Breasts and sexuality after cancer: it matters

There is nothing “Pink” nor “Feminine” about breast cancer. In fact, just the opposite.  So let’s not pretend otherwise. It’s an insult to women. Yes, “women”, not “warriors” nor “fighters”.   It denies them a much needed safe space to talk about their breasts, nipples, vaginas and sexuality.

Women are be told to “fight back” as if they have any control over this dastardly dreaded disease. 1 in 28  South African  women will develop breast cancer in her life time. And as more and more women survive breast cancer, their quality of life becomes more and more important. And sexuality is a recognised piece of quality of life. In other words, when your disrupted sexuality is not restored post breast cancer, your quality of life sucks.

“My body feels betrayed by you” is the story women tell breast cancer.  Once the diagnosis has been made, survival kicks in and gratefully you hand your body over to medical science.

There is an immediate detachment or disconnection from pleasure your body once gave you. And yet, and yet, research demonstrates that soon after treatment begins, women ask about their sexuality.

This study shows that intimacy and sexuality should be repeatedly included in consultations, at every stage of the disease but especially shortly after treatment started. Women with breast cancer expect that professionals (preferably nurse or primary doctor) initiate this subject via a personal conversation (alone or with their partner). Sexuality matters. Breasts matter.

If you are a breast cancer survivor, did your health care provider discuss the sexual side effects of your treatment? Did they share with you research that tells the difference women feel sexually after a conservative mastectomy, and a mastectomy with reconstruction? 

Approximately 60–70% of breast cancer survivors experience sexuality problems resulting from treatment. Frequently occurring problems include decreased sexual desire, decreased sexual arousal or lubrication, dyspareunia, and vaginal dryness.

Let’s factor in another not discussed element of BC:  the fact that the sexuality of your partner is also affected.

As part of a larger, randomized controlled trial, researchers  evaluated longitudinally the sexual functioning and relationship satisfaction of 69 partners of breast cancer (BC) survivors who received Internet-based cognitive behavioral therapy (CBT) for sexual dysfunction

About 75% of these partners of BC (breast cancer) survivors indicate that the BC and its treatment negatively impact their sexuality and sexual relationship. They cite a reduction of sexual activity and a lack of fulfilment relation to sex. And when tested for erections, their erections were just not as reliable or strong as before the diagnosis of their partner.

Is anyone out there listening??

Anxiety and depression inhibit desire as does body image. BC changes body image. Breasts are modified and sometimes a complete hysterectomy is necessary.

Some women have just their ovaries removed or have their ovaries treated with radiation to make them stop working. This is another way to get rid of the hormones a cancer needs to grow. Removing these feminizing hormones throws the body into surgical menopause. And your body shape and size change. Any of these treatments will most likely cause symptoms of menopause. These include hot flashes, menstrual cycle changes, and vaginal dryness. In spite of these changes, a woman should still be able to feel sexual desire and reach orgasm.

Imagine being an adolescent or young adult (AYA) having to endure menopause for the rest of your life?! AYA (Adolescents and Young Adults) YA cancer survivors experience challenges or dissatisfaction around sexual relations and intimacy

Concerns about body image and sexuality are especially hard for young breast cancer survivors. Early menopause /surgical menopause, concerns center around having children and dating.  Early menopause can cause changes that decrease sexual pleasure. Some chemo drugs irritate all mucous membranes in the body. This includes the lining of the vagina, which may become dry and inflamed. Yeast infections are common during chemotherapy.

The right to sexual health and pleasure is denied to young people if silence is held.

Has your body image and quality of life improved over time as you negotiate the discrepancy between the “Self ad body” and the societal expectations for femininity? 

Women who are getting chemo often notice decreased sexual desire. Physical side effects, such as upset stomach, decreased appetite, and weakness, can leave little energy for sex. Sexual desire most often returns when a woman feels better. If a woman is getting chemo every 2 or 3 weeks, her sexual interest might only come back a few days before she’s due for her next treatment. After chemo ends, the side effects slowly fade, and sexual desire often returns to previous levels.

Women getting chemo also tend to feel unattractive. Hair loss, weight loss or gain, and sometimes central venous catheters (tubes in the vein that stay in for weeks or months) can make it harder to have a positive sexual image of yourself.

 

Some useful information about your sexuality at the time of your treatment:

  1. Because your immune system may be weak, it’s especially important to avoid sexually transmitted diseases. It’s important to practice safer sex from start to finish (use condoms or other barriers to avoid body fluids). Do this every time you have oral, anal, or vaginal sex.
  2. During sexual intimacy, it’s important to avoid touching the vagina and the urethra with anything that has been used to stroke near the anus. Lingering germs from the bowel can cause infection if they get into these areas.
  3. Chemo can also cause a flare-up of genital herpes or genital warts if a woman has had them in the past.

Is anyone out there listening and talking about how to optimise on sexuality?

Let’s talk about your breasts.

A study was done that compared and evaluated the sexual function of women who underwent conservative mastectomy, and mastectomy with our without reconstruction using the FSFI (Female Sexual Function Index) .

Results demonstrated a lower prevalence of female sexual dysfunction in patients treated with conservative mastectomy or reconstruction after radical mastectomy.

Conservative mastectomy is a surgical technique to remove breast glandular tissue without disruption to the appearance of the breast. In other words women who could keep the appearance of her breasts, either through conservative mastectomy or reconstruction, had less sexual dysfunctions.

A recent study demonstrated that patients who underwent implant reconstruction had diminished sexual well-being at two years, compared to baseline, while patients who underwent autologous reconstruction had greater sexual well-being at 2 years compared with patients who underwent implant reconstruction.

What has been your sexual experience and quality of life with the impact of prophylactic mastectomy and breast reconstruction on your sexuality, whatever breast conserving or oncoplastic procedure you have had? 

When comparing patients’ quality of life who received a breast conserving therapy to those who additionally received an oncoplastic procedure, this study demonstrated women had difficulties with sexuality on several levels; body image, disappointing outcomes with regard to aesthetics and sensation, as well as partner relationship issues.

In summary, breasts and sexuality matter. Partners matter. Partners should be more involved and informed about expectations on outcomes and sexuality as well. Partners state being afraid to address the topic, touch the reconstructed breast or feel disappointed by the outcome. This can be overcome by standard psychosexual education, information and counselling.

Truth is Sexuality is disrupted by the occurrence of cancer.  Women withdraw emotionally, no longer feel desirable due to aesthetic damage, and become overwhelmed by the thought of sex. Hair loss and mastectomy elicit feelings of unattractiveness affecting even some women with nipple sparing mastectomy.

I urge you to talk to a health care provider about your sexuality and breasts.

Contact me for a range of lubricants and moisturisers which are hormone free, safe and will add comfort and pleasure to your sexual activities.

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