Breast cancer can affect a person in many ways. It can take your energy, your hair, your breasts, your sense of self and your plans for the future.
After treatment ends, there’s a lot of focus on post-cancer care, returning to some familiar things and making some new choices. Yet one less spoken-about topic post-breast cancer is a woman’s sexuality.
After a marathon of breast cancer diagnosis and treatment, your sex life can take a big hit. In fact, more than 73% of breast cancer survivors are at risk of experiencing sexual problems known as sexual dysfunction. Maybe treatments induced early menopause or maybe you’re grappling with self-confidence after mastectomies and scarring.
“Surgery and treatment can threaten femininity, self-image, confidence and sexuality, changes that you may not fully understand, which can lead to confusion, insecurity, shame, guilt and fear that you’ll never enjoy sex again,” said Debra Wickman, MD, an OBYGN and sexual medicine specialist with Banner Health in Phoenix, AZ.
It may take time for you to feel physically and emotionally well enough for any form of sexual activity. The good and reassuring news is that all isn’t lost when it comes to intimacy and sexuality.
Read on to learn more about sexual dysfunction after breast cancer and what you can do about it.
The impact of breast cancer on intimacy and sexuality
The effects of a breast cancer diagnosis can be life-altering and sometimes life-threatening. It can be daunting and cause feelings of uncertainty. There may be fear of the unknown – “Will my life end?” “Will my relationship end?” “What will I need to endure in order to live?” Faced with this level of uncertainty and stress, your sex life takes a backseat to treatment, recovery and survival.
“Sexual intimacy is replaced with caregiving and emotional support from the committed partner, who may feel they might be perceived as selfish or uncaring if they express a desire for sex during this time,” Dr. Wickman said. “The woman affected with breast cancer may also offer sex out of guilt or ‘duty’ even though it is uncomfortable (due to hormonal changes). This sense of duty can lead to resentment. And if the pain is just tolerated during sex, the body will have less desire for sex over time.”
When you’re no longer able to be a satisfying sexual partner, you may also feel depleted of your feminine value. You may have feelings of guilt and shame because you feel different, look different (after surgery) or behave differently with your partner. You may even feel misunderstood. All are devastating to self-worth.
“The stress and hormonal changes can take the ‘spark’ out of your personality, at least for a while, and it takes effort and work by you and your partner to regain it,” Dr. Wickman said.
Getting help with sexual problems
Making sex great again is a challenge, but it is possible. Dr. Wickman shared the following tips to help boost your self-confidence and sex life.
1. Become reacquainted with yourself
Intimacy after breast cancer starts with you. Before physical intimacy can be dealt with, you must become physically comfortable with yourself. It’s important to accept yourself as you are, without judgment.
“When you have a mastectomy or other cancer treatments, it can change the landscape of your body and your comfort level with your body,” Dr. Wickman said. “Self-consciousness can become a third, unwelcome person in your relationship.”
To become more acquainted with your body, Dr. Wickman suggested touching the areas that are different now, such as surgical scars, and affirm positive focus. The more you look at and feel your body the less different it will seem.
If you continue to feel uncomfortable about looking at your body, it may even be helpful to get assistance through counseling or therapy.
2. Communicate with your partner
The key to adjusting to sexual changes in your relationship after cancer is communication. In many cases, sex was already on the back burner prior to the cancer diagnosis, so cancer can be a “wake-up” call to re-establish meaning in your relationship.
“It can seem easier to avoid talking about sex, but this can lead to further frustration and confusion,” Dr. Wickman said. “Let your partner know what you’re going through and how they can help you cope. Define goals for physical intimacy and expand emotional intimacy.”
3. Take things slow
Set aside time for other types of intimacy and activities together before diving into sexual intercourse. Focus on activities that don’t involve penetrative sex, such as massage, snuggling and skin-to-skin contact.
4. Focus on other aspects of your relationship
Take more time to appreciate one another and infuse gratitude into your relationship. “When your partner shows up for you in this way, it’s rocket fuel toward igniting desire, or at the very least the desire for desire.”
5. Seek help from your health care team
“Some women feel guilty bringing up sexual health concerns; that they should be grateful to be alive,” Dr. Wickman said. “The more they speak up, the more they can be supported in all aspects of their care. Their medical team should know it matters to them.”
There are a lot more options than most realize when it comes to restoring genital sensation and function. Your health care team can provide answers if you’re experiencing side effects like low libido (sex drive), vaginal dryness, vaginal narrowing, loss of sensation in your vagina, tightening of the pelvic floor muscles, painful sex or difficulties reaching orgasm.
“Satisfying sexual intimacy usually requires assistance due to physical changes from hormonal depletion or treatment,” Dr. Wickman said. “This is where things like vaginal lubricants, hormone therapy and pelvic floor exercises can help make sex more pleasurable.”
Counseling, talk therapy and medications may also help with low mood, depression, anxiety and low libido (sex drive).
“It’s easier and most effective when your concerns and issues are addressed during treatment or as soon as possible afterward,” Dr. Wickman said. “Be proactive in your strategy for recovery.”
Breast cancer and its treatments can have a variety of impacts on your sexuality, but there are things that you and your partner can do together to deepen and strengthen your relationship and intimacy with one another.
“It’s easy to get overwhelmed with the process,” Dr. Wickman said. “Take it one step at a time, and don’t do it alone. Let your partner fully be there for you. Take the time to regain your vitality in all aspects of life so that the focus isn’t entirely on the physical state. Work with a therapist or coach as needed.”