The evening Eden and her partner were supposed to celebrate one year together became the most painful turning point of their lives. Instead of a restaurant table and a celebration of young love, they found themselves at an urgent care clinic facing a devastating diagnosis: Eden, 31, an artist and designer at the start of her career, had advanced cancer.
The diagnosis came after five days of unusual fever and abdominal pain. “On the fifth day, I said, OK, instead of a restaurant, let’s go to urgent care,” Eden recalls. At the hospital, she was told she had stage 3-4 Hodgkin lymphoma. From that moment, she was forced to trade her paintbrushes for aggressive treatment cycles and a daily battle for her life.
The reality became even more complicated when the war broke out. A sense of physical insecurity and fear of being alone led the couple to move in together earlier than planned. Amid national and personal chaos, the intimate structure of their relationship underwent a painful transformation: her partner left his job, and the young romantic partnership gave way to a caregiver-patient dynamic.
“I was completely crushed. I couldn’t get up from the couch by myself,” she says. “He declared himself my main caregiver and didn’t leave me for a moment. On one hand, that is amazing. On the other hand, the things that brought us close at the beginning of the relationship, sexuality and togetherness, disappeared completely. My illness put everything in a sensitive and unclear place.”
As the intensive chemotherapy and biological treatments began, the physical space that had once been a source of pleasure became a source of fear. Blood thinners created an existential fear of injury or bleeding, turning intimacy into a potential threat. “They warned me that if I got injured, the bleeding wouldn’t stop. I knew that could also happen during sex, and I was very afraid,” she says.
Extreme weakness left no room for desire. Eden describes trying to preserve fragments of closeness out of sensitivity to her partner’s needs, even as her own body betrayed her. “I gathered the strength to pleasure him, but slowly that also stopped. There was no possibility of pleasuring or being pleasured by anything connected to the body.”
Months passed, and the disease receded. But the physical disconnect remained even after treatment ended and follow-up care began. The hope that everything would return to the way it had been was crushed into reality.
A year and a half after her diagnosis, Eden is still mourning the loss of the ease and naturalness that once defined the relationship. Intimacy has turned from a source of comfort into a task requiring effort, practice and a constant fight against the body’s memory of pain.
The trauma of treatment left her with extreme sensitivity that surfaces during moments of physical closeness. “Every little thing hurts,” she says. “During intimacy, pain suddenly surfaces in unexpected places, where it should not be felt. I tense up, and it ends right there.
“To this day, we haven’t really returned to an intimate routine. From something that was simply fun, sex between us turned into exercises, difficulty, pain and anxiety. This takes work even when the instinct is to pull away. There is so much guilt and difficulty around it; it feels like yet another front in the battle. I often find myself grieving the fact that it hasn’t returned, and realizing I have to get to know myself all over again inside this new reality.”
Cancer is not only a disease of the body. The psyche is also under attack. The first battle is, of course, for life. Against a sophisticated and elusive enemy, the first goal is survival in the most basic sense. But for many patients, the battle against the disease is not only a confrontation with cancer cells that have invaded the body. It is also a daily struggle over sexual identity and the couple relationship, an area often pushed aside because of medical urgency.
Studies show that about 60% of women dealing with breast cancer experience significant damage to sexual function, including dryness, pain and a dramatic drop in desire following hormonal changes and treatment. Among men, the situation is similar: A Harvard University study of prostate cancer patients found that about 70% cope with erectile dysfunction following surgery or radiation.
The difficulty is not only mechanical or physiological. Changes in the body and body image, including scars, hair loss or a feeling of betrayal and insecurity, create an emotional wall that makes openness and intimacy harder. When a partner becomes a caregiver instead of a lover, it becomes difficult to preserve the romantic spark.
“I underwent a mastectomy and reconstruction because I wanted to regain a natural, feminine appearance. It was a long, complex operation, about 10 hours, followed by at least a month of recovery,” says a breast cancer survivor in her 40s.
“Every evening, my husband changed the dressings and effectively became a nurse. The chest area and the abdomen, from which the tissue was taken for the reconstruction, looked terrible. He was really good at it, but the more grateful I felt for his devoted care, the more sexually distant I became. How can you feel desirable after your partner has seen you in that state?
“Another disappointment came when I understood that as wonderful as the reconstruction looks, and as amazing as the doctors are, sensation in the breast will never return. An organ that was so warm and sensitive to touch became numb, a monument to what it once was. The love remained and even grew stronger, but you have to work on its physical expression. You have to find alternatives to what was familiar.”
