Breast Cancer & Sexuality

Over 2 million women in the United States are now living with breast cancer. There are many ways breast cancer and its treatment can affect intimacy and sexual response. Your activity and energy levels may change. Worrying about your illness may intrude upon your everyday life. Other stresses such as sadness, financial problems, pain, and treatment side effects will have their impact. Breast cancer might change the way you view your body physically, and how attractive you may feel. How you and your partner deal together with breast cancer also may alter sexual feelings.

A woman's desire and need for sexual activity and intimacy doesn't necessarily change because cancer comes along, however these needs can be greatly influenced by the diagnosis, treatment and emotional affects of a cancer diagnosis. This section is to help inform you on the ways breast cancer effects sexuality, and help you to begin take charge of your needs for sexuality and intimacy.

Ways to Cope with Changes in Sexuality and Intimacy

Although your doctor may not bring it up, sexual functioning is a legitimate area of concern when discussing breast cancer treatments. Particularly if you are an older woman, a doctor may not initiate a conversation about the impact of treatment on your sex life. Your doctor can help you evaluate what is normal for you, and what changes in your sexual activity may be due to breast cancer treatment. If you are uncomfortable talking with your doctor about these issues maybe a social worker or nurse may be easier for you to talk to. Remember to be patient and give yourself time with dealing with these sexual issues. It is important to talk to your doctor about:

• Decisions about breast reconstruction, what is important to you, available to you, what to expect what the outcome is likely to be. It is necessary to be realistic (ask to see pictures), and to understand the effect on sexuality. For example, a reconstructed breast will most likely have little or no sensation when touched. There are two options: implants and autologous procedures/tram-flap (which means using your own tissue from areas such as the abdomen, back or buttocks). Ask also about nipple replacement and what choices you have. Many women report positive feelings about their appearance, and increase in self-esteem after breast reconstruction.
• Information about ways to help alleviate some of the physical changes, such as vaginal dryness or pain. Different positions during sexual activity may help sex be more comfortable. There are also products available that women can use to provide moisture to the vaginal area. Two that don't require a prescription are Astroglide and Replens.
• Treatments and suggestions for coping with side effects that contribute to loss of sexual desire such as nausea, mouth sores, fatigue and pain. Ask for help, there are many options available. Lymphedema (a condition that occurs in some women after a lymph node dissection) can be managed. Find a physical therapist that specializes in physical side effects of breast cancer treatment.
• Reassuring a partner who is worried about harming you during sexual activity. Sometimes partners also have their own anxieties about cancer. Include your partner in discussions with your doctor.

Think About What You Need

Give yourself time to get used to the changes. Spend some time alone, looking at your body, touching it and exploring the changes. This might be hard initially, give yourself time, many women find this difficult to do. When you feel ready, talk to friends or partners about your feelings about your new appearance. Grieving the loss or change in your breast is normal and can help you move forward. Talk to other women who have had breast cancer to see how they have coped. Joining a support group may provide you a place to talk about these feelings.

Increasing your comfort level in your first post-treatment sexual experience. You may feel some anxiety about activities that used to be natural such as undressing in front of your partner, or sleeping naked. Some women find wearing attractive lingerie helps. Plan sex for when you are feeling stronger and energized, which may be earlier in the day, or at times between treatments. Have some quiet time first with your partner that includes affection, to get used to each other again.

Take the pressure off intercourse and express sexuality using other ways such as oral sex, massage, kissing, and fondling, without it having to culminate in intercourse or orgasm.

Talk with your partner to find positions and activities that provide the most pleasure and minimize any discomfort. While engaging in intercourse or more intense sexual activity, stop the activity if you are feeling discomfort; help your partner understand what you were experiencing, change positions and apply extra lubricant.

Communicating with Your Partner

Breast cancer happened to your partner as well. Opening the lines of communication can create opportunities for intimacy and sharing that you didn't know were possible.

• You may both need to make time for something more intimate, like talking, affection and touching. Partners may be very busy providing wonderful, concrete, practical help like shopping, laundry, or preparing meals so you can rest.
• Start off by talking, about anything! Reconnecting is crucial and will open the door to talking about other issues. It is often easier to talk outside the bedroom and not during sex. Create a time and place where you can have privacy and few interruptions. Ask a grandparent to baby-sit, plan an evening together. Remember, if you have never talked about sex before, this is a good time to open the door to the subject. Have realistic expectations.
• Although it is difficult, you may have to be the one to bring up the subject of sexuality. Partners may not know what to say or fear talking will be too painful for you. Talk about what is important to you, any fears of rejection, and any feelings about the changes in your body. Ask and listen to what is important to your partner, the fears and feelings he or she may be having.
• Your partner may worry about pain and how to touch you. Make an agreement to let your partner know when and if any activity causes discomfort, so your partner can proceed with confidence.
• Although you may view your body in a different way, don't assume your partner is having the same experience. Studies show that partners of breast cancer survivors see the loss or alteration of a breast as less important in comparison with the fact that you have survived and are with them. Your partner cares for you as the whole person, not by each body part.
• Many women fear their partner will abandon them. A breast cancer diagnosis does not increase the incidence of divorce. Sometimes the crisis of illness will help partners to work harder. Sometimes the stress of illness on an unhappy relationship will be too much. Many women are the ones to leave their partner after breast cancer, choosing not to waste time in an unhappy relationship. If your relationship does fail, try not to place blame on yourself or your illness as the only cause.