Sexual changes associated with breast cancer
In this resource, we refer to people diagnosed with breast cancer as women. We also acknowledge that people who are diagnosed with breast cancer include men, transgender people and people who are non-binary.
- What to do about lack of desire?
- Sex and menopause
- When intimate partners become 'patient' and 'caregiver'
- Adjusting to change takes time
What is "sexuality"?
The term "sexuality" is a broad term that refers to how you experience yourself as a man or as a woman, your sexual feelings for others as well as how you express yourself sexually. Sexuality is affected by many things including: physical health, how you feel about your relationship with your partner and your feelings about your body, your values or beliefs about what is important in life, and childhood experiences, to name a few.
Sex and intimacy
The term "sex" is often understood as "sexual intercourse". In fact, "sex" could be broadly defined as any kind of intimate physical touch ("intercourse" and "outercourse"), where the focus is on giving and receiving pleasure and closeness. Sex is often a primary way that couples have of feeling close to each other. Men and women often (though not always) experience closeness or intimacy differently: Women often want to feel close to their partner before engaging in sexual touch, whereas men more often want sexual touch in order to feel close. This difference can be a source of conflict for couples. A satisfying sexual experience usually requires that both partners want to be sexual with each other at that moment in time; that both feel emotionally safe and respected in the relationship; and that there is an opportunity for both giving and receiving pleasure.
Sexual changes associated with breast cancer
Unfortunately the diagnosis of breast cancer and its treatment has the potential to negatively affect your sexual relationship in a number of ways. This includes the impact of treatment on sexual interest and function, fertility, body image (how you feel about your body) and even on your overall relationship with your partner. Our focus here is on sexual interest and function.
There are many reasons why you may be less interested in sexual activity. For both of you, the emotional distress and worry associated with a diagnosis of cancer can put sex on the sidelines for a while. The effects of treatment and adjustments to changing roles and responsibilities often increase fatigue or you may feel more preoccupied.
What to do about lack of desire?
Chances are that if your sexual relationship was working well before, over time you will adjust and return to your usual level of sexual desire. However, a few tips about sexual desire may be useful.
In the traditional model of the sexual response cycle,* there are four phases: desire, arousal, orgasm, and plateau or resolution. However, many people actually find that desire comes after their partner begins touching them, not before. Take a look at these two versions. This may be particularly true for women, so it may not be wise to wait until you "feel like" having sex.
It may be useful to think of sex as a meal. Sometimes you may want (or be willing to have) a small snack or to take a bite of something without committing to the whole meal. Just be clear with your partner when you have had enough food, or which kind of food you might prefer. At times you may find that after the first bite, you want more. At other times not. Try to give each other lots of good quality feedback about what feels comfortable and pleasurable for you.
Adjusting to changes in your sex life are easier to do if your "sexual scripts" are flexible. A sexual script entails all the behaviours each of you engages in when having sex. If you are used to a very predictable script (this kind of touch, followed by this kind of intercourse, followed by one of both of you having an orgasm), this can be more challenging. However, if you are willing for your sexual scripts to be more flexible, then "sex" may mean any kind of physically intimate and pleasurable touch, with or without intercourse and with or without orgasm. Adjusting to sexual changes may require that you develop your flexibility and even your playfulness in the bedroom!
Some women report feeling like their bodies have been "invaded" by health professionals and may find it hard to engage in sexual activity for a time. If there is surgery, the alteration to the sensations of touch to the woman's breast may also negatively affect sexual experience. While either of you may not want to be sexual with your partner for a time, that doesn't mean you don't need comfort and physical closeness. Ask your partner for the kind of touch that feels comfortable.
Sex and menopause
Chemotherapy may cause early menopause. Some women are less bothered by menopausal symptoms than others, however vaginal dryness is quite common and some women experience painful intercourse as a result of dryness. Vaginal dryness can be treated with a vaginal moisturizer such as Replens, which is used 3 times per week. Like any moisturizer, the full effect may not be evident for about 4-6 weeks.
Water-based lubricants such as Astroglide, Silky Stuff and Oh My! are becoming more widely available and can increase comfort and pleasure tremendously during stimulation of the clitoris and vulva as well as during intercourse. Many women can use vaginal estrogens and these are also very effective. Discuss the pros and cons in your particular situation with your oncologist.
When intimate partners become 'patient' and 'caregiver'
In most relationships, when one partner is ill, the other partner usually picks up more of the day to day responsibilities at home and becomes the "caregiver". In the short term this is usually not a problem. However, if an illness has been prolonged, problems can arise. The caregiver can get very tired and stressed with the extra responsibilities; the patient can feel irritable and 'sick of being sick.' Both of you may be feeling preoccupied and anxious at certain times, which of course is not conducive to feeling open and sexual with one another. Especially in younger couples, the roles of "patient" and "caregiver" are a far cry from what you've come to know and expect of yourselves as 'lovers.'
Bear in mind that shedding the roles that breast cancer has foisted upon you, is not as simple as taking off a hat and gloves. Feeling more like your former selves — in your everyday life and in the bedroom — is a gradual process that takes time.
Adjusting to change takes time
Try to remember that any change in your sexual relationship can be distressing for both partners and adjusting takes time. It is important for you to talk honestly about your concerns and fears in this area. Men often want to support their partners but may be at a loss to know what to do. They may be hesitant to raise the issue of sex for fear of appearing insensitive. Women may be feeling unattractive and avoid sex for that reason. It is perhaps easy to see why couples sometimes experience silence and confusion about sex! Nonetheless, most couples do sort out the issues and continue to have a satisfying sex life. Your health care team can be a source of information or referrals to specialists in this area. Don't hesitate to talk with them about your sexual concerns, even if they don't ask you!
