Sexuality and breast cancer
Not all women with breast cancer will experience changes in how they feel about sex. Indeed you may find that your sex life improves because you have had to think about your sexuality, and feel closer to your partner as a result. If there are problems, physical and emotional issues can arise weeks and months after treatment, if not years later.
Talking about sex and sexuality can be difficult. But the more you understand it, the less awkward you may feel when discussing it with your partner, doctor or nurse.
What is meant by sexuality?
Sexuality has many different meanings and we all have our own individual ways of expressing it. Your sexuality is quite unique to you and involves your physical and emotional feelings. Your social background and cultural and religious beliefs can also influence your sexuality. You can express your sexuality in many different ways – through the clothes you wear, the way you move and speak, as well as by kissing, touching, and how you have sex.
Cancer treatments and their effects
Breast cancer treatment or the cancer itself can cause physical and emotional side-effects that may affect your desire for sex. These side-effects include:
Changes to your body or your appearance
Discomfort or pain
These side-effects can impact on your sexuality during treatment or in the months or even years afterwards.
Emotional effects of treatment
Body image and self-esteem
Body image refers to how you think about your body and the way you look. Your breast cancer treatment may bring changes to your body image. When looking at your body, surgery scars, weight loss or gain, skin changes, hair loss or regrowth may be a reminder of your cancer experience.
This may fill you with sadness or make you feel less of a woman. Your confidence may be at a low ebb as a result, making you avoid situations where people might comment on your appearance.
Your self-esteem may be affected too. You may no longer feel good about yourself and how you present yourself to the world. If your self-esteem is low or damaged, it can affect how you feel sexually. You may think that your partner finds you less attractive, which may not be the case at all. He or she may be looking for a way to help you but feel unsure where to start. A word from you, even if you find it embarrassing or hard at first, might make all the difference.
Take time also to explore other ways to be intimate with your partner and so get used to your new body image.
You may have to cope with the effects of hair loss due to chemotherapy. This can include body hair such as eyebrows and pubic hair, which can affect your body image and confidence. If you need more information call the Irish Cancer Society Cancer Nurseline on freephone 1800 200 700 or call into a Daffodil Centre.
Breast reconstruction is one way of coping with changes to body image following surgery. You may decide to have breast reconstruction for reasons related to body image, self-esteem and sexuality. It is possible to have reconstruction done straight after surgery or months or years later. It is important that any decision you make is right for you.
If you would like more information, call the Irish Cancer Society Cancer Nurseline on freephone 1800 200 700 or visit a Daffodil Centre and ask for our booklet Understanding breast reconstruction.
Weight loss and weight gain can be other side-effects of treatment for breast cancer. These can change the way you look and feel, and you may not feel comfortable with these changes.
Some women experience lymphoedema (swelling) following surgery or radiotherapy to lymph nodes in the armpit. You might be very conscious of the swelling and be reluctant to have intimate contact or sex.
If you have breast cancer, you might have feelings of anxiety and worry. As a result, you may not want to be the one to start physical contact or intimacy. Because of changes to your body image, you may feel your partner finds you less attractive and that your relationship is less special than before. You may also be anxious about meeting a new partner.
These anxieties will certainly take from your enjoyment of sex. You are also less likely to become aroused and reach orgasm if you are anxious and tense. These feelings are normal and will decrease over time. In the meantime, talking to your partner about your concerns may put your mind at rest. Let others know about your concerns, so that you do not feel you have to cope on your own.
Depression can affect some women with breast cancer. It can make you feel sad, low, lonely, and very tired. You may even lose your appetite and have trouble sleeping. You may no longer have any interest in your appearance or in sex or you may take little enjoyment from sex. If these symptoms persist, you may need specialist help. First talk to your GP or medical team, who may suggest ways of helping you at this time, such as counselling, therapy and drug treatments.
Breast cancer treatment can affect your fertility too. For younger women, it can be particularly worrying not knowing if your fertility will return after treatment ends.
