The married couple wanted a family and resumed their efforts to do so after Chow beat thyroid cancer. After the diagnosis of endometrial cancer, though, they put their family plans on hold, before Chow’s ovaries were removed. This triggered the start of her menopause, shattering their baby-making goals.

Chow wondered whether her marriage would fall apart after her operation. Thanks to the hormonal changes in her body, she felt “no desire” for sex.

“I was very scared he would just leave me,” she said, tearfully.

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According to Dr Tse Ka-yu, a council member of the Obstetrical and Gynaecological Society of Hong Kong, common types of gynaecological cancers are those of the uterus (endometrial), ovaries and cervix. Depending on the case, treatments may have physiological changes that affect one’s ability to feel in the mood for sex. Endometrial and ovarian cancer patients may have their ovaries removed, which triggers the onset of menopause.

“Afterwards, their oestrogen levels are reduced, and this can affect sexual functioning,” explains Tse, adding that symptoms can include vaginal dryness and a lowered libido. Other consequences may be anatomical. Some cervical cancer patients undergo a hysterectomy – the surgical removal of the uterus.

“Their vagina will be shortened so this could cause difficulty in intercourse,” explains Tse, who adds that radiotherapy can result in a shortened vagina and dryness, too.

Assistant professor Chow Ka-ming from The Nethersole School of Nursing at the Chinese University of Hong Kong (CUHK) said it is common for female cancer survivors to suffer intimacy issues.

The academic led a study, which was published in medical journal Psycho-Oncology last year, that surveyed 225 Chinese gynaecological cancer survivors from ages 21 to over 60.

The study found that many reported feeling sexual impairment, and that 50.6 per cent of respondents had resumed their sex life only in the past one month of the study period. This was even though, in this sample, 76.4 per cent or 172 patients were married or with a regular sexual partner, and 62.2 per cent had completed cancer treatments more than six months prior.

There were many reasons the survivors did not engage in sexual relations. They often felt unconfident in their bodies as they adjusted to new disfigurement and scars, especially if they had had tumours or body parts removed.

“Some worried about reoccurrence [of the cancer] and some worried about transmitting cancer to their partner,” Chow says. “But we know this is a misconception.”

Such false beliefs can be corrected by a health care professional, but patients seldom air their fears.

“If we can clarify those misconceptions, their anxiety and uncertainty [about engaging in sex post-treatment] can be reduced,” Chow said.

Chow and Koo didn’t harbour such misconceptions, but assumptions they made about one another resulted in distance anyway.

“I didn’t know if she was ready, she may have had concerns. We dared not bring it up,” recalls Koo, adding that they wanted to respect one another.

This year, when the couple tried to get intimate, Chow found that sex was a painful experience for her.

She learned, through having attended Hong Kong Cancer Fund’s (HKCF) programmes for patients, about a two-day sexual health and intimacy workshop for breast and gynaecological cancer patients and their partners.

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The workshop was a trial project for the NGO, according to programme manager O’Nes Lai Pui-yu. Upcoming workshops are to be held quarterly, with partnering sexual health consultants. That includes registered sex therapist, nurse and counsellor Cannis Tang Wing-kam, who hopes attendees will broaden their views of intimacy and realise that the issues they face are not uncommon.

“They have this concept that sexual life equals sexual intercourse, but sexual life means many things – caressing, touching, kissing and other sexual activities,” Tang said.

According to Tang, a cancer survivor’s body changes, and this can include her erogenous zones. “They need to explore and re-explore those zones,” she explains.

Chow and Koo have found a new normal in their sex life thanks to lubricant and a vaginal moisturiser. Koo also took greater efforts to awaken his wife’s desires, he says. His work paid off.

“I experienced an orgasm that moved me to tears,” reveals Chow.

For Koo, it wasn’t the techniques so much as the workshop being a facilitator to get the couple to communicate and initiate questions about their changed sexual relationship. “All [of] this helped us trust each other and communicate more,” he says.

Chow agrees. “I encourage patients going through this to openly communicate with your partner how you physically feel and suggest what you need.” For her, that meant more foreplay, kisses and caresses.

For survivors who are experiencing discomfort or pain during sex, there are plenty of solutions available.

“Quality of life is important especially to those who survive cancer,” Tse says. “I encourage women to discuss this issue with your doctor, who may have a way to help.”

For more information about HKCF’s support on sexual health for breast and gynaecological patients, visit its Women’s Support Centre at Unit 5, Ground Floor, The Centre, 99 Queen’s Road, Central, or call 3666 3131. The next workshop is on January 11, 2020.