For Eyal, 43, “happily married” and a father of two whose career at El Al was at its peak, cancer was not only a biological invasion. It was a threat to everything that defined him as a man.
Diagnosed with Hodgkin lymphoma at 37, Eyal had to confront the illness while also facing an old trauma. He lost his mother to cancer when he was 16, and the memory of her fighting to maintain a normal appearance was seared into him. “It was very important to her that people not know,” he recalls. “If someone knocked on the door, she immediately put on a wig.”
When chemotherapy began to threaten his own appearance, old demons woke up. “There was enormous stress when the disease arrived,” says Eyal, a member of the “Stop Cancer” community for young cancer patients and survivors. “It connects to a lot of childhood insecurities, after years of self-work and understanding that I am a good-looking person and that my appearance is very important to me.
“One of the side effects of chemotherapy is hair loss. Forget all the existential fears, suddenly you are also worried about losing a very significant marker of your appearance. Losing the look you are used to is a crisis. It sat in my head the whole time and sent me into a spiral: What will I look like? Will people accept me? Love me? Will I still look good?”
The identity crisis peaked when his body began to change. “After the second treatment, I sat in the waiting room, put my hand on my head and when I lifted it, clumps of hair were left in my palm. That day I decided to shave it all off.”
But the hair was only the beginning. Steroids and treatment changed the way his body felt, inside and out. During the long months of treatment, sexuality became an unattainable luxury. Eyal describes a state in which the body and mind shift into survival mode and libido simply disappears from consciousness.
“It wasn’t on the table at all. At the beginning, doctors say, ‘These are unhealthy substances; you have to wait a few days before sexual contact.’ So from the start, you have to be careful. Later, you retain fluids from the steroids and feel completely swollen. The body is very sensitive, there is severe fatigue and you simply don’t feel sexual. The libido does not exist. You do not need sex. You cannot even imagine it.”
For Eyal, as for Eden, the major crisis came precisely after the final treatment, when the medical envelope disappeared. “After six months or a year in which you are constantly surrounded and protected by doctors and tests, suddenly all at once you are left in a vacuum, with a mind that deals with the disease all the time: What if it comes back? Every small pain, every sensation, every sleepless night worries you because of the trauma. It took me a very long time to recover and accept my new body. I had to rebuild myself, to mend the breaks and wounds.”
His return to himself was active and deliberate. He did not wait for the feelings to pass on their own, but set out on a rehabilitation journey that included intensive exercise and deep work as a couple. “I started training toward the end of the treatments. I wanted to return to a body I loved, one I felt comfortable with, not to be out of breath from every small action.”
The attempt to restore what had been lost in the bedroom was accompanied by conflict and the need to learn the language of intimacy anew. “It took me a long time to let go, because when your head is preoccupied, things don’t work.
"Physically, my wife adjusted to the new situation more quickly. That led to quite a few fights, because ultimately everyone wants to feel desired. But the body remembers. When the mind stops dealing with fear or anxiety about what might happen, it makes room for the body to work.
“We sought advice and attended workshops to help rekindle it. It is work in every sense of the word. After 15 years, attraction is not the same as the raw passion of early dating, but you learn to make other things come alive: scent, touch, intellect. Slowly, you return to life.”
One of the main barriers to coping with the loss of sexuality and desire during illness is the silence of the medical system. Caregivers do not often ask about the subject, and patients feel it is superficial or inappropriate to deal with sexuality when life itself is at stake.
Studies published in the past have shown that patients feel the issue of sexuality rarely comes up in conversations with oncologists, leaving them isolated and guilty.
Prof. Gal Markel, director of the Davidoff Comprehensive Cancer Center at Rabin Medical Center, points to a gap rooted in mutual embarrassment. “It is not only that patients don’t talk about it. Doctors don’t ask about it either,” he says.
According to Markel, while doctors tend to focus on physical side effects and clinical fears, patients are often troubled by existential questions about their identity. “Doctors think the patient is anxious about what side effects they will have or how much pain they will be in, when in fact much of what occupies them is entirely different questions, such as whether I will be able to keep working, function as a partner, as a parent, whether I will be able to continue providing, to be a friend, a family member. The effects on sexuality can come from countless directions, even if there is no direct injury to the target organs.”
Treating sexuality among cancer patients, Markel says, is not a quality-of-life bonus, but a core part of modern medicine. “We are not treating a disease. We are treating human beings. Not only the patient, but also the family. I talk about this in every lecture I give. It is a significant part of our vision and mission.”
How does that translate into practice?
