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Renegotiating Sex and Intimacy After Cancer: Resisting the Coital Imperative

Ussher, Jane M. PhD; Perz, Janette PhD; Gilbert, Emilee PhD; Wong, W. K. Tim PhD; Hobbs, Kim MSW

doi: 10.1097/NCC.0b013e3182759e21

Background: Previous research on sex and intimacy in the context of cancer has focused on documenting sexual changes and difficulties, primarily focusing on heterosexual individuals who have sexual or reproductive cancers. Analyses of sexual renegotiation and the social construction of sex are largely absent from the research agenda.

Objective: The objective of this study was to explore renegotiation of sex in individuals with cancer, and in partners, across a broad range of cancer types and relational contexts.

Methods: Semistructured interviews were conducted with 44 people with cancer (23 women, 21 men) and 35 partners (18 women, 17 men), 86% of whom identified as heterosexual. The data were analyzed with theoretical thematic analysis, from a material-discursive-intrapsychic perspective.

Results: Renegotiation of sex or intimacy was reported by 70% of participants, reflected in 3 themes: “resisting the coital imperative: redefining ‘sex,’” “resisting the coital imperative: embracing intimacy,” and “adopting the coital imperative: refiguring the body through techno-medicine.” The importance of relational context was reflected in the theme “the inter-subjective nature of sexual re-negotiation: relationship context and communication.”

Conclusions: Whereas previous research has focused on embodied changes associated with sexuality after cancer, or their psychological consequences, the findings of the present study suggest that hegemonic constructions of “sex,” in particular the coital imperative, are central to the experience and negotiation of sex and intimacy after cancer.

Implications for Practice: Resistance of the coital imperative should be a fundamental aspect of information and support provided by health professionals who seek to reduce distress associated with sexual changes after cancer.

Author Affiliations: Centre for Health Research, School of Medicine, University of Western Sydney (Drs Ussher, Perz, Gilbert, and Wong); and Department of Gynaecological Cancer, Westmead Hospital, Sydney (Ms Hobbs), Australia.

This research was funded by an Australian Research Council Linkage grant (LP0883344), in conjunction with the Cancer Council New South Wales and the National Breast Cancer Foundation. The authors received in-kind support from Westmead Hospital and Nepean Hospital. The chief investigators on the project were Drs Ussher, Perz, and Gilbert, and the partner investigators were Gerard Wain, Gill Batt, Kendra Sundquist, Ms Hobbs Catherine Mason, Laura Kirsten, and Sue Carrick.

The authors have no conflicts of interest to disclose.

Correspondence: Jane M. Ussher, PhD, Centre for Health Research, School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 2751, Australia (

Accepted for publication September 20, 2012.

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