How the Fear of Death Can Impact Intimacy

Staying close helps joy overtake fear.

Source: Juan Moyano / Shutterstock

Stephanie Pfeil’s young marriage had the most dramatic high and low a couple could face: A new baby and a grim 8 percent chance of her survival from a rare, aggressive cancer. Her oncologist warned her not to get pregnant again because her treatments could have a harsh negative effect on a fetus. And birth control pills were out when the cancer caused a blood clot.

The options for intimacy were obviously limited.

Fast forward to 2024: Steph and Mark have celebrated their twentieth anniversary, and their son Caden, now 18, is headed to college.

Steph’s entire journey in those early years of her marriage and illness comes to life in a book written by her father, Michael Schnabel. Mike brought the story to me, and I was very moved by it, ultimately helping him publish his book. Apart from that, I interviewed Steph to focus her story on the issues covered in this blog.

In Daddy’s Girl: A Father, His Daughter, and the Deadly Battle She Won, Mike talks about the blissful first week Caden is home and how, as new grandparents, he and his wife embrace the silliness of baby talk. He concludes Chapter 2 with, “The second week everything changes.”

Steph was diagnosed with a type of colon cancer so unusual that her doctor said it’s only discussed in textbooks. She makes it very clear that every day of her battle, she felt the strength of her connections with her parents, husband, and newborn.

Mike shares with others the mechanisms for sustaining that kind of strength in a short book he wrote that distills the lessons in Daddy’s Girl. It’s an eBook called Living Through a Crisis: A Guidebook for Loved Ones, which he gives to anyone asking for it.

Steph notes,

When I got sick, Mark and I grew closer. We hadn't been married very long. Connecting with him suddenly meant connecting in a different way. It was connecting in having a new baby and the intimacy that came along with that. It was being with him and doing things together—trying to raise the child together and not being alone in fighting cancer.

She continues,

Since we were living with my parents at the time, to have quiet time together, Mark and I would either go upstairs and leave Caden downstairs with them or bring Caden with us. Whatever it took to help us focus on ourselves together and continuing our life as a couple. Even though we had a newborn, even though I was sick, we still took the time we needed to nurture our relationship through talking, hugging, sharing our joy as new parents.

The spectrum of responses to a couple’s fear that one of them might die is wide. In interviewing dozens of couples for the book Sex and Cancer, which I co-authored with my gynecologic oncologist, Saketh Guntupalli, I heard stories of strengthened connection and commitment over and over again. But I also heard stories of the cessation of intimacy after a cancer diagnosis. The fear of death overwhelmed some partners. It robbed the couple of connections at a time when their mutual need for the happy hormone related to intimacy of all kinds—oxytocin—was a desperate one.

Guntupalli and I saw all of the following:

• Increased emotional distance, with one or both partners experiencing a sense of isolation or a preoccupation with personal fears, makes it challenging to connect with others on a deep emotional level.
• The desire for connection drove the partners to seek even greater emotional and physical satisfaction with each other than they’d had before. They made their intimate relationships with both partners and others a priority.
• Impact on sexual intimacy that tracked with the ill person’s physical ability and the couple’s shared need. As the story of Steph and Mark suggests, some couples necessarily had a decrease in the full range of sexual activities, yet that didn’t preclude them from focusing on each other in enjoyable ways.
• Communication challenges—fear of death is a tough thing to talk about—that result in reduced trust or feeling of complete comfort with a partner. That is bound to impact intimacy negatively, at least for a time.
• Desire for a more contemplative approach to the relationship, with one or both partners feeling more inclined to reflect on the meaning of their lives together than sexual intimacy.

Steph explains that she and Mark didn’t ignore the reality of her illness and pretend life was normal. They just didn’t let it ruin the life they wanted together—the life they committed to having together that was full of joy, intimacy, and new parenthood.