“The more whole, secure and functioning a person is in the psychosocial aspects, of which sexuality is an essential part, the greater the chance that treatment of the disease will also be more effective,” he says.
“It is not enough just to survive. You also have to thrive. Even if ultimately the treatment fails, the journey itself is very, very important. For those who recover and for those still inside the journey, sexuality is critical, part of the most basic things about being alive. Addressing all these layers builds resilience and eases suffering.”
That difficulty, shared by many patients of different ages, led in November 2024 to the opening of a new service at the Davidoff Cancer Center: a sexual therapy clinic.
The professional service offered to patients includes not only direct counseling, but also staff training on “how to talk and what to do,” to make sexual therapy and emotional support an integral part of the oncology protocol. Similar clinics have opened at other hospitals in recent years, and various cancer organizations also provide sexual counseling.
The clinic at Rabin Medical Center (Beilinson) was established through an unusual grassroots collaboration between the hospital and the Stop Cancer nonprofit. The nonprofit, founded in memory of Tal Yakobson by her parents, Zohar and Yankale, together with CEO Shira Segal Kuperman, works on behalf of young patients and survivors. It examined which patient needs were going unanswered and found sexuality ranked high on the list of untreated concerns.
Today, the clinic accepts patients free of charge, even though sexual therapy is not included in Israel’s public health basket. The clinic is headed by Malca Graucher, a certified sex therapist who brings a unique identity to the therapeutic field.
Graucher, an ultra-Orthodox woman, entered the profession 20 years ago after a young yeshiva student approached her with a question about sexuality while she was working as an educational counselor and parenting instructor. “To help him, I made inquiries through rabbis, and that is how I reached a course in marital intimacy guidance,” she says.
The need for the clinic stems from the understanding that sexuality is an inseparable part of a person’s vitality precisely at the hardest moments, explains Graucher, who sees sexuality as a tool for easing the threatening loneliness of patients.
“No one truly understands, or can understand, what a sick person is going through,” she says. “The very fact that there is a partner who is with them is a significant source of strength. I am speaking about sexuality in the broad sense, everything connected to connection, touch, a hug, a kiss, holding hands. If serious illness is perceived as death, sexuality is life. They are really two extremes.”
But the path to intimacy is full of painful obstacles, especially around body image. Many patients feel deeply estranged from themselves. “They tell me, ‘They turned off my switch,’ ‘I don’t recognize my body,’ ‘I can’t look at myself,’” she says. “Women come to me after breast cancer and they look amazing. Their hair has grown, their body is beautiful, they are thin, and everyone around them is happy that they have returned to themselves, except them.
“When I sit with such a woman in the clinic, it sometimes becomes clear how deeply she is grieving the scars and the body that did not return to the way she had hoped or imagined. They share that during sex with their partner, they do not take off their undershirt, and some cannot even look at themselves in the mirror.”
The damage, Graucher says, is systemic. Treatments can “castrate” patients physiologically, and changes in the vagina, uterus or male function create “a new body the patient does not know.”
To address that complexity, the clinic operates with a broad multidisciplinary approach that includes a full array of professionals. “Oncologists, urologists, gynecologists, endocrinologists, psychologists, social workers, physiotherapists, fertility doctors for men and women, psychiatrists, coordinating nurses, radiotherapy staff, and we even have a rabbi. The goal is to provide a precise response on the physiological, emotional and cultural level.”
Treatment at the clinic examines sexuality on physiological, psychological and sociocultural levels. It begins with a sexual assessment questionnaire that also clarifies the patient’s type of cancer, stage of disease and specific treatments. Graucher looks closely at side effects and asks for a comprehensive sexual history to understand the patient’s condition before the illness.
Although the initiative began in connection with the young adults clinic, intended for patients ages 18-44, Graucher stresses that treatment is available to all ages. “I also have patients in their 70s,” she says. The service is available to all patients and their partners.
The goal of treatment, she says, is to “expand the body’s space” for men and women without penetration or conventional sex, and to focus on giving and receiving pleasure equally. A central tool in the process is sensate focus, in which couples are instructed “not to touch any intimate organs, not to have penetration, not to have conventional sexuality,” but to relearn the body through giving and receiving pleasure.
Graucher notes that “our largest sex organ is the brain,” and that “fantasy is above all.” “Sometimes the partner says, ‘I am afraid to touch. Maybe I will hurt her or do something unpleasant.’ It is important to normalize that, saying: ‘This is a known phenomenon. You are not the only one this happens to. It makes great sense that after one treatment or another there will be pain, there will be fatigue.’ The pace is not mine to set; it belongs to the person in front of me. My role is to create space, normalize what they are experiencing and give it legitimacy.”
