Patrizia Giungato | Psychologist – Psychotherapist – Oncology Coach

Sexuality represents a fundamental dimension of human experience and quality of life. It extends beyond sexual function to include identity, relational, emotional, and symbolic aspects. The World Health Organization (WHO) defines quality of life as the individual’s perception of their position in life within the cultural and value systems in which they live, and in relation to their goals, expectations, standards, and concerns (WHO, 1998).

In the oncological context, however, this dimension is frequently overlooked. Clinical attention is primarily focused on survival and disease management.

Fear of death and fear of recurrence represent two central dimensions of the oncological experience. These fears become so dominant that they diminish attention toward the body as a place of pleasure, relationship, and identity. In this scenario, sexuality is often perceived as secondary and therefore suspended.

Numerous studies show that sexual dysfunction affects a large proportion of cancer patients, particularly women (Brotto et al., 2016; Reese et al., 2017). Despite its significant impact on quality of life, sexuality remains insufficiently addressed within care pathways (Stead et al., 2003).

Cancer and its related treatments extend far beyond the biological dimension, affecting the individual as a whole.

The body is the first place where the disease manifests:

The body may shift from being a place of experience to one of fragility and loss of recognition (Carter et al., 2018).

Diagnosis introduces a fracture in personal identity:

This dimension is not limited to emotions but involves a deep reorganization of internal experience.

The couple relationship is profoundly affected:

Partners may also experience significant distress. Men, in particular, may develop a fear of harming the woman, perceived as fragile or ill, leading to avoidance of intimacy.

In some cases, the relationship is unable to sustain these changes and may enter into crisis or dissolve. Not all partners are able to assume a caregiving role, and withdrawal or abandonment may occur (Manne & Badr, 2008).

When sexuality is lost, the relationship risks losing one of its primary channels of connection.

Many women no longer perceive their bodies as a source of desire.

Attention shifts toward symptoms and treatment side effects, particularly hormonal therapies, which significantly reduce sexual desire.

There is often a lack of education and information from the very beginning of the care pathway (e.g., Breast Units).

Sexuality is therefore experienced as no longer accessible.

The turning point lies in the recovery of femininity, understood as a deep dimension that is not lost but needs to be rediscovered.

The present work introduces the CORE model, developed by the author, as an integrated clinical framework:

The CORE model allows a multidimensional understanding of the person and guides both assessment and clinical intervention.

The symbolic approach described here, developed by the author, represents the operational key to the CORE model.

It is not an additional component, but the clinical device that enables the model to be effectively applied.

Through images, metaphors, and sensory representations, individuals can access the meaning of their experience.

This allows:

In clinical practice, the symbolic approach enables the transformation of the illness experience through meaningful imagery.

One patient initially described her illness as something dark and invasive. Through the therapeutic process, this representation evolved into a pink cloud, symbolizing fragility, transformation, and possibility.

This image was drawn and placed in her living space as a symbolic anchor.

This transformation allowed the illness to become integrated into her experience.

This approach may represent a useful tool for other professionals.

An integrated approach is required:

Vaginal laser therapy may also be beneficial; however, many women are not informed about this option.

There is a need to increase awareness and accessibility of such interventions.

When sexuality is reintegrated into care:

The process begins with the recovery of femininity and leads to the possibility of renewed pleasure.

Sexuality is an essential component of quality of life.

Fear of death and recurrence risks overshadowing it.

An integrated approach is required, including practices such as Tai Chi, mindfulness, acupuncture, and nutrition, without neglecting emotional, relational, and sexual dimensions.

Living in fear means living outside the present. The present is the space of resources and possibility.

Individual and group work provide the framework through which individuals can recover a true dignity of life.

The meaning of illness becomes an entry point into a new way of relating to oneself and others.

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