The issue of long-term infertility may have to be faced. Naturally, this can make you feel quite alone and unable to express the sense of loss you may be experiencing. You may think that your young fertile friends could not possibly understand. Facing infertility when you are young may make you feel less of a woman.
For more information call the Irish Cancer Society Cancer Nurseline on freephone 1800 200 700 or visit a Daffodil Centre and ask for a booklet called Younger Women and Breast Cancer.
Hints and tips - Dealing with the emotional effects of treatment for breast cancer
The emotions you feel before, during and after cancer treatment can be difficult to deal with and can affect how you feel about yourself and your sexuality. Your partner may be affected too. Here are some ways to reduce the emotional effects of cancer treatment:
Give yourself and your partner time to adjust to / get more comfortable with any changes to your body and work through any sadness or shock you may feel because of your new body image.
Look after yourself and your appearance - continue your usual beauty routine and find out about wigs, clothing and breast prostheses that might help you to feel better.
Relieve anxiety by speaking openly to your partner about your feelings and any concerns you have about intimacy, and allow your partner to do the same.
If you feel that you need extra support, contact your GP or medical team, who can advise you on specialist counselling, therapy and drug treatments to help you get back to normal.
Physical effects of treatment
Pain and discomfort
More than likely you will experience some degree of pain or discomfort, regardless of the type of breast cancer treatment you have. It may be difficult to hold or hug your partner, especially if your wounds are still healing or if you have scarring after surgery. Your breast area may also be tender and painful to touch if it has been treated with radiotherapy. Solutions may include taking painkillers and a change in position during lovemaking so there is less direct pressure on your chest.
Fatigue is often experienced when having cancer treatments. It is an extreme form of tiredness, which is often not helped by rest or sleep. When feeling fatigued, you may have no desire for sex or perhaps would prefer a less active role. Try not to push yourself. Gradually the fatigue will fade and your energy levels will improve so you can actively enjoy sex again.
Most women experience menopausal symptoms after the following treatments for breast cancer: chemotherapy, hormone therapy, and ovarian ablation. Ovarian oblation stops your ovaries working either in the short term or long term. Symptoms may include fatigue, hot flushes, night sweats, mood swings, hair thinning, vaginal dryness or loss of elasticity. How you feel about yourself as a woman can be affected if you have menopausal symptoms. You may dislike how you look and no longer feel attractive to others. Having night sweats or fatigue may also lessen your interest in sex.
Sometimes younger women being treated for breast cancer have menopausal symptoms caused by chemotherapy or ovarian ablation. This situation can be either temporary or permanent, with quite severe symptoms at first. Menopausal symptoms can make younger women feel older than they are, which may affect their sexuality.
There are ways to help you deal with menopausal symptoms, particularly if they affect your lifestyle. Call the Irish Cancer Society Cancer Nurseline on freephone 1800 200 700 or visit a Daffodil Centre for more information on menopausal symptoms and breast cancer.
Vaginal changes after treatment for breast cancer, such as dryness and irritation, can result in painful or uncomfortable sex. Vaginal thrush is also common if you are having chemotherapy, especially if you are taking steroids or powerful antibiotics to prevent infection. Talk to your doctor about treatment for this problem.
It is best to wear loose-fitting cotton underwear and loose-fitting trousers. In general avoid tight-fitting clothes. Perfumed soap and bath products are also more likely to irritate your vaginal area. Symptoms can be relieved by vaginal moisturisers and lubricants, such as Replens MD®, Senselle or Hyalofemme®. Apply a water-based lubricant such as K-Y® Jelly, Astroglide® or Yes®, if you have discomfort during sex.
Dealing with the physical effects of treatment
Here are some tips to help you to manage the physical effects of breast cancer treatment.
If you are sore after surgery or radiotherapy take painkillers and try different positions to make yourself more comfortable during lovemaking.
Allow yourself time to rest and recover, especially if you are suffering from fatigue. Hugging and other gentle forms of physical contact can help maintain intimacy when energy levels are low.
