This article is part of Generation Why, a HuffPost Healthy Living series putting the spotlight on young adult cancer patients and survivors between the ages of 15 and 39. For more on the series, click here.
In 1997, fresh out of college, Tamika Felder moved from her hometown in South Carolina to Washington, D.C., to chase a job as a television producer. When she landed her first gig, she didn't care that it didn't come with health insurance. She was just happy to be working. If a health crisis came up, she figured she'd go to a free clinic.
Four years later, Felder's career was on track, and she was happily single and dating. When she secured a job with health insurance in 2001, she scheduled a routine gynecologist visit for a long overdue exam and pap smear. The test turned up cancerous cells on her cervix, and she was diagnosed with advanced-stage cervical cancer. "I never really knew anybody my age who had cancer," she says. "I actually thought the doctor was crazy."
Felder underwent a procedure that removed her uterus, cervix and part of her vagina, leaving her with her ovaries. That was followed by a month and a half of chemotherapy and radiation treatments. After treatment, she was left with bad radiation burns, a crooked butt crack ("It's like a question mark almost," she says) and an inability to have children. She can still have sex, but her vagina is only two inches long.
"You're 25 and feel like you're 85," she says. "Everything that made me feel like a woman was gone."
The self-described "boy-crazy social butterfly" quickly retreated from the social scene, falling into a deep depression. Dating was off the table. "There was the anxiety of having to come clean about me not being 'normal,'" she says. "I felt like a leper."
Each year, some 70,000 young adults in the U.S. between the ages of 15 and 39 are diagnosed with cancer. While cancer at any age can be devastating, this group finds themselves battling a sometimes deadly disease at the same time they're asserting their independence in ways both big and small: moving out on their own, establishing careers, managing finances and, yes, dating.
When it comes to finding love, in particular, having cancer takes so many of the issues that singles face -- body image, sexual experience, self-esteem and the task of explaining one's personal history -- and amplifies them. "Dating with cancer is like dating intensified," says Kairol Rosenthal, author of Everything Changes: The Insider's Guide to Cancer in Your 20s and 30s, who was diagnosed with thyroid cancer at age 27. "It's like dating on steroids."
"On one hand, it's a terrible time to think about dating because you're really vulnerable," she says. "On the other hand, when you're really vulnerable and you're single, you really want the hope of comfort."
That doesn't necessarily mean young cancer patients need to hit the pause button on dating, but it can be more complicated. Like anyone else in the midst of a traumatic life event, experts say, they should be cautious about pushing themselves to date before they're ready, despite cultural and familial pressures to marry and have children.
Rosenthal -- who dated and ultimately married her husband during her yearslong battle with thyroid cancer -- says patients and survivors, much like their healthy counterparts, need to be honest with themselves about what they're really looking for: a companion? a distraction? a life partner? If an individual doesn't know or if a sick person is likely to mistake her own neediness for feelings of love, it may be best to hold off on dating altogether. Although, Rosenthal points out, fate can override such decisions: If someone meets the right person, even after deciding on a dating hiatus, he shouldn't necessarily dismiss that person on principle.
Complicating matters further, Rosenthal says, cancer patients can sometimes have trouble relating to a healthy partner. Diagnosis and treatment can create a bubble of sorts, and they might be shocked to see others worrying about trivial things when they've been focused on the enormous task of staying alive. "I think it is important to recognize that you might be in a different headspace than the rest of the humans walking around you," Rosenthal says.
When patients do opt to date, Rosenthal suggests setting clear boundaries: Obviously, health and treatment take priority over a hot night out. Making that choice can take self-awareness and discipline -- and support.
Sometimes the best advice comes from other patients in the form of online or in-person support groups. "The doctor may tell me one thing, but the doctor is some old guy in a white coat. My parents might tell me something, but they're my parents," says Bradley Zebrack, associate professor of social work at the University of Michigan, whose research focuses primarily on adolescents and young adults with cancer. "Now here's somebody I can relate to."
Inevitably, some patients and survivors end up dating each other, taking comfort in someone who can commiserate. (Certain online dating sites even promise to do the matchmaking.) But Rosenthal cautions that while she certainly wouldn't rule out a mate with cancer, it's hard enough to make a relationship work when one partner is diagnosed with the disease. "I would not like to have my life struggles times two," she says.
While receiving treatment at Johns Hopkins Hospital in Baltimore, Felder recalls meeting one young married couple in their mid to late 20s. The wife was there for every one of her husband's treatments, Felder says. "I remember thinking, 'I wish I had someone,'" she says. "Partly because if I was already married, if I was already in a committed relationship, that person wouldn't leave me."
But Felder eventually realized she had to accept herself as a cancer patient before anyone else could. "It can really shock people's confidence and self-image," says Zebrack, the University of Michigan professor. "It can sometimes take years until that comes back, if at all."
It took Felder about a year before she was even comfortable flirting and months after that until she could think about dating. Her first trip back to happy hour was difficult. "I couldn't even enjoy the cute boys," she says, "because I was trying too hard not to be the girl who had cancer."
