Sexual health and breast cancer
A topic that is not frequently discussed is that of intimacy and sexual health post a breast cancer diagnosis. Whilst these conversations do take place between patients and medical practitioners, there is often hesitation about raising questions and discussing the reality of intimate relationships.The psychology of a diagnosis
Receiving a cancer diagnosis is a shock. How the patient works through what is a life-changing event affects all aspects of wellbeing during treatment and afterwards. The initial emotional upheaval can make it difficult to function or think straight for a week or two and even lead to mood disorders such as anxiety and depression. These lift gradually as you work through the diagnosis and treatment and realize that life goes on.
This process lasts about 6 months and often leads to a significant mindset change towards life. It is important to understand that you are powerless over the diagnosis, but you are not powerless about the journey that you undertake from there. There is no right or wrong way to react and how you cope depends on age, personality, the type, and prognosis of the cancer you’re facing, and the support you have.
The physical signs of stress and anxiety include a change in appetite, feeling sick, sleep disruption, muscle tension, tightness in the chest, racing heart rate, difficulty concentrating, diarrhoea and feeling more irritable than usual. To feel deep emotions is normal, the approach to managing those will differ per person, but some of the tools that assist are: Talking to someone, counselling, planning, physical activity and good lifestyle choices, meditation, visualisation, and quiet times and distracting yourself from dwelling on what is perceived as a negative situation. None of these are easy, but they do work.
Physical changes
In a study published in 2022 entitled Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship, it is acknowledged that “factors that contribute to sexual health concerns in breast cancer survivors are bio-psychosocial, as are the barriers to addressing and treating these health concerns”.
According to this study, breast cancer treatments can lead to the following physical effects.
Cancer surgery: Body image concerns; loss of sensation of nipple, breast, and/or chest; and swelling of the arm.
Chemotherapy: Premature menopause; genitourinary syndrome of menopause (GSM – a term that encompasses any urinary, genital, or sexual dysfunction related to a low oestrogen state); hair loss aggravating body image concerns; anxiety related to cancer diagnosis; treatment-related weight gain, fatigue, and peripheral nerve function problems; and pelvic floor problems.
Radiation: Temporary painful skin inflammation; and loss of nipple sensation.
Endocrine therapy: Premature/early menopause; decreased Libido; GSM; sexual pain due to hormonal insufficiency; treatment-related muscle pains, fatigue, weight gain, and hot flushes with sleep disruption
Skin-nipple-areola sparing mastectomies and newer forms of breast-conserving surgeries, where the cancer surgery is integrated into a breast lift or reduction can be discussed and there are treatments for hot flushes, vaginal dryness, anxiety, sleep disruption, loss of libido and more. It is important to discuss the psychological and physical challenges with your medical team and it is appropriate to do so.
Effects on the non-affected partner
A cancer diagnosis and treatment are life-changing events and as such also affect the intimate partners of the person diagnosed, especially as sexual organs and their functions are affected/altered by treatment.
Non-affected partners often assume the role of “carer”, which in itself has a psychological impact on an intimate relationship.
With a life-threatening diagnosis, it is obvious that the dynamics of a relationship will change. The person receiving the diagnosis is on their journey – their loved one is on another – and neither can fully understand the other’s perspective.
In several relationships, this dichotomy leads to either the strengthening or breakdown of the relationship. Being rudely reminded of our mortality is bound to produce complex emotions and responses. People who were single during the diagnosis and treatment also report that they are worried about finding a partner due to possible recurrence or that they feel ‘defective’.
What to do
Cancercare lists the following as important steps to take with your partner:
• Talking to your partner. Many partners need reassurance that you still find them attractive. You may feel the same way. It is best to talk through these feelings and not ignore them.
• Be honest. If you are both honest, it helps bring what might feel like a difficult topic into the light and remove the stress of denying that anything might need to be discussed.
• Talk about the physical closeness you need. You might feel self-conscious about your body. You might not be ready for physical intimacy but crave affection. Speaking to your partner will also alleviate your partner’s discomfort about knowing what you need and how to provide that. It also allows them to share with you how they feel.
• Let yourself feel loved and cared for. Remember what you like about yourself. Not just physically, but also personality-wise. Be compassionate towards yourself. It allows your partner to be compassionate too; mutual support is a deeply human trait.
• Be patient with yourself. The cancer and effects of the treatment are beyond your control. Understanding that you need to adjust is a personal experience. It’s also completely appropriate if you don’t feel ‘ready’ to be intimate.
• Get support when needed. Sometimes a third party is a great help. They are objective and able to facilitate conversations that you might not feel ready to have.
The psychology of recovery
For intimate partners, the psychological navigation of having been a caretaker can take a while to balance out. Often there is a fear of further damaging the physical and psychological well-being of the cancer survivor or an inability to cope with the new reality.
This stands in direct contrast to the survivor’s need for intimacy as a sign of the normalisation of existence. The person who has travelled the breast cancer journey has been through a gamut of physical and psychological journeys. The ability to communicate openly and honestly is one of the most important elements to get right.
With these discussions, psychological safety can be established for both parties, with an understanding that sexual and mental health are linked. There has usually been a fear response from both sides, with both parties dealing with this in their own way. Without talking through the experience of the diagnosis, treatment, and psychological effects, it is difficult for sexual health to be restored within a relationship.
When embarking on a new relationship, a cancer survivor might feel vulnerable to having deep discussions with new partners.
“When I think about regaining sexual functioning, three words come to mind: patience, exploration and support,” says Dr Vencill, a Mayo Clinic psychologist. She suggests that exploration of your body sensations could be helpful. Finding out what works for you now, instead of trying to recreate what you had. It takes time to recover from a cancer diagnosis, and Vencill suggests doing this exploration without a partner first to explore your baselines and comfort levels.
It’s important to be your advocate when it comes to sexual health post-cancer diagnosis. Many people struggle to have conversations with their medical teams or partners due to social or personal restrictions; if that challenge can be overcome, there is a plethora of support mechanisms that can be provided by your medical and/or counselling team, and a new relationship with your body and your partner to be explored.
*Dr Justus Apffelstaedt is a specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology.
** Opinion pieces and letters by the public do not necessarily reflect the opinion of the editorial team. The editors reserve the right to abridge original texts. All newspapers of Namibia Media Holdings adhere to the Code of Ethics for Namibian Media, a code established jointly with the Media Ombudsman.