Insights into Cancer, Sexual Health, and Intimacy: Survivors and Experts Speak Up
One aspect of cancer that is seldom discussed is how it affects our sexual health and relationships. A cancer diagnosis is always life-altering, but specifically with breast and ovarian cancers, the surgical alternation of reproductive organs and hormonal interventions can have significant impact on how our bodies and minds handle intimacy.
According to a recent study published in the Annals of Surgical Oncology, of the patients with stage 0-IV breast cancer surveyed, “Most patients reported a decreased sexual desire (69%), vaginal dryness (63%), and less energy for sexual activity (62%) during/after treatment.” It was noted that if patients did receive information about sexual changes with treatment, it was regarding the menopause symptoms they might encounter (hot flashes, vaginal dryness, mood changes, etc.) and not so much about identity, pleasure, quality of life, and the impact on sexual relationships.
“Any sort of body alteration can impact how we feel about ourselves”
Nationally recognized sex and relationship expert, author, and film creator, Moushumi Ghose, M.F.T. agrees that more attention needs to be paid to the psychosexual effects of cancer. “Any sort of body alteration can impact how we feel about ourselves,” Ghose says. Scarring or breast malformation after a lumpectomy or mastectomy can “stand as reminders of the illness and that alone can impact how we feel about ourselves. Add in the way that breasts are viewed in our society as a sign of sexual prowess or sexuality, and this can have ramifications on arousal, body perception, and ultimately sexuality.”
Elizabeth “Brianne” Lovin has a genetic mutation that significantly increases her odds of developing breast and ovarian cancer, so at age forty-one, she underwent a double mastectomy with breast reconstruction, a hysterectomy and removal of both of her ovaries and fallopian tubes. Overall, now almost two years from surgery, she feels more or less back to normal and likes the way the implants look, but after experiencing several postoperative mastectomy complications (hematoma and capsular contracture), she says, “I can't wait to get to that stage when I go all day and just don't think about my tits." Regarding her new breasts and intimacy, she says that since she lost nipple sensation from surgery, “They don't do anything for me. My partner can look but touching them is a turnoff. Also, I am self-conscious about them, so I always wear some type of shirt or bra.”
Suppressing estrogen is often part of treating and preventing breast and ovarian cancer. These effects may be temporary, or may be permanent, as in the case of the surgical removal of the ovaries. Ghose says that hormone therapy impacts us physically, physiologically, and psychologically. “Hormone changes can certainly have an effect on how we perceive ourselves and how our bodies feel. Treatments can make us nauseous, lose (or gain) weight, lose hair, feel fatigue and more. This in turn will impact our sexuality. Bottom line is if we aren't feeling good about ourselves, regardless of how we truly look or feel, we are not going to be feeling sexual. Sexuality is tied to feeling excited and sexy and hormones have an impact on our desire and our arousal.”
In Brianne’s situation, she is able to take estrogen replacement after having her ovaries removed, so she does not experience the menopausal symptoms she otherwise would, but still, she notes that sex requires more deliberate effort now.
"Context is important. Mentally, I have to work harder to get turned on. Setting time aside and making the environment more conducive to feeling sexy helps.”
Other changes from treatment can impact how we feel about ourselves, as well. “Hair, similar to breasts, is a sign of youth and beauty in our culture.” Ghose says that hair loss, a common side effect of chemotherapy, “can have significant impact on self-image, which of course can directly affect sex arousal and drive.” She says that even though there are beautiful wig and other cosmetic options now, “nothing can really override the trauma of having a cancer diagnosis and what it does to your body, mind, and relationships.”
Regarding relationships, Ghose says, “The patient is going to go through a myriad of emotions. The partner may be expected to be there and be supportive but is also going through a myriad of their own emotions. It is important for everyone experiencing a cancer diagnosis- not only the patient, but also the patient’s partner/s, friend, parent, sibling, and children- to get outside help and support. We all need someone to talk to. It's hard enough to deal with our own emotions let alone the emotions of our loved ones. It's important not to try to go it alone.”
Brianne has found her way back to herself by maintaining her routines and taking care of her body. “I have had enough change, so I am careful to keep up with my fitness and health goals so that I can look and feel as good as possible. Eating right, moving my body- consistency is key.”
Ghose’ advice for getting back into a self-confident, sexy groove with ourselves and our partners includes a lot of rest, water, and a good therapist, or several. She says that a couple’s sex therapist can recommend different positions, toys, lubrications, and ways to emotionally and sexually connect even in the midst of cancer treatment. She also recommends the podcast, “Sex and Chronic Illness” with Dr. Lee Phillips and the podcast and book “Come as You Are,” by Dr. Emily Nagoski.