Breast Cancer & Sexual Intimacy
Sex after breast cancer?
In a previous blog and podcast we opined on the difficulties of maintaining relationships with loved ones, family, spouses, partners, etc. following a breast cancer diagnosis. Now we look at the adversarial effects of breast cancer towards sexual intimacy. Many, although not all, women find that breast cancer treatment, I.e. surgery, radiation, chemotherapy, estrogen eliminating hormonal therapy, severely hampers intimate sexual relations. Poor self image, physical exhaustion, painful treatment, and emotional distress all tend to weigh in negatively regarding sex drive. But overall recovery from breast cancer is partially dependent on overcoming the above referenced issues and participating in warm loving sexual acts. Sex can thus play a pivotal role.
As we have mentioned in previous posts, single women who have been diagnosed worry how breast cancer will affect their relationship prospects, and also about how and when to tell those prospective lovers about their condition.
The most uncomfortable stuff to talk about is probably your sex life and the changes that have taken place with your illness. You may not know what needs fixing or how to fix it, but you know things are different.
Many women report having less sex than before their illness, for several reasons:
• The breast cancer experience slows down your body. It takes longer to do lots of things, including getting interested in and starting and finishing sexual intercourse.
• Sex may be uncomfortable or even painful if you've been thrown into sudden onset menopause. No surprise that you tend to have less sex, for now. Many women may have had little or no sex from the time of diagnosis through treatment.
Most people have wild ideas about what goes on in other people's bedrooms. Give yourself a break: The carefully researched book Sex in America (by Michael, Gagnon, Laumann, and Kolata) tells us that Americans have a lot less sex than the movies, television, and the guys in the locker room would have you believe. The averages reported in that book are:
• seven times a month between ages 30 and 40
• six times a month between ages 40 and 50
• five times a month between ages 50 and 60
For people over 60, the numbers continue to decline. But although you may assume that no one in their 70s and 80s has a sex life, that's just not so.
Don't let the myths about other people's sex lives get in the way of what's happening in yours. And remember that there are exceptions to every pattern. If your sex life is not working the way you want it to, your doctor or nurse may be able to referee these issues with your partner and you. You can cue your doctor in advance, since he or she has most likely already touched on delicate issues with you. Maybe he or she can be the tour guide for the two of you. If your partner is there when you talk with the doctor who's managing your care, you and your partner both get a chance to air and dispel fears, and replace myths and false information with facts.
Help from a pro
Not all doctors and nurses are comfortable discussing sexual issues and practices. Most doctors don't routinely ask about your sex life. And patients don't usually begin to discuss their love life with a doctor who hasn't mentioned it. Nobody's talking!
Someone has to break the pattern. A trained social worker, sex therapist, psychologist, or psychiatrist can help you open up communication with your partner and get around to talking about intimacy and sex issues.
A support group may be more helpful than you might realize. Women in these groups often share advice that extends to the bedroom, including ways to increase sexual pleasure that are explicit and specific for women who've had breast cancer.
Meeting needs in other ways
Most marriages have problems that don't get fixed. Marriage is a package deal, and in marriages that work, the good things outweigh the bad. But as a survivor, you may find that breast cancer highlights the problems in your marriage. Can you live with those problems? Can you enjoy your marriage even as you contemplate what's missing? Can you capture the missing pieces in other ways? Give serious thought to your needs and how to meet them.
Other ways to meet your needs:
• Fantasy can enrich your life. Countless women read to fill the vacuum (romance novels are enormously popular).
• Join a book club, a church or synagogue, or a group that meets to discuss investments, movies, or local politics.
• Do more with individual friends, like walking, shopping ("retail therapy"), or travel.
• Make a bigger deal of birthdays and anniversaries.
• Expand your involvement in community or spiritual activities.
• Get politically active in the breast cancer movement: camaraderie for a cause close to your heart.
Having a serious illness almost always takes some kind of toll on your sex life. But breast cancer can bring all thoughts of intimacy and sexuality to a screeching halt.
Treatments can bring on temporary -- and sometimes permanent -- premature menopause, making intercourse painful. Chemotherapy and radiation often lead to crushing fatigue. You may want to stay in bed, but you don’t want to use it for anything but sleep. The medications you take, as well as the emotional effects of the disease, can lead to depression. And of course, from the changes wrought by surgery to the hair loss and puffiness of chemotherapy, breast cancer can have a devastating effect on your body image and your ability to feel sexy.
The sexual side effects of breast cancer can linger long after treatment stops. A 2007 follow-up report on young breast cancer survivors, conducted by researchers at the University of California-Berkeley, found that some women reported persistent sexual difficulties five years after their treatment had ended. And according to the National Cancer Institute, about one out of every two women who’ve undergone breast cancer treatment experiences long-term sexual dysfunction.
That’s the bad news.
But the good news is there is sex after breast cancer!
Sex and self-image
Breast cancer changes the way you see your body. “Women sometimes feel very disconnected from their bodies when they go through this,” says Jean Carter, PhD. Carter is a licensed psychologist and the sexual health counselor for the sexual health program at Memorial Sloan-Kettering Cancer Center. “Your body’s been through so much and it’s worked to get well,” she says. ”But there have been sacrifices.”
