Breaking the Silence: Sexuality After Breast Cancer
Sandra Franco, MD
Co-Director of Breast Cancer Center
Dr. Franco earned her medical degree from Colegion Mayor de Nuestra Senora del Rosario (Universidad del Rosario), Bogota, Colombia. She completed her residency and internship in internal Medicine at Jackson Memorial Hospital, University of Miami, and a hematology/oncology fellowship at University of Miami. Dr. Franco is board-certified in internal medicine and medical oncology.
October 2004 - Although every woman's experience with breast cancer is unique, most patients share many of the same issues concerning body image, sense of self and sexuality. However, most women suffer in silence because they're uncomfortable or embarrassed to talk about these issues. The Breast Cancer Program at Memorial Cancer Institute is dedicated not only to providing the most effective treatment plan for breast cancer patients, but also to meeting their emotional and psychological needs. The Program is directed by two highly qualified and experienced medical oncologists, Sandra Franco, MD, and Alejandra Perez, MD, who are sensitive to the issues female patients often face. In the following Q & A column, Drs. Franco and Perez answer the questions they most frequently encounter with their patients.
How will breast cancer affect my sexuality?
Of all the treatments for breast cancer, chemotherapy has the strongest effect on sexuality. Before menopause, your ovaries produce estrogen, which is responsible for your monthly menstrual cycle and reproduction. Some chemotherapy drugs interrupt ovarian function and cause premature, or early, menopause. Symptoms can include hot flashes, vaginal dryness and decreased libido, as well as depression, anxiety and increased irritability. In addition, the risk for osteoporosis and heart disease increases, and hair loss and weight gain can occur.
Each of these side effects, while troubling for breast cancer patients, can be minimized with treatments. These include drugs and vitamin E for hot flashes, and lubricants, vaginal moisturizers, and in very specific cases and under a doctor's supervision, vaginal estrogen creams for vaginal dryness. We offer support services to help fit you with an attractive wig, if you choose, and a sound nutrition and fitness plan can be devised to help stem weight gain.
Issues regarding sexuality and sexual response can be as psychological as they are physical. Thus, counseling may be recommended for loss of sexual desire, depression, anxiety and other emotional issues.
I can't imagine losing my breasts. What can I expect if I have to undergo a mastectomy?
Breasts symbolize many things to both women and men: femininity, nurturing, motherhood and eroticism. For these reasons, the loss of a breast through mastectomy or alteration through lumpectomy can affect your self-esteem and sexual identity. In addition, you may feel self-conscious about your new appearance, and your partner may hesitate to touch your breasts in fear of hurting you.
Alejandra Perez, MD
Co-Director of Breast Cancer Center
Dr.Perez earned her medical degree from the Health Science Institute, Medellin, Colombia. She completed her residency and internship at Yale University School of Medicine, and fellowships in hematology and oncology at Montefiore Medical Center, Albert Einstein College of Medicine. Dr. Perez is board-certified in internal medicine, hematology and oncology.
Your Questions Answered by the Co-Directors of the Memorial Breast Cancer Program.
On the other hand, you may feel an overwhelming sense of relief to have the cancer removed, and your partner may consider the loss of one or both of your breasts insignificant compared to the fact that you have survived. A loving partner will care about you as a whole person, regardless of any change in your breasts.
Keep in mind that while mastectomies have improved over the years, you may wish to consider your options regarding breast reconstruction. If so, consult with a highly qualified plastic surgeon. You also may want to talk to other women who have had breast reconstruction about how they adjusted to their new appearance. You may find it helpful to join a support group to talk about this and other issues regarding breast cancer.
How will breast cancer affect my spouse/partner?
It is understandable that your partner will be impacted by your experience with breast cancer, and will have concerns about how it will change you and your relationship. Open, honest communication is essential. Take the time to connect with each other and really listen.
While the stress of illness may be too much for an unhappy relationship, it can draw loving, supportive couples closer together. We can refer you to a social worker or psychologist who can help both of you work through your feelings and keep the lines of communication open.
I am going through so many changes. Will I ever want or enjoy sex again?
You need to give yourself adequate time to get used to the changes you're experiencing. With the assistance of your healthcare team to address the side effects of treatment and surgery, as well as the emotional aspects of breast cancer, you should begin to regain desire.
When you are ready to resume sexual activity, be sure to pamper yourself, display affection and practice other means of intimacy with your partner, plan sex only when you are feeling strong, and explore sexual positions that are most pleasurable and comfortable. Sex can be a life-affirming activity.