When you spend time with breast cancer survivors, you will hear concerns about sex. Before treatment, they may be worried about whether a partner will still find them desirable without breasts. During treatment, drugs and exhaustion may reduce their desire, leaving a woman worried that she will never feel sexy again. Hormone suppression follow-up care can send young women into early menopause, which can cause vaginal dryness and other problems.
These concerns are rarely voiced in public. They come up in private Facebook groups or over coffee with one or two close friends who also have breast cancer. People seem most worried about what is happening (or not happening) during intercourse.
I have broadened my understanding of how cancer can affect women’s sexual health after attending a webinar called, “Lost that Lovin’ Feeling (and How to Get It Back Again) by Don S. Dizon, M.D, the director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital. The webinar was presented by the Inflammatory Breast Cancer Research Foundation in October 2017 and can now be accessed online. Here’s what I learned.
Treatment is possible
Women with breast cancer are not the only ones to have issues with sexuality after cancer treatments. Dr. Dizon cites a LiveStrong survey in 2010 that found sexual problems are the third most common physical concern for many types of cancer patients. However, most of those surveyed had not reported those problems to their doctors. Of those who had discussed a sexual issue with a medical professional, fewer than one-half had received treatment for it.
Dr. Dizon urges people to seek out help because there are many possible treatments that could help the various problems that impact sexual health, which include lack of desire and painful intercourse. Non-hormonal vaginal moisturizers are probably the safest intervention, but some studies suggest vaginal estrogen appears to be safe as well, even for women with estrogen receptor positive (ER+) tumors. Hormone replacement therapy, especially for a women with ER+ breast cancer, is probably not a good choice.
Sexuality is more than intercourse
The most helpful part of Dr. Dizon’s presentation for me was not his thorough overview of the research on various treatment options, but his emphasis on seeing sexuality as more than intercourse. He explained the Basson Model of Female Sexual Health, which sees sexual satisfaction as one part of a cycle that requires intimacy, stimuli, arousal, and desire. He says sexuality is much more complex for women than men, and it is much more than intercourse.
He advises that couples should understand that “pleasure is the goal, not performance.” How are couples to achieve that goal? He sees four big C’s to be the guides.
Communication. Sexual health is an important aspect of overall health, so Dr. Dizon believes that doctors should take the initiative to bring up the topic. When they don’t, the patient needs to speak up and discuss side effects and symptoms. Partners need to talk to each other too. For example, after breast surgery, many women experience discomfort or pain when their breasts are touched, and they need to explain that to a partner.
Consultation. People need to seek help and advice proactively. They could try any of the many medical treatments available, or go to a counselor who can help couples find new methods of intimacy. Date nights, cuddling, and kissing can build the emotional ties that may ignite physical desire.
Compromise. If the ways couples connected sexually before cancer treatments are no longer possible, then they may need to compromise to find new ways, including alternatives to intercourse.
Clarity. This circles back to communication. Both partners need to clarify their needs. Talking about sexual issues can be difficult, so it may take more than one conversation for each person to understand the other’s needs.
For details about the medical treatments that may help you, I strongly encourage you to listen to Dr. Dizon’s entire presentation. Even more importantly, remember that the changes you experience in your body don’t have to define you. Speak up about problems even if they seem to be embarrassing. You are not alone with these issues. You can find solutions.
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Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.