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Breast Cancer Basics
Early Detection
Diagnosis & Staging
Facing Breast Cancer
Planning Your Treatment
Treatment Options
Advanced Breast Cancer
A Guide For Your Partner


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.


Side Effects of Treatment
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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Resuming Sexual Activity
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 excitement.

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 to you.

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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Single After Breast Cancer
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 goods."

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 My Cancer?
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 actually curable.

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 Survivor
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 six decades.

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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