Thrush and vaginal dryness are common side-effects of treatment – ask your GP or pharmacist about helpful over-the-counter treatments, such as vaginal moisturisers.
Always ask your GP or medical team if you need help in managing the side-effects of your cancer treatment.
After treatment, beginning or renewing a sexual relationship may fill you with anxiety and doubts:
You may be worried that your partner will make comparisons with the way things were before your diagnosis.
Your self-esteem may be low because of changes to your body, making you feel less confident sexually.
If you are beginning a new relationship, you may be unsure about how your partner will react to your body.
You may be slow to resume any kind of sexual activity, especially if your energy levels are low. It may take some time before you feel emotionally and physically ready for sex.
Not everyone experiences intimate relationships in the same way: they are unique to each of us. While you may have no desire for sex, you may still want to feel close to your partner. Hugging, kissing, holding hands or even massage may satisfy you, or you may have other special ways to feel close.
How you communicate with your partner is vital at this time. Once you and your partner share your feelings and try to support one another, you should be able to enjoy sex and feel fulfilled in time.
There is no perfect time for resuming sex. Do it in your own time and at your own pace, but don’t rush things at first. Naturally, you will feel nervous or anxious about your first sexual experience after your diagnosis. Your relationship will enter a new phase, as you find ways of adapting to changes arising from your breast cancer.
You may have to think about taking painkillers or using different positions so that you feel more comfortable and relaxed. It may take a while for your confidence to return, but there are ways of building it up. You might feel more at ease if the lights are turned down or if your chest area is covered rather than bare. Sex may feel less spontaneous for a while, but at least you may feel less anxious.
Your breasts are an erogenous zone and many women enjoy having them stimulated during sex. Following surgery, the loss of a breast may lessen your enjoyment of sex. Your partner also may have taken pleasure from the look and feel of your breasts. To overcome the sense of loss and feel more sexually fulfilled, you and your partner may want to explore other erogenous zones. Sex toys, like vibrators, can be another way of giving pleasure, if you prefer.
You cannot catch cancer or pass it on by having sex.
Remember that this can be a particularly anxious time for your partner too. He or she will also need time to adjust to your diagnosis and treatment.
The way in which your partner now relates to you sexually will depend on how he or she first reacted to your diagnosis. Reactions can vary:
Your partner may just need time to accept your illness.
He or she may be overprotective and fuss over you to save you from the least distress.
Your partner may not mention or begin to have sex in case it upsets or hurts you.
He or she may find it very difficult to accept a diagnosis of breast cancer.
If you partner is finding it hard to deal with your cancer diagnosis or the effects of treatment it can be especially stressful for you, as you may feel rejected for a short time or even permanently. The best approach is to try talking to your partner and to explain your feelings. It is quite possible that both of you are assuming how the other is feeling. Both assumptions may be entirely wrong and could be made right by sharing your feelings.
At some point after your diagnosis you may begin a new relationship. The prospect then of telling your new partner about your breast cancer can be daunting. You may be unsure about the timing and how to put it into words. However, the more you get to know your partner and the longer you spend in his or her company, the more you can relax and talk about all your life events.
Eventually, the time will feel right. Your new partner is likely to react in one of the following ways. At first, it may come as a shock and he or she may not be as supportive as you had hoped. But having had time to adjust to the news, they may then rally round.
On the other hand, your new partner may be very understanding and recognise that your breast cancer is just one of your many life experiences.
Coping with the emotional and physical effects of a breast cancer diagnosis can be very difficult. Naturally, you and your partner will need time to accept any changes arising from your diagnosis.
There is also professional support available from counsellors, psychologists and sex therapists. Ask your medical team for further information. Because everyone’s sexuality is unique, your reaction to your diagnosis is individual to you.
Before your diagnosis, you may not have given your sexuality much thought, but now you may know exactly what it means to you. As a result, you may be more able to enjoy and be fulfilled in your sexual relationship.