iStock - Georgljevic, used with permission
Source: iStock - Georgljevic, used with permission

Beating cancer means being and feeling alive and having hope. Beating breast cancer means that plus more - feeling like a fully-alive female and sexual being.

Most of the women I’ve treated after breast cancer tell me – NO ONE warned them that cancer would interfere in such a profound way with their sexual desire and functioning. They knew they might lose their breast(s) – a profound injury to femininity, yes – but they didn’t know they would also lose their vagina though dryness, thinning and atrophy.

Sex connects us to our partner in an incredibly alive and exhilarating moment even though breast cancer does its damnedest to stop our enjoyment. After fear and death have had their reign of terror, survivors often realize how every moment matters and every connection is sweeter. Here are four areas of primary concern and 12 ways you and your partner can fight back!!

1st primary concern - Fear and Anxiety – When our very survival is at stake, sex can be the furthest thing from our minds. Many survivors tell me that during this first year after diagnosis, through surgery and more treatment with chemotherapy and/or radiation - their only focus was on staying alive.  Partners too, can be desperately scared and put their sexual needs on the back burner. But sex is a comfort. It's a life affirmation. Orgasm ratifies our body as a source of pleasure despite the pain. Lovemaking connects the two of us when separation threatens like a widening cavern.

1.  Keep desire alive. Offer your wife a “her orgasm only” night – no reciprocity necessary. Perhaps think of the many times she has selflessly offered you a quickie when she was not particularly in the mood. Ultimately keeping her desire alive while it’s not on her mind will help preserve sex for the long haul and regular orgasms feed female sexual hunger. Give her plenty of physical pleasure and comfort with orgasms, back rubs, foot rubs and where-it-doesn’t-hurt rubs. 

2. Use sex-sustaining medications. Survivors - ask your physician for only anti-anxiety or anti-depression medications that DON'T interfere with sexual desire. Most SSRIs (Prozac, Zoloft, Celexa, Lexapro, etc.) dampen desire and make it harder to have an orgasm.  Ask your doctor about the possibility of using a norepinephrine-dopamine reuptake inhibitor (NDRI) instead and about treating panic/intermittent anxiety with short-acting anti-anxiety meds. Be a strong advocate for yourself here and consult a psychiatrist (an expert in psychotropic meds) if necessary instead of just your oncologist.

2nd primary concern - Breast Loss – Cancer survivors may have their breast marred by lumpectomy, lose one breast, or lose both breasts.

Amputation - Losing the body part(s) that at first glance mark a woman as female is a dreadful blow to the whole self let alone the sexual self. It’s mutilation. It is a physical and psychic trauma. Often physicians concerned with the gravity of the cancer diagnosis ignore or minimize the complex and painful experience of the breast loss. 

Many cancer survivors tell me that friends have tried to comfort with the grossly insensitive comment, “Well, you’ve lost your breast but at least you have your life.”

I also don’t want to minimize the challenge that women also feel with distorted breast shape after lumpectomy.  Any change to the breast when profound, can seriously damage a woman’s sexual self-esteem.

3.  Rage like nobody’s listening. Grief and anger are a natural part of the healing process but it is very difficult to do when you are the glue that holds your family together. Get together with other survivors, a best friend or a therapist and let it out!

Sexual Identity  - This part of a woman that brought pride in adolescent development, and reflexive joy in relationship now is the toxic enemy. Despite our culture’s struggle to describe gender as individual, for the breast cancer victim, there is an imperative need for instant redefinition - she is feminine with or without breasts.  But for the survivor, there can be a difficult struggle to maintain her historical sense of her identity after mastectomy. What is femininity?

