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Breast Cancer and Sexuality
(09/30/2004) by Annette Owens, MD PhD
According to The American Cancer Society (www.cancer.org), breast cancer is the most common cancer among women, other than skin cancer. Being diagnosed with breast cancer is life changing. Each woman deals with this disease in her unique way, depending on her specific circumstances. In this article, I will focus specifically on how sexuality can be affected. Responses are manifold and influenced by whether there is a sexual partner, by the quality of relationships and by whether sex has previously figured prominently in the woman’s life or not. For women without partners it is useful to reach out to friends or family members for support. The resource section at the end lists additional sources for information.
The Acute Phase: In the early phase of breast cancer diagnosis, sex may be the last thing on a woman’s mind. Her priority instead will be on treatment and survival. However, she may find much needed comfort in sex with her partner at this time. Feeling close may be more important now than ever. I always encourage the partner to be sensitive to her specific needs, whatever they might be. Cancer is not contagious. Receiving radiation or undergoing chemotherapy does not harm others. Holding, hugging, and kissing will become more meaningful than ever. Having a supportive partner or friend is crucial at this time. Going to the oncologist appointments together makes it easier to absorb all information and to ask all questions. Couples should talk about problems as they appear and try to be open with each other about the effects of the disease on their life.
Treatment Side Effects:
Whether breast cancer treatment consists of surgery, hormonal therapy, chemotherapy, radiation or a combination of these, it usually leaves a woman depleted of energy. What energy is left goes towards dealing with nausea, pain, fatigue and other treatment side effects.
Hormonal therapy is usually directed against cancer cells that are sensitive to or depend on estrogens for growth. Side effects of hormonal therapies include decreased sexual desire, hot flashes, cessation of menstruation in premenopausal women (stop having your period when you should), urinary problems, edema (swelling), vomiting, and nausea.
Chemotherapy may trigger menopause in women, causing vaginal discomfort (including soreness and dryness), hot flashes, mood-swings and decreased libido. Application of estrogen cream (only if prescribed by the oncologist – it may be contraindicated if the cancer is estrogen sensitive) may reduce or relieve some of these side effects. Application of lubricants such as KY Jelly or Astroglide helps against vaginal dryness. Other side effects of chemotherapy include hair loss, weight loss, fatigue, anorexia (decreased appetite for food), nausea, vomiting, and bone marrow depression. Many of these side effects will cease over time following the completion of chemotherapy treatment.
While a woman receives radiation therapy, fatigue and skin discomfort can be potential concerns.
After Treatment Is Over: After the acute phase is over, the woman has to adjust to her new role as a breast cancer survivor. Typically she feels emotionally and physically drained and uncertain about the future. Resuming sex at this time can seem a tremendous barrier, but this is also a hurdle that might prove rewarding to leave behind. Sex can bring partners closer at a time when it is most needed.
Desire for sex may be low due to depression, anxiety, grief, emotional stress or fatigue. Or perhaps it was low to begin with. Here I will focus on situations where the breast cancer survivor does want to make sex a part of her life again.
Making Love Again: Many women find that the “usual” ways of making love are remnants of the past, and that significant adjustments will have to be made in order for sex to be pleasurable. If touching or sucking of the nipples used to be arousing, then having one or both breasts removed can create considerable anxiety. I always explain to my clients that there might be other things that can turn them on and I invite them and their partners to try to involve all senses in their search for arousal: Using visual stimulation (looking at sexy pictures or films), reading erotic material, smelling delicious foods, or searching by touch for other pleasurable areas on the body that may become new sources for pleasure.
Pain During Intercourse: Consulting an oncologist or gynecologist about this problem is advisable. Pain during intercourse can sometimes be relieved if the woman is on top, controlling the level of penetration and the amount of thrusting. Lots of lubrication can make intercourse less painful.
Body Image And Feeling Attractive: Some physical changes are only visible to the lover and it may take courage to reveal them in intimate situations. Often the breast cancer survivor is more upset about her mastectomy scar, or possible hair loss, or weight gain, than her partner. It sometimes helps to try to imagine that the situation was reversed and the partner is the one who has the “flaws.” I ask my clients: “Would you mind making love to your partner with those physical changes? Chances are that your partner is just as attracted to you as before. We usually judge ourselves too harshly. So if your partner tells you that he or she still finds you attractive, please DO believe it! If you still feel uncomfortable about your body, consider wearing a brief night gown, camisole, or bra during sex. Whatever makes you feel better about yourself is fine.” The book Show Me (See resources) has photos of breast cancer survivors and their stories about body image. Seeing other women with or without breast reconstruction sometimes helps a woman to accept her own body after cancer treatment. The American Cancer Society offers a program “Look Better….Feel Better” which teaches cancer survivors skills to improve and enhance their appearance (See resources).
When The Lover Also Is The Caregiver: In situations when the lover also is the caregiver, perhaps helping with personal hygiene, it can be difficult to feel sexy around each other. It may help to clearly separate care-giving times from times when the couple has sex.
Fertility: Breast cancer treatment can affect fertility. Women with cancer who wish to become pregnant in the future should discuss this concern with their oncologist.
Resources:
Harpham, W.S. (1995) After cancer. A guide to your new life. HarperPerennial
Schover, L.R. (1997) Sexuality and fertility after cancer. John Wiley & Sons, Inc.
A booklet on sexuality and cancer (by Dr. Schover) is available for free from the American Cancer Society, 1-800-ACS-2345 or www.cancer.org
“Look Good….Feel Good” program by the American Cancer Society, 1-800-395-LOOK
Show Me. A Photo Collection of Breast Cancer Survivors’ Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image (1999) Penn State Geisinger Health System; (717) 531 5867
Many cancer survivors highly recommend the books and audio tapes by Bernie S. Siegel, MD: http://www.peoplesuccess.com/siegel.htm
The American Association of Sex Educators, Counselors and Therapists (AASECT), www.aasect.org; (804) 644 3288
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