Dating Post Diagnosis - Six Practical Tips

Editor's Note: For many women breast cancer can feel like a double whammy, an assault on our health and femininity. Throw in being single, and it gets even trickier. So I am so pleased to have this article on dating by Dr. Jan Gurley. Doc Gurley is not just a medical expert she is really funny! So enjoy, and happy Valentine's Day! Suzanne

When Avatar -esque aliens finally descend on us from another multi-verse, they will undoubtedly believe that Valentine's Day celebrates the mating rituals of the svelte, the pristine, the adored, and the orthodontically flawless. In other words, we take a day to honor sex lives of the Photoshopped. Because that's what you see everywhere, isn't it?

Our telescoping media-porthole onto the world has no room for people who wheeze, or snort, or gurgle adenoidally - not even for people who are frankly, well, (and there's no other way to put this) human. We all know that only beautiful people are supposed to kiss with any passion. Unless, of course, an audience needs some comic relief.

So where, after a lifetime of multimedia disgust-cultivation for the tiniest imperfection, does that leave anyone recently hit with a major diagnosis? Especially when we're talking about that most brutal of combinations - a disease whose treatment leaves you altered physically in some way, combined with the cut-throat environment of the dating scene?

But hey, some of you may be asking yourselves right about now, what qualifies Doc Gurley, or frankly, any other doctor, to talk about this issue?

To which I retort, cuttingly, um, good question. See, there's probably not a single other group of people who could out-geek the medical profession. And usually, when it comes to doctors, we're not talking about the adorable sub-genre of Juno-nerdishness, but a more socially stunted flavor. Because even if a budding pre-doctor began his/her existence with an above-average quota of insight and savvy, that training-decade of severe isolation and stress (during peak dating years, BTW) tends to permanently impair even the most promising. In other words, even social redwoods are, through training, emotionally pruned into Bonsai distortions. Which begs the question - is there any doctor, anywhere, ever, who should be giving dating advice?

Well, when you put it that way, maybe not. But see, here's the thing about medicine. There's no topic off-limits. And you do your patients a huge disservice by rebuffing, or failing to at least try to learn how to help. Even if you are emotionally reclusive, the day will come, sooner or later, when someone - a patient, a friend - cannot help themselves and breaks down, sobbing in an exam room, asking some of life's most raw and painful questions.

But isn't this a "social" issue, after all? Why should a doctor care? Or intervene? Why not just hand over the tissues and nervously re-arrange a jar of tongue depressors until the emotional storm passes? Hey, plenty of doctors do. But the problem is, for many patients, when it's time to face recovery, and the battle for survival has receded a bit, self-doubt is a disease that is epidemic, and virulent. Left unchecked, it can mutate into self-loathing, and then leave permanent emotional scars that can disable.

So how does your average, ill-prepared doctor learn what might help patients? Here's how - you channel your geekiness and put it to good use. You survey those who are better-informed. You take notes. You ask the people who succeeded how they did it. You look for patterns and methods and check them for internal validity. You brainstorm with your patients (experts). And then, of course, if there's not much out there on the topic, you write an article about it (ahem).

So here, in honor of love, are some practical tips on how to re-dip your toe into the dating scene after a major diagnosis.

1) Take inventory - There's nothing like a brush with near-death to force you to open your emotional closet, get out the bar-code scanner and see how your supplies are running. Is your resilience tapped out? Are you feeling vulnerable? Has there been a run on hope - so much so that your stores are severely depleted? Have your friends, family and loved ones rushed to replenish your stock? Do you see your treasures beginning to rebound? These are all important things to know. No one indicator means that you shouldn't reach out to others, whether in the dating scene or in other settings. but it's important to know where you stand before taking that first plunge post-major diagnosis. That self-knowledge can help guide you in knowing how much to protect yourself, and how slow to go, if you're ready to reach out and date - maybe with people you don't know at all. And if time is passing farther and farther post-diagnosis, and your emotional stocks never seem to replenish, it may be time to take steps to get help. Before opening yourself up to strangers, in any setting.

2) Show; don't tell - Proving that it's truly an ill wind that blows no good, there are times when the burden of confession is lifted from your shoulders. If you're rockin' a glorious Melissa Etheridge 'do, then you know that fretting over disclosure is something you won't have to worry about. But it may raise other questions for you: was your diagnosis part of the attraction? Are their other, less visible issues you'll struggle to reveal? If you're still on your treatment-journey, how much more resilience will you need if there's a break-up too? In a certain way, no matter whether your post-diagnosis self has visible changes or not, you certainly know that your psychological landscape has probably changed. Some of those changes may not even be apparent to you until you discover or explore them with a partner. Which leads us to...

