Sexuality And Breast Cancer Treatment

There are many ways in which standard breast cancer treatments affect a woman's sexuality, both in the short and long term.  The removal of even part of a breast (lumpectomy), let alone the complete removal of one or both breasts, represents a loss and a change in a part of the body that is loaded with sensitive nerve endings and very involved in sexual arousal.  Having only a lump removed along with surrounding tissue, can involve severing nerves that were very involved in producing physical sensation in that area. In addition, the alteration in physical appearance caused by breast surgery, may cause a woman to experience herself as less womanly and less sexually desirable. As if that is not enough to process, females who undergo chemotherapy, will usually be thrown into menopause, with all of the changes that entails, such as fatigue, possibly severe hot flashes and decreased vaginal lubrication. Being jolted into menopause via chemotherapy is a very different physical and psychological experience than the experience of a natural and gradual cessation of menses occurring over a period of years. Adding to the menopausal effects of chemotherapy, drugs like tamoxifen and aromatase inhibitors are routinely prescribed to further reduce and suppress estrogen. Sex can become painful, and the walls of the vagina can atrophy and become very thin and dry. Vaginal yeast infections and urinary tract infections are also more likely to occur. (For more information on this, see Dr. Michael Krychman's blog post http://community.breastcancer.org/blog/sex-matters-vaginal-dryness/.)

The good news is that breast cancer survivors are still very capable of experiencing sexual desire and sexual pleasure. However, due to all of the physiological changes induced by breast cancer treatment, women often come to feel that they need to become acquainted all over again with who they are as sexual beings. This realization may come as a surprise, since oncologists often glide over these sexual sideeffects, in their zeal to rid the body of cancer, and because psycho/sexual/emotional aspects of cancer treatment are complex and outside of their area of expertise and comfort. It is important for cancer survivors and psychotherapists who work with them, to understand that along with physical and emotional healing, time and patience may be required for patients to uncover the sexual trauma related to the treatment, and to discover who they now are as sexual beings. Living in the realm of "the new normal", cancer survivors may need to learn what works now for them sexually.  For example, where and for how long they want to be touched in order to achieve sexual arousal and gratification, may be different from before cancer treatment. Partners of cancer survivors also need to be educated that what was pleasing and stimulating before the treatment, may be different now, and that their partners' bodies may not function in the same way.