Dear Doc | After breast cancer ... I simply don’t feel sexual
Q Dear Doc, after reading your article last week, I have a question. You spoke about having a baby after breast cancer, but I am finding it very hard to feel comfortable enough around my husband any at all, much less to be intimate. I simply don't feel sexual. I have become very self-conscious about how I look, and I don't feel attractive at all. My hair is yet to grow back, and my chest is distorted! I don't even want to go to the beach! Can I even put in breast implants? Is that a sensible thing if I want to have a baby in the future? Please help me before my husband gets frustrated and leave.
A The issues you raised are very real to breast cancer survivors, and one many do not discuss openly. In addition to having to cope with the emotional stress that accompanies cancer and its treatment, patients with breast cancer will also find themselves dealing with changes in their appearance as a result of their treatment.
Some changes are short term, such as the hair loss associated with chemotherapy, but even these short-term changes can have a significant negative effect on how a woman feels about herself. But in these days of wigs, weaves and hairpieces being fashionable, there are numerous options available to help women cope with hair loss.
Alternatively, some women choose to wear their baldness proudly, and use it as a way to identify themselves as breast cancer survivors.
Other more permanent changes - like the loss of part or all of a breast, or even both breasts, after surgical treatment - are obviously more traumatic, and less of a simple fix. Some women choose to have breast reconstructive surgery after mastectomy to address this issue, while others may opt for a breast form.
A breast form is a prosthesis (artificial body part) worn either inside a bra or attached to the body to mimic the appearance and feel of a natural breast. Breast forms are an alternative to breast reconstruction for women who have had a mastectomy, especially if they do not want further surgery, because breast reconstruction can sometimes require several procedures to complete.
If you are considering breast reconstructive surgery, it should ideally be discussed with your doctor before surgery to treat the cancer. Decisions about the type of reconstruction, when it should be done, as well as the type of reconstruction desired, will depend on each woman's medical situation and personal preferences, as there are several types of reconstructive surgeries available.
A woman might choose to have breast reconstruction for many reasons:
- To make her chest look balanced when she is wearing a bra or swimsuit.
- To permanently regain her breast shape so she won't have to use a breast form.
- To be happier with her body and how she feels about herself.
However, breast reconstruction can often leave scars. The reconstruction surgery will leave scars on your breast and areas where tissue is removed to create the new breast mound, such as the buttocks, tummy, or shoulder areas. If tissue from your tummy, shoulder, or buttocks is used as part of the reconstruction, those areas will also look different after surgery. The scars usually fade over time, but it is something to keep in mind. Also to keep in mind is that the reconstructed breast will not be a perfect match or substitute for your natural breast.
Regardless of what your preference may be, speaking with your doctor, other members of your healthcare team, and your partner, is a good starting point.
Sexuality after breast cancer
It is common for women to have concerns about sexuality after breast cancer. Physical changes which occur during and after treatment will make most women less comfortable with their bodies. Also, some treatments such as chemotherapy can change your hormone levels and may negatively affect a woman's sexual interest and/or response. Additionally, for women who are seeking to choose a partner or have children, a diagnosis of breast cancer can be especially difficult.
Surgical treatment for breast cancer, particularly removal of the breast, can damage a woman's feeling of attractiveness. Our culture has taught us to view breasts as a fundamental part of beauty and femininity. If a breast has been removed, a woman may worry about whether or not her partner will still find her attractive. She may also be worried about not being able to enjoy sexual stimulation in the affected breast.
However, even after having a breast removed, some women still enjoy being stroked around the area of the healed scar, whereas other women may actually dislike being touched there, and may no longer even enjoy being touched on the remaining breast and nipple. Some women who have had a mastectomy may also feel self-conscious in certain sexual positions, where the area of the missing breast is more visible.
But we cannot forget the partner in all this, because the cancer diagnosis can be very distressing for the partner as well. Partners are usually concerned about how to express their love physically and emotionally after treatment, especially surgery. But breast cancer can be a growth experience for couples, especially when partners take part in decision-making and go along to treatments.
Regardless of the changes you may experience, it's important to know that there is advice and support out there to help you cope with them. Speaking with your doctor or other members of your healthcare team is often a good starting point. There are also many support groups available, and they can refer you to one that is suitable for your needs.