3) The dance of the seven veils - No matter your gender, your diagnosis, or your state of healing, there's something to be said for ALWAYS viewing sex with a new partner as a dance of the seven veils. By that, I mean a deliberate step-by-step unveiling (sometimes physical, sometimes emotional). It can be hard to re-orient yourself to think that way, much less impose it on your actions, if you're a sexually mature adult. Kind of like acknowledging your newly-tender, possibly retro-sexually-adolescent self. But think of the joy and tenderness that was the best of adolescent exploration - that's what you want. When it comes (har) to sex, an unveiling is both powerfully seductive, and powerfully protective. If you deliberately move gradually into intimacy, you can, at each stage, take a breath and check whether this still feels right to you. Maybe your dance of the seven veils happens over seven months. Or, in contrast, seven minutes (hey, done safely, post-diagnosis, there's something to be said for pulse-pounding, unzipping, up-against-the-wall sex). Either seven veils in seven months, or seven minutes, can work, sexually, for some. But when it comes to the dance of the seven veils of emotional intimacy, however, that usually takes a bit longer to be performed safely - because you're dancing with each other. Emotions don't shift and settle as quickly as a pulse. The fact is - and there's probably a neurologic basis for this - it's hard to truly gauge another person's emotional reaction with any speed. Some things take a while to sink in - both for you and your partner. Knowing where you stand, and how you both feel, is worth the gift of time.

And so what happens if you feel the pull of love, but your partner doesn't seem willing to give you the time to move from veil to veil? That question reminds me of a great kid I know, a boy who wore his sister's neon pink ankle socks with long pants to the first day of second grade. His mom, a very lovely and reasonable person, didn't notice the socks until pick-up time after school. On the way home, she neutrally said, "Mike, hmm, those are interesting socks you wore." "Yep," he said, while munching on his after-school snack, "I thought it'd be a good way to find out who's mean." Someone who won't give you time doesn't deserve your intimacy. I know that sounds easy to say when your heart is not raw and aching, but it's important to remind yourself of your worth and the value of your gift of self. But what if your time frame seems to stretch "too long" - and even caring friends are telling you so? Some people would say there is not such thing as taking too long to jump back into dating and sex, that you should always follow your own time-table. But it's also important to consider whether you might be delaying intimacy for other reasons - maybe it's time to get out that bar-coder again and take inventory on your emotional state. Get help if you think a reality check is in order, but don't doubt your instincts because of partner-pressure.

4) Tell; don't show - What about the approach where you wave your diagnosis flag right from the beginning? There's some value to early ultimate disclosure. For some diagnoses, in some states, it's actually the pre-sex law (such as with herpes and HIV diagnoses). And, for some people, it's a "pink socks" way of sorting through the intimacy-applicants. But here's the downside: the goal of emotional health is that you are not defined by your diagnosis. Nor by the effects of your treatment. In every bed there is, optimally, only two people. Inviting your diagnosis/treatment into a sexual relationship before it even begins usually means that every action or reaction can be (rightly or wrongly) viewed through that lens. Crow-barring your diagnosis out of the bed at a later date may be harder than you might anticipate. So what's a middle-ground approach? Ah, one everybody likes to indulge - foreplay. Lots of it. Certainly find out if you can even tolerate the way your partner kisses before you hand over your heart/breast/prostate/HIV infection on a platter.

5) You show me yours and I'll show you mine - Many people report that mutual vulnerability is the way to go. By this, I mean that intimacy (physical and emotional) occurs in tandem. It's the strip-poker approach to post-diagnosis dating. For example, a person might say that they didn't feel comfortable revealing their struggles until they found out their partner had been through something traumatic in his/her past. Is there value to this approach? In terms of relationship power-dynamics (especially if you begin a relationship while you're still feeling fragile), the answer is definitely. But there are potential pitfalls. Once again, the goal is to be emotionally healthy (within and outside the relationship), and not to define yourself or your partner by your vulnerabilities. Except, perhaps, by the amazing strength and character that overcoming them has given you, thereby enabling you to live life to the fullest. There are few things more inspiring than meeting a patient who honestly forgets to mention a life-threatening disease or, when asked, refers to a cross-body scar, with a gurgling barroom laugh, as "what? that old thing?" It's a state that we all wish for ourselves and our loved ones - the battle scars that add character, instead of symbolizing an absence. There is much value to sharing your wounds with someone who's also wounded, but there are risks as well . Especially when it comes to your journey and efforts to reach a new level of peace and self-assurance, post-diagnosis.

6) What about when the rubber hits the...well, you get the idea - So happens when the glorious, gritty moment of full-contact slippery-sport arrives? It's important to keep in mind that, no matter what the diagnosis, or the self-perceived disfigurement, there are few sexual experiences that cannot be improved by three crucial L's: lube, love and laughter. If the relationship is right, and the intimacy dance is mutual, it'll be okay. Really. There are moments in everyone's life when something basic to human existence feels impossible to obtain. It's in those moments that it's good to remind yourself of one of the benefits of our massively-populated, over-connected age: thousands upon thousands of people with circumstances similar to yours are doing it. Right now. That's encouraging. Others have made it through this path. There are people to turn to , when you need help and reassurance. The bottom line is that if others can make it, so, (with appropriate protective steps to safeguard this gift of your true self that you want to give another), can you. Good sex is a powerful, nurturing force in life. Take steps to let it into yours.

Dr. Jan Gurley, a board-certified internist physician, is the only Harvard Medical School graduate to have been awarded a Shoney’s Ten-Step Pin for documented excellence in waitressing. 

She will be leaving for Haiti in a matter of days, and you can read about her journey at http://www.docgurley.com/ 

You can also follow her on twitter @DocGurley

Illustration from costcutting.com