Sex after breast cancer

Studies show that up to 70% of women diagnosed with breast cancer still experience sexual problems two years after diagnosis. What makes the problem worse is that the issue of sex and libido is often overlooked by medical caregivers during the process of diagnosis and treatment, when targeting the cancer is the first priority.

However, when things have settled down, when the cancer is removed, when chemotherapy and or radiation therapy has been concluded, what happens to sexual function? One thing cancer and its treatment cannot erase: the memory of how good sex is and of the intimacy it creates with a partner.

There is no reason why this cannot be achieved once again!

More recent studies have shown that after early stage breast cancer, women can, and do have good emotional adjustment and sexual satisfaction within a year after treatment.

CHANGES IN YOUR SEX LIFE

Many women report having less sex than before their illness for several reasons:

EFFECTS OF CANCER TREATMENT

The tiredness, nausea and pain from surgery and chemotherapy all can be so debilitating that sex is the furthest thing from your mind. Add to this, the associated emotional stress of just getting through each day, and pleasure from sex seems like ancient history.

CHANGE IN BODY IMAGE

Hair loss from chemotherapy, mastectomy scars, and sometimes weight gain all affect self-esteem to the point that women often cannot look at themselves in the mirror let alone allowing their partners to look at them or even touch them in a sexual way.

Breasts are viewed as an internal part of beauty and femininity. Removing a breast or both breasts can create fear that partners will not find us attractive or that we may not be able to enjoy sexual stimulation in the affected breast.

Even after mastectomy, some women still enjoy being stroked around the area of the healed scar. Others dislike being touched there and may no longer enjoy being touched on the unaffected breast and nipple. A few women have pain in their chests and shoulders after surgery. Supporting these areas with pillows during intercourse and avoiding positions, which put weight on these areas, generally helps.

If radiation therapy is involved as part of the treatment plan, the skin may become red, swollen and tender. This usually resolves after treatment.

Breast reconstruction can be done at initial surgical treatment or be planned for later. Whilst this can restore breast shape it cannot restore breast function. Sensation from a reconstructed breast and nipple is much less. In time the skin on the reconstructed breast can regain some sensitivity but will probably not give the same kind of pleasure as before mastectomy.

All these problems already discussed can bring up important relationship issues. A cancer diagnoses can be very distressing for a partner as well as a patient. Partners are usually concerned about how to express their love physically or emotionally after treatment.

The best way to tackle this as a cancer survivor is to give your partner information. Perhaps you can find this together, about what to expect from your personalised treatment plan. Also, discuss what your own preferences and feelings would be, for your own partner looking and touching your breast after treatment.

For a partner, just being available emotionally and physically may make it easy for your partner to be honest about her feelings and insecurities.

Breast cancer can be a growth experience for couples – especially when partners take part in decision making and attending treatment sessions.

DEPRESSION

This occurs commonly after a breast cancer diagnosis, and even during treatment, and can directly affect libido or interest in sex. Medications themselves, to treat depression, especially those like Prozac and Zoloft can make matters worse.

HORMONE LEVELS

By its nature, breast cancer is largely hormone dependent. That means that in many instances, treatment strategies involve some form of suppression of a woman’s own hormone levels. Premature menopause can even occur in some instances. This definitely not only reduces libido, but can affect the body’s physical function of vaginal lubrication. The resulting pain with intercourse can be extremely challenging. It can also become harder to get aroused and even more difficult to experience orgasm.

Simple strategies to improve sexual experience, when used together, can work miracles.

The tool kit to get your groove back should include:

Vaginal moisturisers: These are not lubricants. “REPLENSE” is a brand widely available in South Africa. This comes in a pre-filled syringe and is inserted into the vagina two to three times a week. It attracts water molecules and helps with moisture for up to several days after insertion.

Lubricants: If this is combined with regular use of a moisturiser, the results are better. Silicone based lubricants also seem to work better than water based formulations. For the rubbing or burning sensation during intercourse, more lubrication is needed. If a stretching feeling is experienced like the skin is going to split, then more moisture is necessary.

Exercises: Kegels exercises here are best. This involves tightening and releasing the vaginal muscles like one would do to stop and start urine flow. This not only increases blood flow to the area but if done just before intercourse, it fatigues the vaginal muscles so that the vaginal area is more open.

Vaginal Dilators: This involves regular and gentle stretching of the vaginal muscles. The technique can be learnt from your gynaecologist or a sex therapist.

Using the above methods will allow hormonally deprived women a better sexual experience and so jump-start the return of sexual feeling and intimacy.

MEET THE EXPERT

Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg. She is also a blogger. Check out her blog “vaginations by Dr E” on www.vaginations.co.za

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