Femininity contains a reflexive feeling in response to desirability – “I will feel desire if I inspire desire.” (While I write a good deal about women also having subjective desire, I am speaking here about a particular psychological injury post-mastectomy.)  Some women fear that they are inadequate sans breasts and report feeling like an imposter even with reconstructive surgery. Women can worry about a critical or rejecting glance at the breast absence in “place of the [previous] esteem.”1

Women post-mastectomy reveal that they feel a loss of beauty and therefore a loss of erotic value.  Our culture has high ideals for the female form as it is and a woman’s new body disrupts her mind’s schema of her sexual body. The deformed body (even reconstructed) can be highly difficult for the self to recognize and without integration, the woman can experience the lack of sexual feeling, even sexual aversion.2

4.  The first and best mirror is the loving eyes of our partner who says – “You are beautiful.” A woman can experience what I call the  “Picasso feeling” – what used to make sense in the mirror now doesn’t and we need mirrors to know who we are. Women who have accepting husbands/partners-wives do much better in recovery. But some women are single, of course, and some partners are too distraught themselves to offer much reassurance. Friends and loved ones can also mirror your value and beauty. Listen to them. Let the love in.

Even with the blessing of a partner’s loving gaze, sometimes a woman doesn’t believe it because she herself is disoriented about the new self.  Depression can be a real factor in dealing with the mixed up body that used to give her pleasure easily and looked the way she expected it to.  Women can withdraw from loved ones and social contact at just the point when they deeply need friends who know and love them. Get therapeutic help if you have a persistent feeling of body image decompensation. 

5. Use meditation to soothe the confusion, pain, and loss. 

3rd primary concern - Arousal and Desire - Once bringing sexual delight from being cupped, held, and squeezed with accompanying exquisite nipple sensation - the loss of breasts robs women of a familiar, reliable, sexual arousal pattern.  Sometimes breast play is enough to bring a woman to orgasm.

6. Grieve and release. It’s not fair.  It’s not fair to lose a proven pathway of sexual arousal.  You have to mourn the loss. Your partner may have to mourn the loss of their pleasure in your breasts as well. And yet sexual arousal gets harder for all of us at some point. Flexibility will keep you enjoying your sexual body. Find alternative ways to experience sexual arousal. 

7. Use tools. What used to be toys pre-cancer become necessary tools to reach prior levels or arousal. Vibrators - particularly, clitoral vibrators can reach through the clouds of medications and treatments that have muted your body's ability to respond sexually. Ask your doctor about the new meds to spur desire or increase lubrication. Consider Sildenafil or it's cream version (yes, that's what is in Viagra - #notjustformen) for it's vasodilation.

4th primary concern - Vaginal Atrophy and Dryness – to add insult to injury, many breast cancer treatments from chemotherapy to prophylactic oophorectomy can cause premature or accelerated menopause. Tamoxifen and aromatase inhibitors essentially remove all the estrogen in your body and suddenly your vaginal tissue feels like you are 80 years old. Painful intercourse can lead to avoidance of sexual penetration.

8. Redefine sex as sexual pleasure not vaginal penetration. Don't grit your teeth and have intercourse even when it's painful and you are bleeding. Get vaginal rehabilitation first.

9. Keep lubricated – Use water-based lubricant suppositories, massage the vulva and vaginal opening with vitamin E oil.

10. Stay open – Insert your own fingers into your vagina while washing in the shower for a vaginal stretch daily, stretch with dildos or vibrating toys or partner fingers often. Try the suggestions for my Vagina Wishlist from my website.

11. Physical therapy – yes, there is specific PT for just this problem called women’s health physical therapy (WHPT) and it’s not as awkward as you might imagine. WHPTs work magic for painful vaginas by increasing muscular stretch and defining and healing pain points.  

12. Laser resurfacing -  many gynecologists are using FDA-approved laser vaginal resurfacing with fabulous results to rebuild collagen to thin, dry vaginal tissue.

1, 2Arroyo, José Manuel García, &  López, María Luisa Domínguez (2011). Psychological Problems Derived from Mastectomy: A Qualitative Study. International Journal of Surgical Oncology,Volume 2011(Issue), Article ID 132461, 8 pages. Link

For more from author Laurie J. Watson - listen to her podcast on iTunes or Stitcher - FOREPLAY Radio Sex Therapy or visit her website AwakeningsCenter.Org for speaking and online sex therapy appointments.

Begin working on your sexual and emotional connection to you partner now by taking the QUIZ on the first page of Laurie's website - www.AwakeningsCenter.Org

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