Intimacy and Sexuality After Breast Cancer

Intimacy and sexuality is an integral part of being human. We make love for a number of reasons: to be close to one another, to experience cherishing a loved one and being cherished, to demonstrate love, to give and receive pleasure, for sexual release, and for procreation. More than at any other time, women today are bombarded with images equating breasts with sexuality and attractiveness. Breast cancer, then, might be seen as a doubly cruel disease. Bad enough to be diagnosed with cancer, but to have the very symbol of your femininity and sexuality tampered with…

Does having breast cancer mean the end of sexual intimacy?
No. It may well seem like it at first, but sexual pleasure will return if it is important to you. • Take charge of your life after the initial uncertainty by finding out as much as possible about your diagnosis and treatment. • Build a support system and take an active part in your treatment. • Make an effort to rekindle sexual and other intimacy.

How will the treatment affect my sex life?
The effect depends on the type of treatment you have and the quality of your sex life before the diagnosis.

Do all women react the same way?
No. Some women experience increased intimacy, others a variety of emotions. One of these emotions may well be an overwhelming feeling of grief for the loss of a breast or seeming loss of sexuality. Inhibitions, especially as a result of changes in body image, may lead to bad communication, loss of sexual desire and stimulation. Some women need more support from their partner and regular confirmation that they are still attractive. Others may feel unsure of their partner’s response and try to hide their bodies. Your partner may also feel very confused. Sometimes your partner may feel negative about your changed appearance or be scared that postponing intimacy may make you feel rejected. At the same time your partner may feel that intimacy may cause discomfort. Worries about your health may lead to depression and decreased libido.

I have no sexual desire. What can I do?
Think of sexual desire as being like a great river that is fed by many streams. If all the streams are flowing, the water level is high – you think of sex more often, become sexually stimulated more easily and respond more willingly to sexual advances. Physical, emotional, hormonal and relationship ‘streams’ control the water level of the great river. If more than one source of water is blocked, sex falls lower and lower on the list of priorities. A sexual drought may even result. The shock of the diagnosis, fears of the future, depression, anger, grief and the temporary effect of the treatment may easily suppress your sexual desire. Allow yourself to experience these emotions. Talk to your partner about your fears, self-image and your love. Give your partner the opportunity to talk about his/her emotions and physical exhaustion. Sometimes it’s easier to do something together rather than talk about emotions. Look at the scar together, (with the doctor present, if needed). Allow your partner to change the dressings, help you wash your hair, or just hold you if that’s what you need. This will help you experience intimacy on much deeper levels than simply sexual intimacy. At the core of many women’s lack of desire is a conviction that, because they have lost one or both breasts, they have also lost their femininity. Reconstruction can change this perspective, but many women choose not to undergo this. For them, a well-fitted prosthesis can still allow them to wear feminine clothes and lingerie. Indulge yourself: ask a friend to take you shopping for sexy clothes and underwear. If you have had chemo, treat yourself to a different hairstyle once your hair has grown back. Remember; there is far more to you and your body than one or two breasts!

How does surgery affect sexual response?
Women who have had a lumpectomy or wide angle excision have a more positive body image that those who have had a mastectomy. They have fewer problems with nudity and take up sexual relations sooner.

When should we look at the breast or scar?
That depends entirely on you. You can decide whether or not you want to look at it immediately, alone, or with your partner. You may be surprised that it doesn’t look so bad at all.

Will my partner still find me attractive after a mastectomy?

• Touching the scar will be uncomfortable at first because the area is hypersensitive.
• The skin of the chest wall (collarbone to ribs) may feel uncomfortable or numb because of damage to nerves. Some women regain sensation after one to two years.
• Touch the area as soon as the skin has healed. As soon as you know what kind of touch feels good, you can guide your partner.
• Relearn enjoyable areas.
• If you have had a breast reconstruction, the areas around the reconstruction may feel numb for up to two years after surgery. Guide your partner to more sensitive areas.