After a series of bad dates, including one in which she nervously chatted the whole time about cancer ("I never heard from him again") and another in which a man asked her if not being able to have children meant she was up for spontaneous sex ("Ah, no"), Felder eventually built her confidence back up. "Go out, have fun kissing boys, enjoy your life," she says. "I might not have all my lady parts, but I'm still a woman."
Self-esteem problems aren't confined to women, of course. Jonny Imerman, founder of the cancer support group Imerman Angels in Chicago, was diagnosed with testicular cancer at age 26. He had his testicle removed and underwent chemotherapy. When he was 28, the cancer recurred with four tumors in his abdomen, which were surgically removed. When his scans were finally clear, he says, his confidence had hit a "0.00." During treatment, he had gained 40 pounds from inactivity, his skin became dry and cracked, and his eyebrows and eyelashes were gone. "I remember looking in the mirror sometimes crying," he says.
Despite a very supportive network of family and friends, Imerman says, he craved the comfort of a steady relationship. "It's so chaotic when you're single that all I wanted when I was done [with treatment] was stability," he says. Two months out of chemo, he rushed into a serious relationship. But as his confidence started increasing post-cancer, he realized she might have been the perfect fit for "Chemo Jonny," but not for cancer-free Jonny. She was an introverted movie buff, which worked well when he was still exhausted from treatment, but as he started to get his old energy back, he realized their temperaments weren't aligned.
"Dating after cancer is like being blindfolded in the dark forest trying to get to the other side," Imerman says. "You don't know who you are after that. You're so rattled."
A cancer diagnosis isn't always a social disadvantage. "It was certainly a great icebreaker," says Will Reiser, screenwriter of the 2011 film "50/50," which was inspired by his own experience with cancer. At 25, Reiser was misdiagnosed several times ("For like three weeks, I thought I was going to die," he says), before his doctors concluded that he had a large cancerous tumor wrapped around his spine.
One area of his life that didn't take a hit was dating. Unlike his "50/50" counterpart Adam, Reiser didn't deliberately exploit cancer to pick up potential dates, but he says telling women he had just survived the disease certainly didn't hurt. "I felt a lot of nurturing female energy around me," he recalls. "When you tell people you're a survivor, people always seem so impressed, like I had anything to do with it … It's like I got a doctorate or something, like suddenly I had more insight into life."
But while cancer didn't necessarily hurt his social life, it did kill his sex life. "You feel really alienated from your body," he says. "The idea of dating and trying to feel attractive is really difficult when your body isn't functioning the way it should."
Cancer can take a profound toll on sexual health, says Sage Bolte, a licensed clinical social worker and an oncology counselor for the Life with Cancer program at Inova Cancer Services in Fairfax, Va. In her own work, she's found nearly everyone experiences some impact on sexual function, whether because of direct effects of the disease on a sex organ or because of treatment side effects, such as extreme vaginal dryness, shifting hormone levels, exhaustion or changes to the skin due to radiation. An altered self-image after cancer can also affect sexuality. "The brain is probably the most powerful sex organ," she says.
On top of that, young adulthood is usually a time of sexual experimentation, learning what and whom we like and don't like. "Certainly cancer and its treatments can stunt that exploration in a big way," Bolte says. Sex may be good, perhaps even better than before cancer, she adds, but it will always be different -- either because the body has changed so much or because there are lasting psychological effects, and sometimes both.
Once someone is ready to re-enter the dating scene, one of the biggest challenges is figuring out when -- and how -- to tell a date about the cancer. "Some people are really out there," Zebrack says. "They'll wear it as a badge of courage because their attitude is if the person can't handle it, they might as well know upfront."
Jen Smith, a 35-year-old divorced mother in Champaign, Ill., calls cancer her "d-bag filter." She was first diagnosed in September 2007 with breast cancer at age 30 while she was still nursing her 8-month-old son. She had a lumpectomy, six months of chemotherapy and seven weeks of daily radiation. Three months later, she found out that not only had the cancer returned, but it had spread to her bones. That meant the disease was stage-four, or terminal; median life expectancy after such a diagnosis is about three years. She was 31, her son almost 2.
"I decided that if my time is going to be short, you look at the whole quality vs. quantity," Smith says. There was no time to be unhappy: She exited a bad marriage in 2009 and set a goal of seeing her son go to kindergarten, which she reached this past August. And she's dated a bit, posting some online dating profiles that reveal her diagnosis ("I do have cancer but that's a part of me like having brown eyes") and others that don't. She says she received more responses with the latter approach, but with the former heard more often from the type of man she'd like to date -- someone who has the same enthusiasm for life, she says, whether that means embracing a vacation together or just giggling while cooking a shared dinner at home.
"I'm looking for someone who just really knows how to love life," says Smith. "I'm not bored, I'm not desperately lonely. If you add to my quality of life great, but if not, I don't have time for it." After two casual and one more serious relationship, Smith says the greatest lesson she's learned from dating is about herself. "I know that I'm lovable," she says. "I know that cancer didn't take that away from me."
