Although concerns about sexuality, physical intimacy and fertility may not take center stage when you are first diagnosed with breast cancer – whether you are single or engaged in an intimate relationship – you may find yourself dealing with these issues at some point during your cancer experience.
Sexuality and Body Image
While current research suggests that approximately 50 percent of women who have been treated for breast cancer experience long-term sexual dysfunction, other studies indicate that many women who undergo breast conservation procedures or mastectomy do not experience persistent sexual difficulties. In fact, many researchers and health care professionals concur that the primary predictors of good sexual health after breast cancer may have more to do with a positive body image and satisfaction with sex and relationships prior to the cancer diagnosis.
Body image concerns for all breast cancer survivors are prevalent, though several findings suggest that women who undergo breast conservation surgery have more positive feelings about their bodies and appearing in the nude. Other studies indicate that women who had mastectomies did not demonstrate any significant problems with sexual and emotional adjustment. What is important to emphasize is that every breast cancer experience is unique, and can have a distressing impact on you and your feelings of attractiveness and desirability, even if you don’t display the physical manifestations associated with cancer and ensuing therapies.
Why and Where Did My Libido Go?
Treatments for breast cancer – including chemotherapy and radiotherapy – and side effects like nausea, fatigue, pain and hair loss may affect your body image, lower your sex drive or cause discomfort during sex. Moreover, chemotherapy can propel some women into early menopause, generating the sudden onset of symptoms that are supposed to appear gradually during a transitional phase of the life cycle.
In addition, if you are receiving hormone replacement therapy (HRT) to alleviate menopausal symptoms, you usually need to stop HRT after a breast cancer diagnosis, particularly if your cancer is sensitive to estrogen and/or progesterone.
Treatment protocols for breast cancer also use hormonal therapies. For example, the effect of tamoxifen on sexual functioning remains inconclusive though recent studies conducted by Mortimer and colleagues suggests that tamoxifen, whether taken alone or concurrently with chemotherapy, may negatively impact sexual intercourse. Again, it’s important to reiterate that each experience is unique and many women can and do regain improved sexual functioning anywhere from six months to one year after breast cancer treatment.
Medicines given to treat symptoms can also lead to a loss of interest in sex, as well as difficulties in attaining an orgasm. “Some of the medicine used to treat depression greatly affect sexual function, as do pain medications,” says Judith Paice, Ph.D., R.N., a pain management specialist with Northwestern University Medical School in Chicago. “The opioids can cause suppression of testosterone and other hormones which then causes problems with sexual function – all of these work hand in hand.” Dr. Paice judiciously includes questions about physical intimacy in her assessment process and notes that people are appreciative when she brings it up, but she also states that many health care professionals are hesitant to broach the subject for fear of offending, upsetting or embarrassing their patients.
The Emotional Rollercoaster
You and your partner may confront immediate or subsequent worries about body image and sexual relations. A series of questions will likely surface for both of you – Will treatment disfigure me? How will I cope with losing my breast from surgery or my hair from chemo? Will I still want sex and will I still be sexually attractive? Will she still want sex? Can I touch her? Will I hurt her more if she’s already in pain? All too often assumptions are made and direct communication avoided when it is most needed to clarify respective feelings and needs.
If you are single and dating, you may be even more keenly aware of subsequent alterations in your appearance and how if will affect potential relationships.
Resetting the Biological Clock
If you are a woman of childbearing age, you may be concerned about your ability to conceive. Chemotherapy and radiation treatment may cause damage to the ovaries and can result in menstrual irregularities, temporary or permanent infertility. Nonetheless, many women do regain reproductive capacity after treatment has been completed, although research has suggested that older women have a higher risk of developing complete ovarian failure.
The good news is that fertility preservation options do exist for breast cancer survivors and can be initiated prior to the start of chemotherapy. In addition to the widely accepted medical practice of embryo freezing, experimental methods include egg and ovarian tissue freezing, as well as the promising development of alternative hormone stimulation protocols utilizing tamoxifen and aromatase inhibitors to minimize estrogen levels.
Lindsay Nohr Beck is founder and executive director of Fertile Hope, a national nonprofit organization dedicated to providing the latest research and information on fertility and preservation options for cancer survivors and their families. She stresses that there is a lot people can do to preserve fertility.
“Many people think that if they didn’t bank eggs or freeze embryos, they’ve missed the boat, especially if they experience premature menopause,” she says. “But there are a lot of options before, during and after treatment.” Lindsay also draws a clear distinction between infertility and premature ovarian failure – damage sustained to eggs and ovaries can still cause difficulty conceiving even if your menstrual flow resumes and appears normal years later. Thus, immediate and appropriate family planning is important.
Moving Towards Intimacy
As breast cancer survivorship rates continue to increase, many patients, their loved ones and their healthcare teams are focusing on these important quality of life issues. So what can you and your partner do now to adapt to the changes in your body and create an environment where physical and emotional intimacy can flourish?
Les Gallo-Silver, an oncology social worker and Director of Clinical Programs for CancerCare in New York, suggests that partners need to cultivate their listening skills. “You must listen to what is said and what is not said. Sometimes the woman you love with breast cancer is going to want to be alone, leave her alone. Sometimes the woman you love will want to be with you, be with her. If you don’t know which time, ask.” He also offers some very practical tips for women: seek a cosmetologist evaluation to help you adjust your makeup, if you wear it, to changes in skin texture and hair loss; take control of your hair loss – if you can’t bear to have a short haircut or hair removed suddenly, shop for a wig before your hair is gone to match texture and color; throw away your long T-shirt and wear something colorful – something that makes you feel beautiful — to bed; and keep a personal diary or journal to help you begin to articulate your inner feelings.
Dr. Paice also stresses the importance of communication. If you can’t discuss your feelings with your partner, talk to your physician, nurse or seek the assistance of a sex therapist. Many breast cancer survivors find support groups to be an invaluable source of support and shared information. The Y-ME National Hotline (1-800-221-2141) and Men’s Partner’s Match program also provide a confidential outlet to discuss your feelings about intimacy-related issues.
During or after breast cancer, intimacy may take on an entirely new dimension. Learn to touch, hold hands, experiment, be together and simply try to relax. You may rediscover yourself – and romance and sex – in very different and fulfilling ways.
Originally taken from Lifeline Winter 2005 edition.