Does intimacy revolve only around sex?
Not at all. What matters is what both of you are comfortable with. The key to intimacy is understanding, love and finding pleasure in each other. Caresses and touching convey acceptance in a way that words can’t. Sometimes intimacy starts by just spending time together again. Sexual activity, including intercourse, can be resumed as soon as both of you feel ready. The lateral (side to side) position will prevent pressure on the scar.

Is spontaneous, unplanned sex realistic shortly after surgery?
Not necessarily. Communication as foreplay is very important. Use words or your hands to tell your partner when you are ready to be touched, when and how you want to show your breasts, what feels good. Discuss what makes you feel more comfortable: being in the nude, wearing sleepwear/a bra/camisole/prosthesis.

What effect will radiation have?

• You may feel tired, even after you have finished radiation. Be honest if you want to wait with sexual intimacy. Enjoy cuddling and being held.
• Your breast or chest area may be red and feel like it has had too much sun. The intensity varies from person to person. Sensitivity disappears after six months to a year.
• Ask your partner to dust the area with maizena, but remember that you may have to cool him/her down as well!
• Loss of sexual desire is less than when having chemotherapy or taking hormone inhibitors such as Tamoxifen.

Will chemotherapy leave me bald, nauseous and frigid?

• Losing hair not only on your head but also eyebrows and pubic hair may make you feel self-conscious and vulnerable. Discuss your emotions with your partner. It may be less traumatic to cut your hair before you start chemotherapy, especially if you ask your partner to participate.
• Experimenting with interesting headgear can be fun for both of you.
• Remember, your hair will grow again.
• If you feel nauseous, do other things together, like reading, watching a movie, listening to music until you feel better.
• If you get mouth sores, avoid kissing for a while. Instead, try stroking or caressing: a gentle massage or masturbating will relieve stress.
• Chemotherapy may cause menopausal symptoms. You may experience hot flushes, mood fluctuations and weight gain.
• Ask your doctor about non-hormonal lubricants if you experience vaginal dryness, pain during intercourse or vaginismus. Please don’t suffer in silence!

Can I become pregnant?

• Chemotherapy and hormone inhibitors like Tamoxifen can cause serious defects in the foetus. You must use contraception like a condom during intercourse.
• If you were planning to have (more) children, permanent menopause is a serious loss. Sexuality is intended for procreation and to enjoy the ecstasy of closeness, touch and caresses. Allow your partner to comfort you with his body, lips, hands and words.

What effect will hormone therapy have?
Hormone therapy like Tamoxifen may cause hot flushes, vaginal dryness or irregular menstruation. Ask your doctor to prescribe a vaginal lubricant.

Will I become depressed?
Depression is a common side effect of the whole experience of breast cancer. A low libido is a common symptom in patients who have to have chemotherapy. However, this side effect disappears with time.

How do we handle our first intimate contact after breast surgery?

• Try gentle caresses and massage rather than intercourse. Avoid touching genitals and breasts; this will help both of you to relax and experience sensual enjoyment.
• Bathing together by candlelight with soft music will not only relax you, it will encourage sensuality.
• Plan times when you can relax and be together without being disturbed.
• Agree beforehand to tell your partner if you experience any pain or discomfort.
• Make time for foreplay and use plenty of lubrication when you decide to go on to intercourse.
• Fantasising about your best sexual experience will increase enjoyment.
• Your ability to reach orgasm should not be affected unless you are taking an anti-depressant that delays orgasm. This can be prevented by longer foreplay.

Sadly, cancer has the reputation for putting a finger on the trouble spots in a marriage or relationship. Very often, partners wanting to be supportive say the wrong thing; or women reeling from the shock of diagnosis misunderstand a gesture. The loneliness of being a cancer patient can’t always be shared, even with the person closest to you. The strongest marriage or relationship may take strain, so don’t be too proud to seek help. And don’t listen to people who tell you to just get on with it and be grateful. One thing cancer should convince you of is to live your life the way you want to.

Reach for Recovery would like to thank Dr Christa Benade, medical doctor and sex therapist, and Beverly Rycroft, Reach for Recovery volunteer, for their input.

Reach for Recovery National cellphone number:
083 897 0221