Intimacy After Metastatic Breast Cancer

Health Writer
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Many people find that sex during and after cancer can be challenging, and those with metastatic breast cancer often face unique issues such as vaginal dryness from hormone changes, bone strength changes — if the metastasis has affected bone density — and even a shifted caregiver relationship with a spouse, according to clinical counselor Claire Postl, MA, LPCC, who specializes in sex therapy at The Ohio State University Wexner Medical Center.


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Navigate the connections

“With metastatic breast cancer, your body will change, your perspective on the future will change, and most likely, your relationship dynamics will change,” Postl said in a phone interview with HealthCentral. “But that doesn’t mean you have to give up intimacy and sex. You just have to shift how you approach them.” Here are some tips on navigating these connections, even during treatment.


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Recognize and redefine intimacy

Sex and intimacy are often considered the same thing, Postl said. But decoupling them can be very useful in the midst of metastatic breast cancer. “See this as an opportunity to build more intimacy into your everyday life,” she says. That might mean more cuddling on the couch, initiating more touching that doesn’t necessarily lead to sex, and even a good old-fashioned makeout session.


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Talk more deeply, more often

Intimacy also involves long, heart-to-heart conversations, Postl added, because it’s all about connection. “Conversations start to become about treatment for many people, and all the details about what needs to be done,” she said. “But take time to step away from that and talk about other things, especially your feelings, your fears, your hopes.”


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Be compassionate with yourself

When you’re going through treatment or you’re on the other side of it, you’re dealing with a wide range of challenges. “Sometimes, you feel like garbage,” Postl said. “And that’s okay. Talk about that with your partner, work through it. Don’t feel bad about yourself because of what’s happening to you, just see it as part of a transition.”


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Acknowledge changed relationship roles

Often, those with cancer and their partners make a major shift during treatment into patients and caregivers, and that makes sense, Postl said. It’s natural for your partner to take up responsibilities like accompanying you to doctor’s appointments, and caring for you when you feel sick. But when people stick to those roles after treatment, it can be challenging, said Postl, and may require a conscious shift back to being romantic partners again.


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Rediscover date night

One way to shift your roles back to romance is by scheduling date nights that include getting out of the house, even if it’s just for dinner and a movie. Even calling it “date night” instead of “going out” can help you in the mindshift toward more romance, Postl advised.


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Revisit your favorite romantic activities

As part of your new dating adventure, consider activities you may have enjoyed back when you were first dating each other. “You need to rekindle what you have,” said Postl. “There’s a reason you’re together, there was a spark there that caught fire. When you go back to activities you used to enjoy all the time, it’s easier to find that spark again.”


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Moisturize “down there” daily

Even if you don’t feel at all ready for sex, it’s a good idea to use some type of product that can moisturize your vaginal tissue, according to Marleen Meyers, M.D., breast medical oncologist and director of the survivorship program at NYU Langone’s Perlmutter Cancer Center. She told HealthCentral in a phone interview that treatment can cause dryness and can thin the tissue. Using products with moisturizing capabilities can help.


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Consider your partner’s perspective

It’s important to talk with your partner about what he or she is feeling. Often, Dr. Meyers noted, these partners feel guilty for wanting more intimacy, or for initiating sex. “It’s very common for a partner to feel bad about wanting life to be ‘normal,’ including having a sex life,” she says. “When you stop talking about these things, it can lead to less connection and less conversation in general. That moves you further away from intimacy.”


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Adjust around your cancer

The locations of your metastases will likely matter when it comes to sex, noted Dr. Meyers. For example, pain is very common in different, affected areas of the body, which increases the need for more tenderness. For example, bone tumors can cause more fragility, so vigorous sex is usually contraindicated. Seeing these as issues to work around — rather than to get frustrated about — can be helpful when re-introducing sex into a relationship.


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Talk to your doctor

In general, many people are reluctant to talk about sex and intimacy issues during an appointment, said Dr. Meyers. Oncologists are unlikely to bring up the topic, so she encourages patients and their partners to start the conversation. “There is nothing your oncologist hasn’t heard, so even if you feel funny mentioning it, I’d advise you to take the step,” she said.