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.
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.