When Anne Shelley went into surgery at University of Colorado Hospital in 2012, she thought she’d wake up without the tumor on her rectum. Instead, she woke up without a rectum—or a bladder or a vagina. Dr. Saketh Guntupalli had discovered more tumors, and her husband, Chuck, had to make a nerve-racking decision: remove several organs and extend, but complicate, Anne’s life or essentially, let her die.

Chuck knew his wife was a fighter. She could get used to the bags that would help her dispel waste. One thing that didn’t occur to him in such a chaotic time: how Anne’s lack of a vagina would affect their sex life.

It’s not an issue that most cancer survivors and their partners think about, partly because the taboo nature of the topic means doctors aren’t likely to bring it up. “Only about 10 to 15 percent of physicians approach patients about sexual dysfunction at all, whether they have cancer or not,” says Guntupalli, Anne’s gynecologic oncologist (read: focused on cancer in reproductive organs such as the ovaries and cervix). “We need to be acknowledging that this is an important part of patients’ lives, and right now, we’re not doing a good job of it.”

Recently, Guntupalli has made an effort to shine a spotlight on the issue. In 2015, he conducted a research study to determine whether women with or survivors of gynecologic cancer face sexual problems and insecurities. It was the first detailed study to examine how the experience of enduring female reproductive cancer—including both physical and emotional side effects—impacted relationships. The results showed that couples were having sex far less frequently after a cancer diagnosis compared to before, and almost 15 percent ended up seeking out marriage counseling as a result.

Guntupalli then partnered with uterine cancer survivor Marynn Karinch to transform their conclusions into the recently released book Sex and Cancer: Intimacy, Romance, and Love After Diagnosis and Treatment, which goes beyond data to explore why cancer can be so debilitating to a couple’s sex life and what they can do to restore intimacy (think: communication, setting the mood, or, uh, using a product that’ll slide the process along).

In Anne’s case, she and Chuck had to think even further outside the box. At one point, she gave him the opportunity to walk away and find a spouse who he could live a more normal life with. “He said, ‘I love you, and we can figure out different ways to be intimate even though you’re missing your parts,’’ she says, laughing. “We’re really enjoying our life together as a couple now.”

In the future, Guntupalli hopes that new medications and therapy before treatment can help female cancer survivors overcome the barriers to an active sex life. “One of the things that happens to both physicians and patients when you get a cancer diagnosis is that you want to cure the cancer and get the patient to live,” he says. “That’s important, but what’s the purpose of surviving if you’re not thriving?”