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Sex After Breast Cancer

No matter what the treatment, how couples can return to satisfying lovemaking.

The bad news is that breast cancer can wreak havoc with women’s sexuality, and therefore, men’s. But the good news is that by two years after treatment, couples in supportive relationships usually adjust and enjoy sex as much as ever—sometimes more.

Long-Term Sexual Impairment?

Most studies paint a distressing picture of breast cancer’s sexual impact:

• It makes women feel less attractive and reduces their libido and sexual satisfaction.

• Seventy percent of women report sex problems after treatment.

• Breast removal (mastectomy) makes women feel disfigured, which kills libido, but even breast-sparing lumpectomy leaves scars that may have similar emotional impact.

• Many studies show that breast cancer treatment causes “long-term” sexual harm.

Of course, any cancer can impair sexuality. Diagnosis is traumatic and treatment side effects often include desire-killing fatigue, depression, hair loss, and nausea. But sex after breast cancer is particularly problematic because women’s breasts are so intimately connected with sexual attractiveness and erotic play.

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Hope for Lovers After Breast Cancer

Unfortunately, most studies of sex after breast cancer explore only the problems and not their resolution. And most “long-term” studies survey women or couples just six to twelve months after treatment, which isn’t very long. Meanwhile, a few studies have focused on couples’ return to lovemaking after breast cancer, and they show that in loving, supportive relationships:

• Sexual frequency and satisfaction usually return to pre-diagnosis levels within a year or two.

• Men’s reactions to women’s cancer-related emotional distress play a significant role in women’s sexual recovery.

• Among women who lose a breast (mastectomy), reconstruction hastens return to satisfying lovemaking.

Researchers at UCLA, USC, and Georgetown surveyed 863 breast cancer survivors two years after treatment. All were sexually active at diagnosis, and all had surgery, with some also opting for radiation and/or chemotherapy. Among the half who had mastectomies, one-third had reconstructions.

Compared with cancer-free control women, the participants’ libido, erotic responsiveness, orgasms, and sexual satisfaction were pretty much the same. In other words, after two years, breast cancer survivors recover not only physically but also sexually.

The Importance of Relationship Satisfaction

However, a subset of survivors noted residual sexual issues:

• Discomfort baring the affected breast to a lover.

• Discomfort having a lover touch it.

• Discomfort having sex in the nude.

• Vaginal dryness and genital irritation. (Chemotherapy suppresses vaginal lubrication).

However, the women who reported post-treatment sex problems also reported low levels of relationship satisfaction in general. Among women who rated their relationships supportive and satisfying, few complained about sexual dissatisfaction two years after treatment. In fact, women in the happiest relationships, often said the cancer had contributed to increased sexual satisfaction.

In another survey of 139 married breast cancer survivors 20 months after diagnosis, UCLA researchers found that sexual activity and satisfaction depended on couples’ ability to support one another through the experience. When the men were open to discussing the women’s feelings and shared their own reactions, the women returned to pre-diagnosis intimacy. But when the men avoided talking about the cancer’s emotional impact, the women were much more likely to report continuing sexual dissatisfaction.

My wife is a 23-year breast cancer survivor, so I’ve had personal experience with the disease’s sexual impact. I agree with the recovery studies. Like other relationship shocks, couple coping depends on a willingness to discuss the situation and provide generous emotional support.

In addition, I’d advise:

• During treatment and for a few months afterward, sex takes a hiatus. But kissing, cuddling, and gentle massage, particularly foot massage, can feel help women feel loved and cared for.

• If women have lumpectomies, reassure them that they’re still beautiful and sexy.

• If women have mastectomies, most feel better sexually with reconstruction, but some are clear they don’t want that. Support whatever your spouse decides.

• When you return to lovemaking, apply lubricant generously.

• Finally, breast cancer survival brings a deeper appreciation of life’s fragility, which can make sex feel more deeply satisfying than ever.

Need Help?

If breast cancer becomes a sticking point in your relationship, consider sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

References:

Bober S.L. et al. “Psychosexual Functioning and Body Image Following a Diagnosis of Ductal Carcinoma in Situ,” Journal of Sexual Medicine (2013) 10:370.

Broeckel J.A. et al. “Sexual Functioning in Long-Term Breast Cancer Survivors Treated with Adjuvant Chemotherapy,” Breast Cancer Research and Treatment (2002) 75:241.

Fallbjörk U. et al. “Aspects of Body Image After Mastectomy Due to Breast Cancer: A Two-Year Follow-Up Study,” European Journal of Oncological Nursing (2013) 17:340.

Frechette D. et al. “The Impact of Endocrine Therapy on Sexual Dysfunction in Postmenopausal Women with Early Stage Breast Cancer: Encouraging Results from a Prospective Study,” Breast Cancer Research and Treatment (2013) 141:111.

Kraemer L.M. et al. “A Longitudinal Examination of Couples’ Coping Strategies as Predictors of Adjustment to Breast Cancer,” Journal of Family Psychology (2011) 25:963.

Meyerowitz, B.E. et al. “Sexuality Following Breast Cancer,” Journal of Sex and Marital Therapy (1999) 25:237.

Neto MS, “Sexuality After Breast Reconstruction Post-Mastectomy,” Aesthetic and Plastic Surgery (2013) 37:643.

Panjari M. et al. “Sexual Function After Breast Cancer,“ Journal of Sexual Medicine (2011) 8:294-302.

Pumo V. et al. “Psychological And Sexual Disorders In Long-Term Breast Cancer Survivors,” Cancer Management Research (2012) 4:61.

Vieira EM et al. “Reproductive and Sexual History of Women Treated for Breast Cancer,” Rev. Brasil Ginecolog. Obstet. [Portuguese journal] (2013) 35:78.

Webber K. et al. “If I Am in the Mood, I Enjoy It: An Exploration of Cancer-Related Fatigue and Sexual Functioning in Women with Breast Cancer,” Oncologist (2011) 16:1333.

 

San Francisco journalist Michael Castleman, M.A., has written about sexuality for 36 years. more...

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