For most of us, breast cancer is our worst nightmare. When the bad dream becomes reality many women react initially with shock and disbelief, followed by fear and emotional numbness. Once we come to terms with the diagnosis, concerns about sexuality usually emerge, regardless of age, relationship or marital status. Breasts have rich associations for all of us, ranging from self-image connected with the nurturing and reproductive capacity, to body image tied to feelings of femininity and sexual attractiveness. Many of us are concerned not only about the effects of surgery and treatment on our own sexuality and feelings about our bodies, but also worry that our partners may view us as damaged and less desirable. Despite their fears, most women find their partners are compassionate and caring.
Women with early stage breast cancer, meaning small tumor, no lymph node involvement and no family history of the disease, are usually treated by lumpectomy, axillary dissection (removal of lymph nodes from the arm pit), and radiation. Ordinarily, early stage breast cancer does not require chemotherapy or hormone therapy and thus will not change hormone levels. Physically there will be little evidence of having had cancer beyond scars from surgery. However, there is still the stress of surgery and radiation therapy before sexual functioning returns to normal frequency and pleasure. Those not in continuing relationships often worry about how and when to tell a prospective sexual partner about their cancer treatment and fear being viewed as sickly and at high risk of having ongoing medical problems.
If mastectomy, chemotherapy and/or hormone therapy is necessary, you face not just the loss of a breast, but treatments that often cause fatigue, nausea, weight gain, hair loss and premature menopause. There is no question that body image and sexual functioning are negatively affected while in treatment and most women report feeling emotionally fragile and experiencing decreased libido. Hair loss and changes in skin and nail color and texture are temporary but distressing treatment side effects. However, oncologists can advise well in advance if hair loss is likely to result from chemotherapy, allowing ample time to purchase wigs and hair pieces. The very popular, no cost, single session Look Good…Feel Better program, sponsored by the American Cancer Society, the Cosmetotology Association and the Cosmetic, Fragrance and Toiletry Association Foundation is particularly helpful in demonstrating the use of cosmetics to maintain an attractive appearance.
If you were on hormone replacement therapy prior to diagnosis, you will likely be advised to discontinue it and you may experience menopausal symptoms as a result.
"Chemical" menopause can also result from chemotherapy treatment. Symptoms and their degree of discomfort are highly variable, just as they are for women who undergo "natural" menopause. In addition to cessation of monthly menstral periods, you may have hot flashes, insomnia or disturbed sleep due to hot flashes or painful intercourse due to vaginal dryness. Some women experience mood changes including irritability, anxiety or depression. Needless to say, such symptoms can lead to decreased interest in or pleasure from sex. Novadex(Tamoxifen), the anti-estrogen prescribed for women with estrogen-dependant breast cancer can also produce menopausal symptoms in premenopausal women, but many report little or no discomfort.
Be assured that not everyone experiences side effects, but should any of the above symptoms occur, discuss them with your oncologist and gynecologist. Doctors can recommend products and medications to improve your sense of general well being, in addition to reducing some of the discomfort that prevents comfortable and pleasurable sex. Vaginal lubricants are strongly recommended. Some doctors will prescribe a vaginal ring which alleviates vaginal discomfort without raising the amount of estrogen systemically.
The decision to have breast reconstruction after mastectomy is a very personal one. Although most women report they do so "to feel whole again," some choose to have reconstruction to reduce emotional discomfort and embarrassment during sex. In fact, partners are usually much more able to accept mastectomy or breast reconstruction scars than women realize, and doctors encourage women to maintain their usual degree of nudity during sex and in the bed and bath during and after surgeries.
You may find it very helpful and reassuring to discuss issues related to sexuality and cancer in support groups or with women who have completed treatment. It helps to realize that you are not alone and that many others have experienced similar fears and concerns. They are happy to describe how they coped with everything from treatment to reduced sexual energy to discussing sex with steady or new partners. Most women come to believe that they would not want to be with a partner who is not concerned about them and the stress they are going through. You may join other women in concluding that we all collect both physical and emotional scars as we go through life; you must be able to adjust to body changes without viewing yourself as a changed person. Often a relationship deepens as a woman learns to tell her partner about her needs, her discomfort or her lack of desire. While undergoing cancer treatment, you may find you have ongoing and often increased needs for affection and physical closeness with your sexual partner. A steady, caring partner usually both senses and understands your lack of interest in sex while you are receiving chemotherapy and continues to provide emotional closeness and affection. Although breast cancer can cause significant stress in many areas of your life, maintaining comfortable sexual functioning during and after treatment should be a priority for you, your partner and your physicians.
To receive the free ACS pamphlet, "Sexuality and Cancer," or to find the location for the nearest Reach to Recovery program, call your local American Cancer Society at 1-800-ACS-2345 or visit ACS online at www.cancer.org. Ask for a free copy of "A Significant Journey: Breast Cancer Survivors and the Men Who Love Them." This videotape is for couples and discusses breast cancer’s effect on communication, intimacy and sexuality. Your nearest Look Good…Feel Better program may be found by calling 1-800-395-LOOK. This program provides hands-on patient education by volunteering cosmetologists as well as make-up samples.
Para solicitar información en español, llame al 1-800-ACS-2345. Un especialista en información sobre el cáncer le asistirá en español.