Intimacy and Sexuality
Your Self Image
We live in a society that considers breasts to be an important aspect
of a woman's attractiveness. The loss of a breast after a mastectomy,
or even a slight change in shape after a lumpectomy may have a serious
impact on a woman's confidence. "Will I still be loved?"
"Will I be attractive?" are valid questions that need to
be answered in a woman's mind.
Doubts about your appearance and attractiveness are normal, but
you should not let them affect your self-image. Remember, there is
much more to sexuality and pleasure—and to you as a person—than
the shape or presence of a breast.
The critical issue is not the loss of the breast itself, but the
way you and your partner treat the loss. Open communication is very
important. Many couples find to their surprise that the patient is
more concerned about the loss of her breast than her partner is.
The side effects of treatment will vary with the treatment choice,
and with your own response.
Many of the side effects are easy to anticipate. Surgery could decrease
or eliminate entirely nipple sensation—which may affect sexual
arousal. Radiation therapy may render breast skin more irritable during
treatment, and perhaps less sensitive years later. Overall, the emotional
and physical demands of treatment take their toll, leading to fatigue.
Most of these side effects are relatively short lived, or tolerable.
Other consequences of treatment may have a greater impact. For example,
if you did not yet go through menopause, chemotherapy or hormonal
therapy is almost certain to stop your periods—temporarily or
permanently. If you are young, your periods are more likely to return
than if you are approaching menopause.
Menopause caused by chemotherapy is much more sudden, and for many,
more difficult than natural menopause. You may go find that you are
having mood swings that are out of character for you, and blame them
on your inability to deal with cancer, whereas in reality you may
be the victim of severe hormonal imbalance induced by the chemotherapy
or hormone therapy. Discuss your problems with your physician. Drugs
like Celexa, Paxil, Prozac and others have proven very useful in dealing
with menopausal symptoms.
A less recognized side effect is that chemotherapy reduces the amounts
of testosterone in the body. Testosterone is generally known only
as a male hormone, but it is present in small quantities in women,
and is responsible for the woman's sex drive. With loss of testosterone,
there is loss of libido—a side effect that often goes unnoticed,
unreported, misdiagnosed, or untreated. If loss of libido becomes
a problem for you and your partner, you may want to find a healthcare
provider who is well versed in the management of such problems.
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Some women and many of their partners worry about when and how it
is acceptable to resume sexual activity after breast surgery. Sometimes
the partner may avoid physical contact simply out of fear of causing
discomfort to the woman.
There is nothing about breast surgery itself that would require
a delay. Even if you still have a dressing, or drains and stitches,
there is no reason not to engage in intimate contact. The decision
is based more on your emotional state than on your physical readiness.
Often you will have to be one who opens the conversation about your
fears or needs, because your partner may feel that these issues are
too personal. Bring the subject up as early as possible. The more
time passes without open discussion, the harder it becomes to deal
with the issue.
If you're not ready, make it clear to your partner that not wanting
to make love is not an act of rejection, and that you may welcome
other forms of physical intimacy.
Some women who have had a mastectomy purchase sexy lingerie, or
have intimacy in subdued lighting to help take the edge off the presence
of a surgical scar, without reducing the feeling of closeness and
If you have loss of sensation in the breast or nipple area, you
may need to gently guide your partner, indicating what is now pleasurable
Hugging, touching, holding, and cuddling may become more important,
while sexual intercourse may become less important. Remember that
what was true before your cancer remains true now: There is no one
"right" way to express your sexuality. It's up to you and
your partner to determine together what is now pleasurable and satisfying
to both of you.
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Being single and trying to start a new relationship, while simultaneously
dealing with breast cancer, can add a lot of stress to your life.
One of the challenges is deciding how and when to tell a new acquaintance,
who may or may not become a love interest, that you had breast cancer.
The main obstacle is that many women who had a diagnosis of breast
cancer feel that they are in some way incomplete or unworthy. "Damaged
I cannot tell you how to begin a successful relationship. But I
can suggest the mind-set that will guide you at least through the
breast cancer issue.
The key is to realize that you are not your cancer. You are not
a victim. You are not less complete, or less worthy than before your
diagnosis. You are who you were. And in addition, as a result of your
experience, you are now an even stronger, more interesting, and more
understanding person than before. On top of that, the concept that
there is something shameful about breast cancer is a thing of the
past. It has been "out of the closet" for years! Just check
prime time TV programming. Breast cancer is there along with other
everyday issues of everyday life.
If you were diagnosed only recently, and the shock is still fresh
in your mind, it is difficult if not impossible to be so confident.
But have faith—soon your brain will adjust, and you will be
able to put your cancer experience in perspective, and realize that
it has contributed something positive to you.
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How and When do I Tell Him About
In Chapter 1, I made a few suggestions on how to discuss your diagnosis
with your life partner. But if you are starting a brand new relationship,
the question is more complicated. Exactly how and when do you bring
up the topic? You are not alone if the thought of informing your date
that you are missing a breast makes your palms sweat.
First, how do you say it? If you are uncomfortable articulating
the words, there are some tricks that may help you. You've probably
heard that some experts recommend that if you are afraid of public
speaking, just imagine that the audience is naked. So if you are afraid
to say, "I had a mastectomy last year," imagine that your
date is jobless, or a diabetic, or Viagra-dependent. Now who's got
the sweaty palms?
Please understand that I am not diminishing the impact of breast
cancer on your life. But it is best to talk about the issue as matter-of-factly
as you would about any other difficult experience in your past. And
remember: at least breast cancer, unlike, for example, diabetes, is
How do you decide when, in the setting of a dating situation, is
best to discuss the changes that breast surgery might have caused
in your body? Many women feel that by clearing the air early on, in
the conversational stages, you will be able to relax and enjoy the
moment if or when the relationship progress to intimacy.
As with so many other aspects of the breast cancer experience, you
will find that joining a support group consisting of women who are
grappling with the same issues, will do wonders for your confidence.
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Being a Young
Breast cancer is not unique to "older" women. Today there
are over a quarter million women living with breast cancer who are
under forty. Being a young breast cancer patient presents a number
of unique challenges. You are in a different "place" in
your life. You might be looking for a date, rather than celebrating
a thirtieth wedding anniversary. You may be fresh out of school, instead
of planning your retirement party. You may be looking at five decades
of life in front of you, not behind you.
It is particularly important for a young woman to insist that her
healthcare providers understand her particular needs. Fertility issues
may need to be considered in making a treatment choice. Support groups
must be age specific. More attention may be given to retaining appearance
and regaining sexuality.
If you are young, take solace in your strengths. Your body can heal
faster. You can tolerate chemo better. And you may be more resilient
and adaptable than someone who has been set in her ways for the past
As a breast cancer "minority", a young woman would benefit
immensely from interacting with other cancer survivors in her own
age bracket. You may want to contact the Young Survival Coalition
listed in the Resource section to get you started.
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