There is sex after breast cancer

by Heather Smith

Some people are concerned about sexual issues while undergoing cancer treatment, while other people couldn?t care less. In one study, 82% of people undergoing active cancer treatment wanted to discuss sexual issues with their primary care physicians. Others have said that sex was the last thing on their minds when they were being treated for cancer.

"If you have a good body concept before treatment and a good sexual relationship, this is the best predictor of a good outcome," says researcher Deborah Watkins Bruner, RN, PhD, who educates women with cancer on sexuality issues.

In a focus group of 25 women recovering from breast and gynecological cancer treatment, one woman said that she would have discarded any survey or discussion about sexual issues if she had received it too soon after her diagnosis. She, and most of the married women in the group, said that six months to a year after treatment would have been the right time to discuss sexual issues. The single women felt differently?they would have wanted to discuss sexual issues immediately.

No matter where you are on the spectrum of breast cancer treatment, you may want information on sexual issues that you?re facing now, or that you?re concerned about for the future. And remember?compared to surviving the trauma of cancer, sexual issues are probably much easier to overcome.

One side effect of chemotherapy is vaginal dryness, the result of early menopause caused by damage to the ovaries during chemotherapy. This can be overcome with the help of a good lubricant. Although some lubricants are too thick and greasy, there are others that nearly mimic nature; you might want to consider Astroglide and ID Millennium.

Adjusting to vaginal dryness may seem incredibly insignificant compared to losing a breast. But some research and clinicians maintain that for many women, having a mastectomy does not interfere with sexual enjoyment.

Sex after mastectomy

Two studies have shown that a year after surgery, women who had mastectomies were just as well-adjusted? sexually and emotionally? as were healthy women or women who had surgery for minor problems. Bruner says that the women she works with find it harder to adjust to hair loss and weight gain than to mastectomy. Studies also reveal that women who have had lumpectomy, as opposed to mastectomy, are more comfortable with nudity and body image, and have intercourse more frequently.

Dealing with the scars

But that doesn't mean that women are totally comfortable with the way their breasts look after surgery. "Most women I?ve worked with still have a certain amount of emotional and physical sensitivity toward [anyone touching or seeing] the breast area," says social worker Les Gallo-Silver, CAWS.

No matter what feelings you're experiencing, you shouldn't feel pressure to "love your scars" after mastectomy, notes psychologist Leslie R. Schover, PhD, in her book Sexuality and Fertility After Cancer. She reminds women that it's a myth to believe that "a woman has not adjusted well to breast cancer unless she learns to love her scars." A woman can adjust just fine and still not feel comfortable having her partner see or touch her scars, says Schover.

Therapy may help

If you're self-conscious about your partner seeing or touching your chest because of a mastectomy or breast reconstruction, it may be tempting to avoid intercourse. For one patient who didn't want her partner to see or touch her breasts after reconstruction, Gallo-Silver recommended that the couple both wear sexy pajamas to bed and simply massage each other's backs, avoiding each other's chests. The couple enjoyed the intimacy, and after additional counseling and exercises, began enjoying genital touch again.

The partner's feelings

In his experience counseling cancer patients, Gallo-Silver sometimes finds that a partner is uncomfortable viewing or touching his partner's scar? but for different reasons than a woman may suspect. For one, he may worry that touching the mastectomy scar will hurt his partner. There are also psychological reasons. "It can be very difficult for a partner to come to terms with his partner's scar," says Gallo-Silver. "It often breaks through their denial and they realize that this person has been injured or is fragile in some way."

Meanwhile, a woman may assume that her partner's avoidance is a sign that he finds her undesirable. If you and your partner are experiencing this miscommunication, a sex therapist may be able to help you. To find a sex therapist, contact the American Association of Sex Educators, Counselors and Therapists (see the "Resources" section below).

Even if you feel entirely comfortable with your sex appeal, the thought of sexual intercourse may not appeal to you. You may not feel the desire, or you may be experiencing the fatigue that can last long after chemotherapy is over. For whatever reason, the idea of sexual activity may seem daunting.

You can resume intimacy? without the pressure of performance? with sensate focus exercises. Although she didn't originate the concept, Schover describes these exercises in-depth in her book.

The exercises are aimed at increasing in-the-moment sensation and decreasing any pressure you may feel to "achieve" orgasm or "perform" intercourse. They can be broken down into three steps:

Step 1:

Your partner touches the back of your body for 15 minutes, and then the front of your body for another 15 minutes, avoiding your breasts and genitals. You then do the same for your partner.

Step 2:

You touch one another for the same amount of time, but this time you can allow your partner to touch your genitals and breasts, and you can touch your partner's genitals.

Step 3:

You follow steps 1 and 2, but this time you can receive and give orgasm if you choose.

The sensations you share might include soft kissing, light touching or massage? any type of touch that you or your partner enjoys.

Regardless of all the self-help information about reviving your sex life after breast cancer treatment, don?t forget the most important point: If you don?t feel like having sex, for whatever length of time, you don?t have to.

"Sex is not love," says psychologist David Bullard, PhD. "You can certainly have a loving, deep intimate relationship without a sexually intimate part to it. But if you miss it, if it?s been interrupted by cancer treatment, and it?s been important [to you] in the past to be sexual, there is help available for couples who want to resume the shared experience of sexual intimacy."