Sexuality following breast cancer treatment

• Breast cancer and sexuality
• Components of sexuality
• Body image and self esteem
• Side effects of breast cancer treatment: Chemotherapy
• Relationship changes after breast cancer treatment
• Cancer myths

 

Breast cancer and sexuality

There are many things which can affect the way a woman feels about her own body and her sexuality following breast cancer treatment. Surgery, whether it be breast-conserving surgery or mastecomy, can change the appearance of a woman’s body and affect her self-esteem. Chemotherapy can cause fatigue, have profound effects on libido (sex drive), and induce premature menopause with associated physical and emotional changes. The emotional impact of a breast cancer diagnosis and the treatment process can also affect a couple’s physical and emotional relationship.
Together, these changes can make sexuality an important issue for women returning to normal life after breast cancer treatment. However, despite its importance, sexuality after breast cancer is an often-neglected issue, as many women feel uncomfortable raising the issue with their partner or health professional. The following article aims to provide an overview of some of the issues which may concern you or your partner, and to provide a starting point for discussion of these concerns.

Components of sexuality

Sexuality is a complex idea. It does not refer simply to sexual drive, desire or activity, but also includes the concepts of body image, self-esteem, mood, support, and emotional connection and intimacy. All of these can be affected by a diagnosis of cancer.

Body image and self esteem

Most women diagnosed with breast cancer will undergo either a lumpectomy (breast conserving surgery) or mastectomy (removal of the whole breast) as part of their treatment. Radiation therapy to the breast may also result in scarring or changes to the shape or size of the breast. This can have a profound impact on a woman’s body image, self-esteem and sexuality.
Some women report feeling ‘less feminine’ after mastectomy, while others feel very uncomfortable being naked, either alone or with a partner. It is important to discuss these changes with your partner, so that you are both aware of your concerns. You may find that it helps to wear a camisole or other nightwear to bed to conceal the surgical scar until you are comfortable. Other women prefer to wear a breast prosthesis and bra at night.
Another issue which often concerns women after mastectomy is the loss of pleasure from the breast which has been removed. Surgical or radiotherapy scars may also be painful or uncomfortably sensitive. One strategy which may help in this situation is to focus on stimulation of other areas of the body, for example the neck or inner thighs. Again, discussion of the changes with your partner will help both of you feel more comfortable with your new body shape, and discover new ways of finding pleasure. Most of all, it is important to take your time.
 

Side effects of breast cancer treatment: Chemotherapy

A number of the chemotherapy drugs used to treat breast cancer have hormonal effects, suppressing the normal function of the ovaries. This causes the early onset of menopause. Symptoms may include hot flushes, reduced libido, or vaginal dryness. The symptoms of chemotherapy-induced menopause may be more severe than those of natural menopause, and women with a history of breast cancer are usually advised to avoid hormone replacement therapies (HRT) to relieve symptoms. All of these symptoms can affect a woman’s sexuality.
There are several strategies which may help to alleviate or reduce some of these symptoms:

• If vaginal dryness is a problem, use a water-based gel that has no perfumes or colouring added. Lubricant gels such as Astroglide can be used on a regular basis for general comfort, or spread around and inside the vagina before intercourse to make penetration more comfortable. It is important that you do not use oestrogen-based creams without first discussing it with your doctor, as they may be considered unsafe.
• Some women may prefer to use a product called ‘Estring’ to improve vaginal dryness. This is a soft rubber ring, similar to a diaphragm, which is inserted into the vagina. It is coated with oestrogen and slowly releases this hormone over a three month period, improving vaginal lubrication. It is thought to be safer for women with breast cancer as the oestrogen is not absorbed into the bloodstream, and acts only locally in the vagina.
• Persistent loss of libido (sex drive) is not uncommon following cancer treatment, and may be at least partially due to the hormonal changes associated with chemotherapy. Testosterone is sometimes used to help counteract these changes. If this is an option which interests you, discuss it with your health care practitioner.
• Another strategy is simply to try to re-focus your attention on your partner in non-sexual ways, such as touching, hugging or massage.

Other side effects of treatment may include fatigue, depression and nausea. If these symptoms persist or are causing you concern, discuss them with your doctor, as there are treatment options available. In particular, it is important to be aware of the possibility of depression. Depression is very common following a diagnosis of cancer, and is a serious illness which requires professional help.

Relationship changes after breast cancer treatment

The diagnosis and treatment of breast cancer can have a significant impact on a couple’s relationship. The partner of an affected woman may be reluctant to initiate or engage in physical intimacy due to fear of causing pain; or sexual desire may have become obscured by fears about the illness or losing their partner. This can be mistakenly interpreted as rejection.
By discussing the underlying reasons, some couples find that their relationship is even strengthened. One strategy which may help you re-connect is by focusing on methods of intimacy other than sexual intercourse. If problems persist, you may wish to consider seeking help from a professional sex therapist.
Single women entering new relationships after treatment for breast cancer may also have fears about the changes to their body, and the possibility of rejection. It can be difficult to know when to share health-related fears with a new partner. Discussing these issues with a counsellor may help.

Cancer myths

Adapting to life after treatment for breast cancer can be difficult enough without the additional stress of misinformation.
Some of the common myths or misconceptions about breast cancer and cancer treatment are explained below:

• Women who have undergone radiotherapy do not become ‘radioactive’. There is no risk to her partner through physical intimacy.
• Cancer is not contagious. It cannot be caught by someone else.
• Resuming a sexual or intimate relationship following breast cancer treatment is not dangerous. In fact, it may help a woman to come to terms with the changes to her body, and begin the process of re-asserting her self-esteem.

Most of all, it is important to remember that the end of your cancer treatment is not the end of your cancer journey. It takes time to adapt to the changes that have taken place. Some women and their partners will take longer than others, and there is no ‘right’ time for this to happen in.
You may wish to consider talking to a health care professional, whether that be your doctor, a nurse, or a specialist counsellor, if there are any issues that are concerning you. There is also literature available, both on the internet and in print, which can give you more information. Communication with your partner remains the most important part of adapting to and accepting the changes that have occurred.

More information

For more information on breast cancer, types of breast cancer and its investigations and treatments, as well as some useful videos, see Breast Cancer.

References

1. Akkerman D, Hordern A. ‘Sexuality and breast cancer addressing the taboo subject,’ Cancer Forum. 2000, 24(2), 165-168
2. Hordern A. (2000). Intimacy and sexuality for the woman with breast cancer,’ Cancer Nursing. 2000, 23(3)
3. Meyerowitz B, Desmond K, Rowland J, Wyatt G, Ganz P. ‘Sexuality following breast cancer,’ Journal of Sex & Marital Therapy. 1999, 25:237-250
4. National Breast Cancer Centre and National Cancer Control Initiative. 2003. ‘Clinical practice guidelines for the psychosocial care of adults with cancer’. National Breast Cancer Centre, Camperdown,NSW.
5. Wilmoth MC. ‘The aftermath of breast cancer: an altered sexual self,’ Cancer Nursing. 2001;24:278-286