One of the most common things Bolte hears from cancer patients is, "Who's going to want me now that I'm damaged goods?" Her answer: "We all come to the table with baggage. If you've lived through adolescence, you come to the table with baggage. The right person will be able to take it as part of their life and not something that weighs them down."
While Smith says some men have been spooked when she's revealed her diagnosis, she gets it. "I can understand why a lot of people would say no. Even if it's this great ride, it's probably going to end in heartache, no matter what," she says. "That's their choice and that's fine."
Now on a combination of five different drugs, Smith, who worked as an academic adviser at a community college before going on disability to become a "professional cancer patient," says her latest scans show the treatment is working, meaning her condition is stable with no new tumors.
WORDS OF ADVICE
Though the decision about when to disclose medical history to a potential romantic partner is a very personal one, experts typically recommend doing so before anyone becomes too emotionally involved. "Everybody has a way of disclosing their story, and there is no right or wrong way to do it," Bolte says. But she often advises patients to share the news by the fourth or fifth date. "Before you start getting overly involved, give them a chance to walk away without you feeling betrayed."
For those on the other side of this difficult conversation -- people considering a relationship with a cancer patient or survivor -- Rosenthal says the most important strategy is to keep an open mind. "I think the first thing that pops into people's minds is hair loss, exhaustion, maybe they'll die," she says. "The biggest thing for them to keep in mind is to not make any assumptions about what somebody's cancer is like. Cancer isn't just one disease … There is a much broader range of experiences."
The best approach, she says, is to ask open-ended questions, make the effort to address difficult topics and, above all, listen. It's normal, too, if someone isn't sure how to have this particular conversation. Individuals might have scripts in their mind for other possible dating bombshells, like a divorce or a child, for instance, but many young people don't know anyone their own age who has faced a serious illness. Rosenthal suggests saying things like, "Is this something you do or don't want to talk about?" or "What's your energy level right now?"
"It's the same boring stuff that makes any relationship work or not work, like communication," she says. "Just be a really good listener."
When asking uncomfortable questions, Rosenthal advises, a simple disclaimer can go a long way -- like, "Sorry if this is a really stupid question, but ..." or "If you don't want to talk about this, that's fine ..." She says, "I understand why people are afraid to ask questions: You don't what to offend somebody. If you're a little apologetic beforehand, the worst thing that they'll say is, 'Jesus, stop being so apologetic.'"
For the really tough questions, such as those related to diminished fertility or sexual dysfunction, Rosenthal advises holding off discussion until the relationship has moved beyond a few dates. And even then, it's best to phrase those inquiries carefully. For example, instead of "Can you have children?" one might ask, "Does this change the way you plan to have a family?" Or rather than "Can you have sex?” try saying, "I'm so sorry if I have this misconception that because you have cancer you're physically fragile, but am I going to hurt you?"
For their part, some cancer patients may feel it's not "fair" to date someone when they're sick and may even push potential suitors away, but Bolte, the oncology counselor, firmly disagrees. In fact, people who have been through a core-shaking experience like cancer may experience a shift in perspective that ultimately makes them even more lovable, she points out -- they might have a new appreciation for life that a healthy person doesn't.
Dealing with mortality, in particular, can add an extra layer of complication. While some with a terminal diagnosis might pull out of dating, others, like Jen Smith, strive to cultivate meaningful relationships to make every moment the best it can be. Bolte, for one, hopes people with a terminal diagnosis don't avoid intimacy if that's what they want. She remembers one patient diagnosed with an aggressive form of cancer in her 20s. When it came back in her 30s, the disease was incurable. At that point, all she wanted was a partner. She found someone who accepted her diagnosis, knowing full well that he would develop feelings and she would die.
"He was an amazing partner. He brought her so much joy. She brought him so much joy," Bolte says. "If they want to date you and they know about it, that's their choice, their informed choice."
For Tamika Felder, the perfect fit came in the form of someone she had met when she first moved to Washington, before her cancer diagnosis. They dated for a bit, but at 21 she was focused on establishing her career and enjoying the single life, while he was set on settling down and getting married.
About a year and a half ago, after Felder's cancer went into remission and just when she was starting to wonder if she'd always be single, her best friend suggested she reach out to that old boyfriend, Rocky. Though she figured he was probably married by then, she contacted his sister on Facebook and asked her to have him call her. She didn't hear back for some four months. But one day, her phone rang at work. "I remembered his voice like yesterday," she says. "So warm and so sunny."
She was scared at first ("He knew what my body was like before cancer," she says), but he was patient and gentle with the realities of her post-cancer body, and the two became engaged this past April. "My life is wonderful. Would it have been wonderful without cancer? Probably. But not this good," Felder says. "It took having my life almost taken away from me to really appreciate it and my worth."
That ending, she says, was worth the wait.
"There is someone out there for everyone. And until you find that perfect someone, have fun with the person before," she says. "You still have to kiss a few frogs until you find your prince, whether it's in the chemo ward or in the club."