Dr Mandy Goldman Strous
MBBCh MMed(Rad Onc) Grad Dip Counselling
President, Cancer Counselling Professionals Inc Australia
Dr Vijayasarathi Ramanathan
MBBS, MMed, GradDip-SexHlth, PhD, FECSM
Lecturer in Sexual Health, The University of Sydney, Australia
The diagnosis of breast cancer is a crisis in the life of the person with it as well as their loved ones. Usually the first concern is survival. Can I die from this?
A lot of information is given in the first few consultations. There is so much to try to understand. It can happen to anyone at virtually any age. You may have a partner and children or you may be single. You may have parents alive or maybe they have passed away. You may be lucky enough to be in a loving relationship or you may be in an unhappy relationship. All these factors impact on how you cope with your breast cancer journey.
Feelings of stress, worry, helplessness and inadequacy are common, as is a feeling of loss of control. There is a change in the way one experiences one’s body. A mastectomy (removal of the entire breast) and even a lumpectomy (removal of the cancerous tumour and some of the surrounding breast tissue), may affect the way you feel about yourself. Feelings of grief and loss may occur. Your breasts may have been part of your femininity.
How will you partner react? Will he/she still love you? Will you be able to have children? Will you be able to breast feed them? Many questions may need to be answered.
Sexuality is a central aspect of being human throughout life and it is about who we are (male, female and everything in between), how we see ourselves in the society (gender identities and roles), to whom we are attracted to (sexual orientation), the way we express our intimate feelings (eroticism, intimacy and pleasure) and how we keep producing the next generation (reproduction). By now, you should be able to understand that sexuality is much broader than merely engaging in the act of sex.
Throughout this page we will be addressing about the challenges that you might encounter when you go through the journey of breast cancer and its treatment and what we (you and the health professionals) can work together to help you achieve better outcomes, both for your breast cancer and sexuality. When we refer sex life, it is not only about the act of physical sex (e.g. intercourse) but also the thoughts and feelings about how our body looks, the way we seek and share sexual pleasure and the ability to be in an intimate relationship. The way we think, feel and our body responds to sexual situations is called sexual response cycle.
Relationship and sexuality
Both partners need to agree on what makes their sex life enjoyable! Often partners have differing levels of desire. Ideally this needs to be discussed, understood and a compromise on both sides often works wonders! Some couples like to have sex every day. Some once a week, some once a month and some even less frequently. Sex is not only for the young and fit. Many old people and disabled people enjoy loving and fulfilled sexual relationships. Sometimes sexual problems centre around anxiety, tension, depression or problems in the relationship. Other times, sexual problems may occur as a result of a physical condition, a medical condition or treatment (medicines) that cause or worsen sexual difficulties. Most of these problems can be treated. Please note that good sex life is only possible within a good relationship. It is not possible to be in an unhappy and hostile relationship and expect the sex life alone to be good. If you want to keep your sex life going, you probably can! Remember, try to bring your partner in to the discussion early on.
Treatment for cancer and sex life
Your doctor would have discussed about the different treatment options available and the one that is most suitable for you. Please clarify or seek more information from your doctor to know about your cancer treatment.
Surgery, radiotherapy and chemotherapy are most common options.
Many breast cancers require the female hormones to grow. By blocking these hormones, the cancer cannot survive. We use different types of hormone blocking treatments, but these treatments all have side effects. In young women, they cause early menopause. That means your periods stop and you will probably experience hot flushes. In addition you may feel emotional or even depressed. The female hormones are responsible for the lubrication of the vagina, keeping it moist. Dryness can cause thrush (a fungal infection) and discomfort. This is turn can make intercourse (sex) uncomfortable or even painful.
Keeping your sex life going despite cancer treatment
Learn as much as you can about the possible effects your cancer treatment may have on your sexuality. Find someone in your health care team you feel comfortable talking to. If your doctor is a male you may feel more comfortable talking to a nurse or other female member of the team. When you know what to expect you can plan how to deal with it
No matter what treatment you are having, you will still be able to feel pleasure when touched. You may feel sick or tired or just not be in the mood. That is fine too. Open communication with your partner will help. Some aspects of your sexuality may have changed but pleasure and satisfaction are possible.
Try to keep an open mind about ways to feel sexual pleasure. Some couples only think of sexual activity as orgasm through penetration. For people being treated for cancer, intercourse may not be possible. This is a time to learn new ways to give and receive pleasure. You and your partner can help each other reach orgasm through touching, stroking and cuddling.
If sex is painful, tell your doctor/nurse. Lubricants and moisturisers may help. Also different positions may be more comfortable
Talk to your partner. Tell him where it is sore. Your sexual routine needs to be adjusted to accommodate changes in your body. He will only know if you tell him
Boost your self esteem
You have good qualities. Remind yourself about them!
If you lose your hair you may wish to wear a headscarf or wig or hat. Some women prefer to wear nothing. If you have had your breast removed, you may wish to wear a false breast (prosthesis). Do whatever makes you feel comfortable and good about yourself. Eat well and exercise moderately. This will keep your body strong and your spirits up. Yoga and meditation are often helpful
Remember, your do not have to be perfect to enjoy intimacy with a partner. Beauty is in the eye of the beholder. You are beautiful in many ways. Thin, fat, no hair, one breast doesn’t make you any less attractive to someone who loves you. Also, you need to learn to love yourself. No one is perfect. Love your imperfections; they make you unique. Embrace who you are! Many people reinvent themselves after going through cancer treatment. So often they come out the other side strong and beautiful.
Help-seeking for your sexual concerns
Many people feel uneasy talking about sex with a professional like a doctor. It is very hard to talk about sex even to one’s close partner. It is awkward and one can feel vulnerable and exposed. Is there such a thing as a “normal” sex life? Actually no! Moreover, sex life does not have to be perfect. Having doubts, concerns or problems with your sexuality is no different to having difficulty with breathing. The way to improve your sex life is by being aware of what sexuality is all about and the next step is to be confident and comfortable to clarify your doubts with the health professionals. You and your concerns will not be judged and will be dealt in a confidential manner.
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