The physical and psychological impact of breast cancer on sex.

Lets talk about sex…and breast cancer! The impact of cancer, more specifically treatment for cancer, on sex can be profound. The physical changes that various treatments cause as well as the immeasurable psychological fall out, can wreak havoc on even the healthiest sex lives.

This is a topic I feel should be discussed more openly with patients upon a diagnosis of cancer. No one on my medical team ever bought up the subject of sex with me. I was to undergo a year-long shlep of treatment for triple negative breast cancer, including chemotherapy. The myriad of potential side effects were discussed in detail, but never once that it would likely make sex complicated and even painful.

I get it, it’s the last thing you need to be worrying about at the time. But it is also something that it pays to be aware of and prepared for. So let’s take a closer look at how treatment for breast cancer can impact sex, and what we can do to manage it.

PHYSICAL EFFECTS.

Temporary menopause.

Whether that is due to chemotherapy, hormone blockers, or both, being plunged suddenly into menopause has a drastic physical impact. Menopause causes a steep drop in oestrogen levels. This causes vaginal dryness, hot flushes and loss of libido. Sexy right?

Vaginal atrophy.

This is as fun as it sounds. Just as chemotherapy can cause mouth ulcers and inflammation on the delicate membranes of your mouth, it can also do a number on the delicate inner workings of your vagina. Diving into menopause contributes to it as well.

Not only was the drop in oestrogen levels cause dryness, but it can also feel extremely fragile and sensitive in there. Sex can become raw and even painful.

Feeling unwell and fatigued.

Nausea, exhaustion, stinging eyes and aching bones aren’t sexy! (I’m sure there’s a joke about aching bones in there somewhere, but I’m going to leave it be.)

PSYCHOLOGICAL EFFECTS.

Body image/loss of identity.

Losing hair during chemotherapy, losing breasts, disfiguring scars, a prominent port in your chest, putting on weight from steroids. Breast cancer can make you unrecognisable even to yourself.

As women, society puts enormous pressure on us to be physically beautiful and sexually pleasing. It’s a sad case that a lot of our self worth is (usually subconsciously) linked to our appearance. So losing some of the things that make us feel feminine like our hair and most profoundly, our breasts, can be severely damaging to our sexuality.

Loss of control.

Being diagnosed with breast cancer and having to undergo gruelling treatment in order to save your life, comes with a stifling loss of control. Nobody physically forces you to go and sit in that chair every week to have toxic poison injected into your jugular. There’s no one leading you at gunpoint to the operating table to be physically maimed forever. But you have no choice in it nonetheless.

Then there’s the constant assault of needles, surgery, procedures, strangers touching and looking at your breasts. Your body becomes a medical subject, and it doesn’t feel like your own anymore. Cancer treatment is incredibly dehumanising, even violating.

Fear.

Fear of dying, and of what we are facing, can’t be underestimated. Most women need to feel relaxed and have a clear mind in order to properly enjoy sex. Fighting cancer puts a person into a constant state of fear and surveillance. All of their energy is directed to surviving, and that can leave little room for anything else.

What can you do about it?

First and foremost, remember that you are going through a lot right now. Your body is in shock, your mind in a state of heightened anxiety. Don’t try and force yourself to have sex if you don’t want to. It will only lead to resentment and a further fear of sex down the line.

I was very lucky to have an understanding and patient partner (now husband.) He never pressured me or made me feel guilty about it. That’s exactly how it should be, and if your partner is making you feel any other way it might be time to review your relationship. If he has at least one functioning hand, he can deal with his sexual frustration himself. It’s not your responsibility, especially while you are wading through the cancer swamp neck deep in muddy treatment.

That said, if you are missing sex, perhaps even find it therapeutic and want to keep things moving whilst you’re going through treatment, here are some things you can try.

- Talk to your oncologist or doctor. You will not be able to take any synthetic hormones, but there might be something topical they can prescribe to help with vaginal dryness and pain.

- Get some artificial lubrication. Silicone based is best. I highly recommend this silicone based one by Sliquid. It is a little more expensive than its water based counterparts, but lasts a lot longer as you only need a tiny amount. It’s the only thing that truly made me more comfortable when I was going through chemo.

- Spend some time with yourself. Yes I mean masturbation. It takes any pressure and expectation off, while you figure out what feels good and what your body can tolerate.

- Keep the conversation flowing with your partner. They might be taken off guard by your sudden disinterest/fear of sex, particularly if it is not something your medical team warned you about. Being honest and open will keep them in the loop and let them know that it is not a reflection of your feelings for them.

- Try talking with a psychosexual counsellor, particularly if the issue is affecting your relationship.

Above all BE PATIENT with yourself. Be realistic, and understand what your body is going through. Know that this is a common side effect and you are far from alone. After treatment your body will gradually find its new normal, and you will hopefully get your mojo back along with it.