One thing you need to know early on is that your partner still finds you attractive and desirable. That’s rough on the days when you look in the mirror and can’t imagine ever feeling sexy again, much less looking sexy to someone else. It’s important to prepare yourself and your partner for what you’ll see. If you haven’t yet had surgery, ask your breast center if they have photographs of women after the kind of surgery you’ll undergo. Look at them with your partner and talk about what to expect.
There's no denying that the sexual side effects of breast cancer can linger long after treatment is over, but there is sex after breast cancer.
Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image. It was created by women in a cancer survivors’ group at Penn State.
“The way your partner looks at your incision for the first time,” says Lillie Shockney, RN, “you’ll remember that forever.” Shockney is administrative director of the Johns Hopkins Breast Center and a breast cancer survivor herself. “If he has no clue what to expect and has a puzzled look on his face, the woman may interpret it as ‘He thinks I’m ugly, he thinks this is awful.’ Showing photographs can take the surprise away.”
Communication is important. Talk with your partner about what you’re comfortable with, and what you’re not. “Both partners may be waiting for the other one to make the first move,” says Shockney. “She’s waiting for him to tell her he wants sex, and he’s waiting for her to touch him.” Your partner may be afraid of hurting you, or afraid that you’ll think he’s pushing you to have sex when you’re not ready simply by asking about it.
If your breasts were major erogenous zones for you before surgery, you may be feeling particularly bereft after a mastectomy or even a lumpectomy . Shockney suggests taking the pressure off by exploring and discovering other areas of your body, rather than trying to “force it” in areas where you still have performance or body image issues. “For some women, the diminished arousal in areas of a newly constructed breast or scar tissue might serve as a painful reminder that their sex life has changed,” Shockney says. Instead, think of areas like shoulders, ears, and knees as new hot spots for intimate touch.
If you’re still not comfortable with your new body, that’s what lingerie is for! There’s nothing wrong with getting a little help. A soft, satin nightie can be sexy and arousing. At the same time, it can help to conceal areas you’re still shy about.
Or you can get even more creative. “I asked a patient to try using a feather boa to help her feel sexy, and at the same time keep her scars from being so evident. She loves it!” says Shockney. “It’s all about finding what you’re comfortable with.”
Coping with changes
But even as you get comfortable with the “new you” in the mirror, other parts of your body may be causing you problems in the bedroom. You may go through temporary menopause because of chemotherapy. Or if you have estrogen-receptor positive breast cancer, you may be taking hormonal therapy that can leave you in a menopausal state for years. The resulting vaginal dryness and other symptoms may make it painful to even think about having sex.
“A lot of women I see are afraid to have sex,” Carter tells WebMD. “They’re really struggling. And it’s a shame, because there are wonderful, simple strategies to improve your sexual experience that, taken together, can work wonders.”
Vaginal moisturizers. These aren’t lubricants, which are meant to be used during sex. Instead, they’re like the moisturizers you use on your face and hands, to benefit the tissues themselves. “They’re introduced as a suppository into the vagina adding moisture back into the vaginal space and giving it that natural elasticity,” says Carter. “It’s meant to be absorbed, and it helps the vagina to have more health and moisture for several days.”
Lubricants. You definitely still want a lubricant for use during intercourse, says Carter. But lubricants should be combined with regular, ongoing use of vaginal moisturizers for best results. “If you’re feeling a rubbing or burning sensation during intercourse,” Carter says, “you don’t have enough lubrication. If it’s a stretching , painful sensation like the skin is going to split, you don’t have enough moisture.”
Exercises. The classic Kegel exercises -- tightening and releasing the sphincter muscle as you do when you urinate -- that so many women use during pregnancy are also great for making intercourse easier. “If intercourse has been painful,” Carter says, “you may tighten up in anticipation of the pain. If you do Kegels right before intimacy , you fatigue the vaginal muscles and it is more open.”
Vaginal dilators. A sex therapist, like Dr. Carter, can teach you how to use these dilators, which help gently stretch the vaginal tissue.
Over and over again,” Carter says, “I’ve seen women who are completely hormonally deprived be able to have comfortable, enjoyable intimacy by using these strategies. A lot of the time, it’s so easy to fix. It astonishes me how often women come into my office and ask, ‘Why didn’t anyone tell me this?
Shockney advises her patients to shake up their previous sexual habits. She tells them they may have been a silent player in bed before. But now she wants them to speak up. She tells them, “Say, ‘This feels good. This doesn’t feel good.’ Don’t rely on grunting for him to figure it out. That’s not the best way to communicate.” She also tells her patients, “If you’ve never watched an x-rated movie, try one -- just one. It may jump-start things, and you’ll be amazed at how active you’ll become. Or try various sex toys. So what if you never did these things before. You never had breast cancer before, either! I’ve had women come to me and say ‘I thought my sex life was great before, and then I thought I was going to lose it. But now it’s better than ever.’”