Breast Cancer Survivors: A Return to Sex and Intimacy

If you ask 10 women who recently finished breast cancer treatment about their sex lives, odds are good that at least eight of them will respond, "What sex life?"

"This is a huge issue for our patients," says Mary McCabe, RN, director of the Cancer Survivorship program at Memorial Sloan-Kettering Cancer Center in New York. "It's an enormous unmet need. One of the things our patients told us they wanted most from a survivorship department was a sexual health program."

For a breast cancer patient, nothing can kill sexual desire faster than the daily nausea of chemotherapy, the vaginal dryness of premature menopause, and the ongoing fatigue associated with just about every stage of breast cancer treatment. It takes longer to get aroused, and when you do, sex can be painful. You may not like being touched in the same way that you did before. Your affected breast may be too sensitive to touch, or if you've had a mastectomy, a reconstructed breast won't feel your partner's caresses at all.

"Frequently, sexual activity stops upon diagnosis," says oncologist Marisa Weiss, MD, founder of Breastcancer.org and the author of Living Beyond Breast Cancer. "Fear and uncertainty are huge drains on your libido. And then your body goes through all these changes at the same time, and women believe that they're less attractive and assume that their partner's not interested."

Getting Into Your Sexual Groove

The good news: you'll get your groove back. It just takes time -- and some creative thinking. In two studies presented at the American Society for Clinical Oncology meeting in the summer of 2004, women reported that the sexual side effects of breast cancer diagnosis and treatment were mostly temporary. One study found that women's sexual function declined over six months of post-surgical treatment (chemotherapy, tamoxifen, or both). But six months later, the same women were as satisfied with their sex lives as they had been before the study started.

Now, six months is a long time to be unhappy with the level of intimacy in your life, and there's no reason that you should be. Your sex life after breast cancer may be very different than it was before, but that doesn't mean it can't be just as good.

The first step: communication. "You can't assume that what's in your head is in your partner's head," says Weiss. "Most of the time, the partner finds you just as attractive as they did before, and they want you just as much." Talk candidly with your partner about how you're feeling. You may find that if he's been reluctant to initiate sex, it's not because of a lack of desire, but because he's afraid you might not be ready and he doesn't want to push you.

Getting used to sex after breast cancer also means getting used to your new body. One book that might help is Show Me: A Photo Collection of Breast Cancer Survivors' Lumpectomies, Mastectomies, Breast Reconstructions, and Thoughts on Body Image. Now in its second edition, the book features images of more than 30 cancer survivors from support groups at Penn State Hershey Medical Center. The women's smiling, beautiful photos, and their thoughts about body image, may help you adjust to the new you that you see in the mirror.

But if you don't feel ready to be fierce and sexy about your new body just yet, there's nothing wrong with wearing a little lingerie to bed if it will help you feel more attractive and more in the mood.

Next: think creatively. "You have to be open to new ideas and be resourceful," says Weiss. For example, if fatigue has you too tired for sex at bedtime, try to find another time of day when you have more energy (maybe a wake-up call).

The symptoms of menopause, especially vaginal dryness, may be getting in the way of your good time. Sex that was once exciting can be painful. Now is the time to take advantage of the countless lubricants available to smooth the way. Many women recommend Astroglide or K-Y Liquid. (Be sure to use it liberally on both yourself and your partner, and keep it handy next to the bed.) There's also a vaginal moisturizer called Replens, which you insert like a tampon about three times a week.

According to two recent studies, antidepressants may also be playing a role in your diminished sexual desire. You might want to ask your doctor about trying Effexor, an antidepressant that's been found to have fewer sexual side effects than most and, as an added bonus, helps combat hot flashes.

Don't neglect foreplay! "In order to get the vagina ready for intercourse, the stimulation you get during foreplay can be really important," says Weiss. "If you're just jumping into it, sex can be a painful act."

Focusing on foreplay, rather than being anxious about the sex act itself, can also make things in the bedroom more exciting and less stressful. You can spice things up with toys and treats from stores like Grand Opening (http://www.grandopening.com), Good Vibrations (http://www.goodvibes.com), and Toys in Babeland (http://www.babeland.com). Oral sex prior to intercourse can be gentler on the vaginal tissues and help get you ready for sex.