How Relationships and Intimacy Are Impacted by Breast Cancer Survival

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The importance of intimacy while coping with metastatic cancer has received more attention in recent years. Breast cancer, in particular, can lead to issues which put a damper on intimacy, but that doesn’t mean it is any less important. Rather, maintaining intimacy while living with cancer may affect you positively in other ways as well.

It’s not just the emotional overlay of metastatic cancer, but the physical side which often push intimacy to the back burner.

Body image can change with mastectomy scars and more. Bone metastases can weaken bones and limit movement, and cancer fatigue can make any activity—especially sexuality—a challenge.

Where Fears May Stem From

Living in a society that views breasts as sexual objects, many of us fear not being sexually attractive to our partner or spouse. For single women who date, there are the fears that accompany beginning a new relationship, sharing information about having breast cancer, and being intimate. Young women who want children may face fertility issues because of chemotherapy treatment.

How Breast Cancer Can Impact Your Relationship

Dr. Marc Hurlburt, Chief Mission Officer of the Breast Cancer Research Foundation, shared the assessment findings of the American Cancer Society and the American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline, which was issued in the latter part of 2015.

As Dr. Hurlburt explains, “The purpose of the Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. It identifies issues that may affect female survivors, of all ages, and suggests clinicians speak with them about their quality of life.

Since many women are uncomfortable bringing up problems of intimacy, clinicians are encouraged to bring up the subject of sexual intimacy and relationship difficulties that may be related to their breast cancer."

Dr. Hurlburt identified the major issues in the care guidelines that impact on relationships and intimacy as:

  • Body image and appearance changes, which affect between 31 to 67 percent of survivors. The six most difficult body image problems for most women included:
    1. Scarring from mastectomy and bilateral mastectomy surgery and breast reconstruction. Sexually active women identified greater body image problems whether or not they had reconstruction.
    2. Chemotherapy-induced early menopause.
    3. Changes in the skin due to radiation.
    4. Difference in the size of the treated breast due to lumpectomy and/or radiation.
    5. Swelling in the arm and hand following surgery (lymphedema).
    6. Weight gain related to treatments.
  • Sexual health issues include reduced libido, vaginal dryness, painful intercourse and difficulty reaching orgasm. Birth control methods for women, in their childbearing years, who take tamoxifen to prevent a recurrence, need to limit their birth control options to the IUD and condoms. Pregnancy on tamoxifen is not safe; it can cause birth defects
  • Cognitive functioning was a problem for over 35 percent of women long-term.
  • Depression and anxiety were reported by 22 percent of the women as being problematic.
  • Other, less frequently reported issues, included: osteoporosis, and bone pain in postmenopausal women as a result of taking a class of hormone therapy called aromatase inhibitors to prevent recurrence.

What Can You Do?

There are a few things you might wish to consider to help you maintain intimacy in your relationship while coping with metastatic breast cancer.

  • Keep in mind that sexuality is much more than sex. There are many ways in which you can touch that don’t include intercourse.
  • Think of ways to keep a spark going even amidst treatments. You may wish to think about how you were when you and your partner first met. Holding hands while receiving chemotherapy, walking through hospital corridors, or back and forth to the car is a start. Sneak a kiss when the doctor isn’t looking. Think of ways to be playful.
  • Be ready for the side effects of treatment before intercourse. Hormone therapy can cause vaginal dryness, so having plenty of lubricant on hand is a must. Many women claim that a “side by side” position is more comfortable if you’re coping with pain from mastectomy scars.
  • Find ways to be sensual. Candles, a new nightgown (or boxers), your favorite music, and even chocolate and strawberries can add a touch when your mood is focused on your cancer rather than intimacy.
  • A lack of desire is extremely common and related to a lot of the symptoms associated with metastatic breast cancer. If you are waiting until you feel desire you may end up with a very long wait period. Some therapists who have worked with people with cancer suggest the “fake it till you make it” approach with desire. It may take “remembering physically” before your emotional side follows.

Your partner may also have concerns that being intimate could hurt you, which can start a vicious circle. While it may be hard to initiate the conversation, having a thoughtful and honest conversation with your partner and your oncologist may clear the air regarding these concerns.

Additionally, much of what the women identified as issues in the assessment can be relieved by getting help from a clinician who can counsel them on what will relieve or reduce their side-effects such as:

    • Scar creams that can reduce the appearance of surgical and reconstruction scars.
    • Lubricants that are safe to use that will ease vaginal dryness and painful intercourse.
    • Breasts that are no longer the same looking, as a result of surgery, can be made so through reconstructive surgery.
    • The side effects of early menopause can be eased with medication and exercise.
    • Skin changes due to radiation that last longer than a few months often respond to treatment.
    • Lymphedema can be treated and swelling reduced for many women.
    • Weight gain from treatment can be kept under control through diet and exercise.
    • Depression and anxiety can be treated with therapy and, if needed, with medication.

    Sources:

    American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines 2015.

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