As a South African woman you can be sure of two things: 1 in 3 of you will be raped and about 1 in 8 of you White women and 35 per 100,000 Black women , will develop invasive breast cancer over the course of your lifetime. The average age of being diagnosed is 38.5 years old. Before you take a breath and think you’re safe as you are cancer free now, know that the incidence of breast cancer among South African women is increasing and it is one of the most common cancers among women in South Africa. It is the most prevalent cancer amongst white and Asian women and the second most common cancer among black and coloured women. And let me add on a little more discomfort : the precise incidence figures in Africa are lacking given the absence of cancer registration in most countries. So the numbers could actually be higher than this.
Flashing your breasts on Instagram or Tinder is what young women are supposed to be doing. Nagging a partner for more sex, or developing avoidance techniques to get out of duty sex, is what features strongly in young women’s minds. A cross sectional study in 254 healthy women , mean age 34.38 years, mean number of children 1.71, mean relationship duration 8.87 years , was conducted to assess coital frequency . And the winner is 2/3 times a week= 38.58%. Being sexual is just what you do.
Finding a lump in your breast is a traumatic event . Breasts are what women wear with great deliberation and consideration. They dress them up in bras, corsets, and nipple jewels . They cut and slash them in the name of beauty. Breasts are deeply associated with sexuality. Suddenly these treasured breasts by necessity enter the hands of the medical world and pride and pleasure are replaced with extreme fear and shame.
And so begins a young woman’s journey into disenfranchised grief. This is defined as “ a kind of grief that is precipitated by a loss that cannot be socially sanctioned, openly acknoweldged, or publically mourned”. Sexuality and self image is viewed as “private” so it is very difficult to process sexual losses. The breast cancer survivor is denied the right to grieve over sexual losses.
And the losses are plentiful : Missing parts, menstruation, sexual sensations, womanhood, maternal opportunities, wholeness, sexual desire, sexual pleasure, social/peer groups leading to feelings of isoloation and social alienation, loss of relationships and dreams for the future.
If you are a breast cancer survivor, tick off which loss /es you experienced that affected you the most significantly. Did the silence of your expected sexual changes from your health care team , concern you? Did you long for this information at any stage of your treatment? How did you manage your sexuality throughout your journey?
Lets walk through your journey with you and attend to the sexual changes that you encounter along the way. There is nothing pink , feminine about this traumatic time.
At the time of diagnosis you are numb and unaware of the short or long term effects of treatments on your sexuality. Fact : 70% of breast cancer survivors have sexual dysfunctions that persist well beyond the first year of treatment and may worsen over time. Your treatments are individualised and differ for each woman. Many smart concerned super specialists gather weekly to consult about the best treatment for each female patient. Here are some that will be suggested for you. Each one of them has noxious sexual side effects. But will save your life.
Lets talk LUMPECTOMY =
- Breasts look different from each other
- Loss in sensation and numbness may persist
- You avoid touching scar area so loss of pleasure. Lets talk MASTECTOMY =
- Fear of rejection by a partner
- You may avoid looking at your breasts
- You may avoid being sexual
- Discomfort due to scarring
- Nerve damage
- Diminshed range of movement makes love making difficult , new and awkward.
Lets talk RECONSTRUCTIVE BREAST SURGERY=
- You feel better in clothing but there is an unnatural feel of breast. As a result you…
- Less breast touching during sexual play
- Avoid face-to-face sexual positions
- Avoid woman on top position
- Loss of nipple stimulation leads to loss of arousal which leads to loss of desire
Lets talk systemic treatments such as Tamoxifen. It is a SERM (selective estrogen receptor modulator) hormonal therapy which blocks the effects of estrogen in the breast tissue by attaching to the estrogen receptors in breast cells. It reduces sexual desire and causes sexual pain. Aromatase Inhibitors stop the production of estrogen in postmenopausal women. And is now used selectively with pre menopausal women too. Immediately this woman is thrown into surgical menopause with consequent symptoms , including major bothersome sexual symptoms .
Chemotherapy induces menopause plus weight gain /loss and hair loss. Like breasts, hair is associated with femininity and sexuality. Its hard to feel sexy with no hair. And radiation leaves you with inflamed scarred breasts that may look and feel differently – and do not invite touch by either you or a partner.
Healthy sexuality is dependent on a healthy mind, body and relationship with self and other/s. Breast cancer has an insidious way of shattering a woman’s body image and femininity , leaving behind a husk of a woman. A woman who is depressed, anxious, with an altered body that requires loads of self acceptance before she can be naked and comfortable with an /other.
Dressing her up in pink , sending her on “Be Strong ” walkathons, telling her she can “fight” this disease as if she has any say in the matter, is an insult to her. Fact is the incidence of divorce in breast cancer survivors is particularly high . Fact is people fear cancer so finding a new partner is tough. Fact is that the over exposure of healthy breasts as a symbol of sexiness leaves a breast reconstructed woman, or a flat chested woman feeling like an outlier . Atrophied vaginas, dulled orgasms( if any at all) painful penetration remove sexual arousal even if the desire for sexual play is there. These symptoms are further exacerbated by the antidepressant she may be taking,
I salute breast cancer survivors. I invite you to become enfranchised and claim back your sexuality. Talk to your wonderful team of health care providers about your sexuality. And then come and get a strong powerful vibrator and a bottle of Liquid Silk moisturiser . Atta girl!