. Body image changes with a scar, or mastectomy, or weight loss; fear of pain teaches the body to brace; and many people grieve quietly for the sexual self they were before the illness.
In our clinical experience, couples are given a great deal of medical guidance in the first track and almost none in the second. The result is two partners who are coping with a physical recovery and an unspoken emotional one, both of whom are afraid to bring it up for fear of upsetting the other.
But the true barrier is silence, much more than the physical change itself.
What is Sex Therapy? How is it Different from Medical Treatment for These Problems?
Sex therapy is a type of talk therapy that focuses on the emotional, relational and psychological aspects of sexual concerns. It is not medical treatment and does not involve any physical exam or contact, the work is done through conversation in individual or couples sessions.
An AASECT Certified Sex Therapist has undergone intensive supervised training that meets the standards of the American Association of Sexuality Educators, Counselors and Therapists, the leading certifying body in the field. It’s the clinical gold standard for this kind of work and there are few offices in the Baltimore area that have it.
Founder Mark Goldberg, LCMFT, AASECT Certified Sex Therapist and EFT Certified Couples Therapist, created the Center for Intimacy, Connection and Change based on this fact: sexual issues following illness are rarely strictly physical. Our team does not replace your medical providers, but works with them. They work on the physical track and we work on the emotional and relational one.
Why do couples avoid sex after a diagnosis, even if the body has healed?
This is one of the most common patterns we see, and it takes a predictable form. After a health scare, the first attempt is awkward or causes anxiety, that discomfort is remembered, and the couple starts, without ever choosing to, to avoid the situation altogether.
Avoidance is the mind’s method of avoiding anticipated disappointment or pain. The problem is that avoidance becomes self-perpetuating. The longer intimacy is put off, the bigger and heavier it gets, until the pressure of a “first time back” feels too great to even try.
At the same time, each partner often misreads the silence in private. The one sees the distance as rejection. The other keeps the distance out of fear or protectiveness. Both feel lonely, and Neither one is really un-interested.
How Therapy Helps Restore Physical Intimacy
Effective therapy for these concerns uses approaches that have real evidence behind them and are tailored to the concerns the couple is facing. Some carry most of the load.
Mindfulness-based approaches to reconnecting with the body
Illness can make many people feel that their body is a place of treatment rather than pleasure. Mindfulness-based sex therapy is designed to rebuild present moment awareness and sensation and to gently shift attention away from monitoring and fear back to what actually feels good.
CBT and ACT for anxiety, body image and self-judgment
Cognitive and acceptance-based approaches focus on thoughts that hijack intimacy: fear of pain, feeling undesirable, or bracing for failure. You’re not trying to talk yourself out of these feelings but out of allowing them to hijack the encounter.
Emotionally Focused Therapy for Couple Connection
Emotionally Focused Therapy (EFT) is an evidence-based couples approach focused on the emotional connection between partners. Illness is isolating for both people and EFT brings back the feeling of safety and teamwork which permits physical risk again.
Getting rid of the pressure to “get back to normal”
Letting go of the goal of returning to exactly how things where is a common turning point in the work. Recovery is usually the creation of a new version of intimacy that works, and that reframe often releases the pressure enough that closeness can come back on its own.
When Should a Couple in Maryland Get Help?
You don’t have to wait and there is no minimum you have to reach to be worthy of help. It’s worth reaching out when a lack of closeness has gone well past physical healing, when avoidance has set in, or when the two of you can’t seem to talk about it without hurt or shutdown.
Getting a pro in sooner usually means a shorter, easier road back, before avoidance and misread silence have set in as a pattern.
We see individuals and couples in person at our Pikesville office and by telehealth throughout Maryland. The practice is AASECT sex-therapy certified and trained in EFT, so the emotional bond and the sexual relationship can be worked on together, by the same team, rather than split between two offices.
Getting Started
A medical event puts a massive strain on your body and your relationship. Surviving it doesn’t have to mean the long-term cost of physical proximity.
To help determine the right fit and starting point with our clinical team, a free 15-minute consultation is available. It’s normal and healthy to reach out as part of the recovery process. The issues you’ve been quietly carrying are ones our team hears every week.
Note: This article is for informational purposes only and is not medical advice. Any physical symptoms that occur after a diagnosis or procedure should be discussed with your treating physician. Questions about medication should be directed to your prescriber.
FAQ
Q1: Why does intimacy change after a serious illness or surgery?
A: It changes along two tracks: a physical one (fatigue, pain, hormonal shifts, erectile or lubrication changes) and an emotional one (body image, fear of pain, grief for one’s former sexual self). Medical care usually addresses only the physical track, leaving the emotional side untreated.
Q2: What is an AASECT Certified Sex Therapist?
A: A therapist who has completed rigorous supervised training meeting the standards of the American Association of Sexuality Educators, Counselors and Therapists, the field’s primary certifying body. Sex therapy is talk therapy only, with no physical exam or contact.
Q3: Why do couples still avoid sex after the body has physically healed?
A: An awkward or anxious first attempt gets remembered, and the couple begins avoiding intimacy without deciding to. Avoidance is self-reinforcing, and partners often privately misread the silence as rejection or disinterest when neither is the case.
Q4: Can sex therapy work alongside my medical treatment?
A: Yes. Sex therapy complements medical care rather than replacing it: the medical team manages physical symptoms while the therapist addresses the emotional, relational, and psychological side of reconnecting.
