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Sexuality After Cancer

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For most women, a breast cancer diagnosis is their worst nightmare. When the bad dream becomes reality, many women first react with shock and disbelief, followed by fear and emotional numbness. Once they come to terms with the diagnosis, concerns about sexuality usually emerge, regardless of age, current relationships, or marital status. Many women are concerned not only about the effects of surgery and treatment on their own sexuality and how they feel about their bodies, but they also worry that their partners may view them as damaged or less desirable.

Women with early stage breast cancer, meaning a small tumor, no lymph node involvement, and no family history of the disease, are usually treated with breast-conserving surgery, lymph node dissection (removal of lymph nodes), and radiation. In most cases, early stage breast cancer doesn’t require chemotherapy or hormone therapy, and hormone levels will not change. But, surgery and radiation therapy can cause side effects like tiredness and nausea, which can affect sexual functioning. It may take some time before things return to normal after treatment.

If mastectomy, chemotherapy and/or hormone therapy is necessary, you face not just the loss of a breast, but treatments that often cause tiredness, nausea, weight gain, hair loss, and premature menopause. Hair loss and changes in skin and nail color and texture are short-term but distressing treatment side effects. In many cases, your doctor can tell you if hair loss is likely with the chemo you are getting, which gives you time to buy wigs and hair pieces. The very popular, free  Look Good…Feel Better program, sponsored by the American Cancer Society, the Personal Care Products Council Foundation, and the Professional Beauty Association is a great way to learn how to use cosmetics, wigs, and other headwear to feel good about the way you look.

There’s no question that body image and sexual functioning can be negatively affected while getting cancer treatment. Most women say they feel emotionally fragile and notice decreased libido during this time. Two major outcomes of breast cancer treatment that can impact your emotions and sex drive are early menopause and mastectomy (the loss of a breast).

Chemotherapy can cause early menopause. Symptoms and their severity vary a lot, just as they do for women who go through menopause naturally. Monthly menstrual periods will stop. You may have hot flashes, problems sleeping, disturbed sleep due to hot flashes, or pain during sex due to vaginal dryness. Some women experience mood changes including irritability, anxiety, or depression. All of these can lead to decreased interest in or pleasure from sex.

Know that not everyone experiences side effects, but if you notice any problems like those listed above, be sure to discuss them with your oncologist and gynecologist. Doctors can recommend products and medicines to help improve your sense of general well-being and help reduce some of the discomforts that may keep you from having comfortable and pleasurable sex. For instance, vaginal lubricants are strongly recommended during sex. Cancer treatments often reduce the amount of lubricant produced in your vagina when you are excited. You may need extra lubrication to make sex comfortable. If you use a vaginal lubricant, choose a water-based gel that has no perfumes, coloring, spermicide, or flavors added, as these chemicals can irritate. Lubricants can usually be found near the birth control or feminine hygiene products in drug stores or grocery stores.

Breast surgery/mastectomy and breast reconstruction
The common sexual side effect from mastectomy and other breast surgeries is feeling less attractive. In our culture, breasts are often viewed as a basic part of beauty and womanhood. If a breast is removed, a woman may feel less secure about whether her partner will accept her and still find her sexually pleasing.

The breasts and nipples are also sources of sexual pleasure for many women and their partners. Surgery for breast cancer can interfere with pleasure from breast caressing. After a mastectomy, the whole breast is gone and there may be loss of sensation. Some women still enjoy being stroked around the area of the healed scar. Others dislike being touched there and may no longer even enjoy having the remaining breast and nipple touched.

Some women choose to have breast reconstruction after mastectomy – this is a very personal decision. Although most women report they do so "to feel whole again," some choose to have reconstruction to reduce emotional discomfort and embarrassment during sex. It’s important to know that the skin on the rebuilt breast may become more sensitive with time, but usually does not give the same kind of pleasure as before.

Talk about sex
The first step to a better sex life is to bring up the topic with your doctor or another member of your health care team. Keep in mind that sensual/sexual touching between you and your partner is always possible, no matter what kinds of cancer treatment you’ve had. This might surprise you, especially if you are feeling down or have not had any sexual touching or activity for a while.

You may find it helpful and reassuring to discuss issues related to sexuality and cancer in support groups or with women who have completed treatment. It helps to know that you’re not alone and that many others have the same kinds of fears and concerns. Others may be able to share how they coped with everything from treatment to reduced sexual energy to discussing sex with steady or new partners.

Often a relationship deepens as a woman learns to tell her partner about her needs, her discomfort, or her lack of desire. While getting cancer treatment, you may find you have ongoing and maybe even increased needs for affection and physical closeness with your partner. A steady, caring partner usually both senses and understands your lack of interest in sex and continues to provide emotional closeness and affection. Although breast cancer can cause significant stress in many areas of your life, maintaining a comfortable, satisfying sex life during and after treatment should be a priority for you, your partner, and your doctors.

To get a free copy of the American Cancer Society’s booklet called "Sexuality for the Woman With Cancer," call 1-800-227-2345 or visit ACS online at www.cancer.org. Your nearest  Look Good…Feel Better program may be found by calling 1-800-395-LOOK.

Para solicitar información en español, llame al 1-800-227-2345. Un especialista en información sobre el cáncer le asistirá en español.

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