Intimacy After Breast Cancer

• Being comfortable with your body and enjoying intimacy can be a challenge after breast cancer. It’s different for every woman, but some issues, both physical and emotional, are common. Fortunately, there are aids and strategies that can make adjusting to your new normal easier.

  Shifts in body image and sexual feelings

  After breast cancer treatment, women often have complex emotions about visible scars, loss of sensation, or losing your breasts or nipples. You may feel empowered that you’ve conquered your cancer or a deep sense of grief about losing a breast—or you may feel both. These intricate feelings can affect self-confidence, body image, and sexuality.

  “Learning some self-compassion is important,” said Jennifer Barsky Reese, PhD, a psychologist and behavioral scientist at Fox Chase Cancer Center who studies breast cancer and sexuality. “It may take a while to become adjusted to those changes. These types of concerns are very common, and for many women they may improve over time. If you’re having significant trouble adjusting, it could be useful to visit with someone about those concerns. For instance, if you notice yourself avoiding looking at your body, looking at your body too much or in a judgmental way, or if your body image is interfering with your sex life, mood, or relationships, these may be signs that it could be helpful to deal with these issues head-on.”

  Attitudes about sexuality can change too. Some women may not want to have sex because they have lost interest in it or are depressed, or it may be painful because of side effects of medications or treatments. But help is available.

  Resources to move forward

  If you’re facing these issues, you’re far from alone—many women have them. Talk to a health care provider who you feel comfortable discussing these kinds of topics with. Counselors or sex therapists could also be helpful, depending on your needs.

  “Depending on what the problems are, there are evidence-based interventions that are available,” Reese said. For instance, some women with breast cancer are treated with chemotherapy or hormonal therapies that may cause symptoms of menopause, such as vaginal dryness or tightness. Over-the-counter products such as vaginal lubricants for use with sexual activity and vaginal moisturizers that are used regularly whether or not sexual activity is happening can help with vaginal dryness, and these are available at your nearest pharmacy. If you need more help, vaginal dilators can help reduce tightness. Pelvic floor exercises can lead to relaxation and strengthening of the pelvic floor muscles.

  If you’re in a relationship, it’s also crucial to talk to your partner about your feelings and concerns regarding sex. After all, chances are both of you are trying to figure out intimacy in a post-cancer world.

  “Oftentimes, partners do not have a good sense for how they should adjust and how they should approach intimacy,” Reese said. “They’re so used to supporting the patient. We’ve heard a lot from partners that they didn’t want to hurt their partner, so they didn’t know whether they should touch their partners’ breasts. And that can be tied into a patient’s ambivalence about her body or if she even wants to be touched.”

  Communication can make a difference. For example, let your partner know how you feel about having your breasts touched and what kinds of things help you relax and feel comfortable when it comes to lovemaking.

  A fresh start

  No matter what specific intimacy challenges you face, there is a “before” breast cancer and an “after.”

  “A lot of women say there’s a new normal,” Reese said. “It sounds like a cliché, but that may be a kinder way to think about it rather than to think that you have to be going back to the way it was before your cancer.”

  Things might not be exactly as they were before diagnosis. But there are ways to enhance sexuality and intimacy.

  “Don’t resign yourself,” Reese said. “Be creative. Try things differently. Adopt that kind of mindset and be flexible.”