The clinic offers not only technical solutions, but above all hope. “I will do everything I can to find an appropriate solution, even if it is only a partial one, because ultimately I want to offer hope and show that it is possible to learn to enjoy the new body and discover a new sexuality within it.
Rachel (alias) is one of dozens of patients treated at the clinic. At 43, while running a thriving business in Bnei Brak, raising six children and celebrating the wedding of her eldest son, an aggressive breast tumor shook not only her body, but the most intimate foundations of her marriage.
“I felt a lump. I went to the family doctor and told him I wanted a mammogram,” she says. Although the mammogram came back normal, an inner intuition and encouragement from a kind technician led her to request an ultrasound referral as well. The ultrasound revealed an aggressive cancerous tumor that required chemotherapy, surgery, radiation and biological treatment.
At the height of treatment, Israeli reality added another layer of difficulty: Her husband was called up for reserve duty, and Rachel was left to manage the home and the disease as her extended family mobilized to keep the household functioning and help with the children. After chemotherapy came surgery, followed by radiation and prolonged biological treatment, which she completed only recently.
The effect of treatment on sexuality was brutal and immediate. Rachel received injections to suppress her menstrual cycle, throwing her abruptly into menopause. “One day I was 30, the next day I was 60,” she says.
Rachel’s 22-year marriage was tested in a way many couples would not survive. “Treatments dismantle the relationship. It is a miracle if you stay together,” she says. The difficulty also lay in how quickly their roles changed: from lovers to roommates, or worse, to caregiver and patient.
The sexual difficulty became physical, emotional and halachic all at once. “During treatments, you close yourself inside a bubble. You have no emotional capacity for anything. Your body hurts and your mind is somewhere else. My husband is healthy, he has his desires, but I am not there, because I am exhausted,” she says.
In the ultra-Orthodox community, those challenges carry added weight. The prohibition on certain contraceptive methods and the difficulty of going to the mikveh during treatment created an almost insurmountable barrier. “It is sleeping in the bed like roommates. People break from something like that. I am lying there and no one can touch me.”
Inside the great difficulty, there was also a point of light. Amid the chaos of treatment, when even making a cup of coffee became impossible, Rachel rediscovered her husband. “He was completely there for me. I told him, 'the medal is on the way',” she says with a smile.
For her husband, cancer was not unfamiliar territory; his mother had died of breast cancer years earlier. “He knew exactly where this journey led. He was afraid of the known, and I was afraid of the unknown. But he knew exactly how to make things easier for me and how to be there for me.”
Rachel says open and professional conversation saved their intimate space. “Graucher helped us understand that we had to approach intimacy differently. Today it is not like it was before, I admit that. Sexuality gives me a comfortable feeling. It reminds me that I am a person, not only a patient.”
The path to recovery begins with redefining sexuality. The key to rebuilding intimacy lies in patience and communication. Experts stress that during difficult treatment periods, sexuality can and should take the form of gentle touch, a kiss or simply comforting physical closeness, without the pressure to achieve traditional “performance.” Open communication about fears and physical limitations is one of the most powerful therapeutic tools. Preserving intimacy is an anchor of vitality and sanity.
“People want to return to life, to return to sexuality and touch. This has a very important place both in the recovery process and after recovery,” Graucher says. “The goal is for the body to also be a source of pleasure, not only a reminder of pain and loss. Many times, we are occupied with the sexual response cycle, with the functioning of organs, especially intimate organs, but sexuality can be expressed in every part of the body.
"We examine the physiological, psychological and social side and try to create desire based on closeness, touch, warmth and love. To expand the body’s space, and allow patients to explore it again while enjoying it.”
Three years after his illness, Eyal feels the journey has made him a more whole person. “Mentally and emotionally, I am in a much more complete place than in the past,” he says. “A healthier place, with less preoccupation with what is not under my control. I focus on the here and now, and on enjoying the life I have.”
Rachel, who is still coping with difficult physical side effects, is learning to accept her new body, thinner and more wrinkled, and finds comfort in small things. “Making a ponytail in the morning and making a sandwich, that is not taken for granted. The children see me. I am present.”
Eden and her partner are not giving up either. They have turned to couples and individual therapy, understanding that a relationship that survived cancer needs new tools to repair the ruins of intimacy.
“It’s OK that it takes time, and it doesn’t necessarily mean we need to separate or that things can’t return to their natural course,” Eden says. “I truly believe that things will work out.”