Breast cancer is currently the second most common form of cancer in the world, and the most common cancer for women. Treatments for breast cancer have become consistently more successful and survival rates for women with breast cancer are good overall. However there are sexual side effects and quality of life issues that emerge as a result of this diagnosis and treatment.

Breast cancer survivors are especially vulnerable to short- and long-term quality of life issues around sexual health and intimacy. Many of the treatments – surgery, chemotherapy and radiation – can have sexual side effects around sexual desire, sexual arousal, body image, and overall pain and discomfort.

Sexuality is to be considered within a holistic framework, which includes physical, psychological and social parts of each person (including partners when in a relationship). Each person is unique and experiences the diagnosis, treatment, and side effects differently. You may be greatly affected by scaring, nerve damage or pain from surgery (lumpectomy or mastectomy). Some survivors feel less attractive or no longer feel feminine after surgery. They may struggle with complex emotions around their nude or semi-nude body, feel betrayed by their body, and have a negative body image. Some women cannot fathom how their partner could still find them attractive, let alone sexy.

Many women no longer feel a desire for physical intimacy in part due to chemotherapy and/or radiation-related side effects. There could be damage to the ovaries or menopausal symptoms that occur as a result of estrogen deprivation. Estrogen deficiency may cause menopausal symptoms including vaginal dryness or atrophy, making intercourse painful, uncomfortable, or impossible. In addition, many women are surprised by how much the hair loss, especially pubic hair loss, affects them sexually. They may not expect to lose their pubic hair and were not prepared for this loss, or did not previously realize how important it is to them as a woman.

Additionally, the body may no longer be related to joy for women after treatment. They have been poked and prodded, sometimes with large audiences viewing them nude or semi-nude, which can be traumatic to some women. Others may experience pain or discomfort after surgery, making it difficult to even imagine escaping into or being fully present in their body through intimacy. Many side effects also include nausea, vomiting, fatigue, and weight gain/loss, which can all make being in the body unpleasant or even foreign.

It is possible to treat many of these sexual side effects and regain sexual satisfaction and intimacy, improving overall quality of life. We will explore more about sexual health and wellbeing related to breast cancer in this series of blogs/writings. There is more to come.

In the meantime, I will leave you with this last thought…

As awkward and uncomfortable as it may be, please make the effort to speak with your healthcare providers when/if any of these sexual side effects occur along your journey (or your partner’s/loved one’s journey). Many healthcare providers find it difficult to talk about sex and have trouble bringing it up during the treatment process (even though they really should in order to effectively treat you). Unfortunately, many healthcare providers do not get proper (if any) training on how to talk to patients about sexual health. Therefore, you may need to be your own advocate for your sexual wellbeing. You may need to bring it up first. Once you make it known that your sexual health is important to your overall care, healthcare providers are usually at least open to discussing this topic, and/or will provide you with referrals for more information.  If your healthcare provider is not able to provide helpful information, or seems ashamed (blushes or leaves the room) and cannot talk about sex, please know that this is their problem.  Some providers have their own personal struggles talking about sex (they are human too) and may blush and dismiss your questions or inquiry.  If this happens, keep in mind that sexuality is very important and should not be ignored or dismissed; know that the problem is not you.  Ask for a referral suggestion instead.

Kimberly Atwood is a holistic psychotherapist working with individuals and couples in private practice in Princeton, New Jersey and Doylestown, Pennsylvania. She specializes in women’s sexual health, intimacy and relationship issues. For more information, please check out her website at kimatwood.com