The Measure of a Woman

For women who have not had breast cancer, it is hard to imagine anything more devastating than losing a breast. Women who have had breast cancer quite often mourn the loss of their breast, or at the very least, their loss of feeling safe in their own bodies. They are also faced with trying to maintain or recapture what it was that made them feel feminine and desirable before their diagnosis. This is not always easy. Our society places such emphasis on the breast as a symbol of femininity; it’s important for women to maintain a strong sense of self in order to avoid the pitfalls of feeling vulnerable or damaged both physically and mentally.

In addition to our physical health, it is extremely important for women dealing with breast cancer and its aftermath to pay close attention to their emotional, psychological, and spiritual wellbeing throughout the entire journey. It is not uncommon for the focus on tests and treatments to overshadow these incredibly important aspects of our lives. A positive body image, as well as feeling both sexually desirable and desiring sex, should not get lost as we move forward after breast cancer.

It has been found that a woman’s choice of treatment is most likely influenced by her age, the image she has of herself and her body, and her hopes and fears. Some women select a lumpectomy with radiation therapy over a mastectomy for cosmetic and body image reasons. Other women will choose a mastectomy because they want the affected area removed, regardless of how it will affect their body image.

Concerns about sexuality can be very worrisome for women with breast cancer. There are a number of factors that come into play which can place women at a higher risk for sexual problems after breast cancer. It is important to bear in mind that some treatments, such as chemotherapy, can actually change a woman’s hormone levels, which in turn can negatively affect her sexual interest and/or response.

It is very common for women to experience a loss of desire for sex after their breast cancer treatments. Women taking anti-depressants or anti-anxiety medication often experience a loss of libido. Many women are distracted by negative thoughts about their breast cancer when they begin feeling well enough to become sexually active after treatment. Women who are experiencing this problem may find it helpful to do a quick mental survey to try to determine what may be inhibiting their desire. It’s okay to ask yourself, do I still feel sexy? How do I feel about my body? Do I feel rejected by my partner? When someone makes an effort to discover where the problems may originate, it is often easier to find ways to eliminate them.

Looking for positive ways to increase sexual pleasure or arousal might include:

• Vaginal lubricants
• Anti-depressants that don’t lower libido or make it difficult to reach orgasm
• Anti-nausea medication
• Alternative sources of sexual pleasure
• Talking openly with your partner

A woman’s relationship with her partner may also suffer because a breast cancer diagnosis can be highly distressing for a loved one. Quite often a spouse or significant other is unsure how the diagnosis and treatments are going to play out in their future together. They may be concerned about how to express their feelings physically and emotionally after treatment. This can be especially true after surgery; because they may be afraid they will somehow physically hurt their loved one. If the surgery has been recent, physical discomfort may be a reality. Talking to your partner openly and honestly about what you are feeling will help to keep the lines of communication open.

Sexual problems have been linked to mastectomy more frequently than to any other cancer treatment. Losing one or both breasts can be highly traumatic not only for the woman, but for her husband or partner. The most common sexual side effects usually come from damage to a woman’s feelings of attractiveness. With the removal of a breast, a woman may feel she has lost part of her beauty and femininity. She may be insecure about whether her partner will still find her appealing or sexually attractive. Although nearly 50% of women have sexual problems after breast cancer, it is crucial to remember that this is nearly the same rate as in other women of similar age and background who have not had breast cancer.

Since the breasts and nipples are also the source of sexual pleasure for many women, losing a breast can create a sense of despair when a woman feels she will no longer enjoy this sensation. Touching the breasts is a very common form of foreplay in our society, so it’s understandable that a woman could feel a great deal of concern about whether or not she is going to have problems getting sexually aroused. She may also feel this will be a problem or turn off for her partner. Getting comfortable looking at and touching the area of your scars or reconstruction can be very helpful in getting acclimated to the person you are now.

Remember that breast surgery or radiation to the breasts does not physically decrease a woman’s sexual desire. Additionally, it does not decrease her ability to have vaginal lubrication, normal sensations in the genital area, or her ability to have an orgasm. However, treatment for breast cancer can interfere with how a woman feels about being caressed. After a mastectomy a woman may not feel comfortable (either physically or emotionally) having someone stroke the area around her scar. Women who have had a mastectomy may no longer enjoy having the remaining breast and nipple touched. How women deal with their body image after surgery is as unique as the women being treated.

Studies show that a woman’s psychological health, relationship satisfaction, and sex life before breast cancer appear to be far stronger predictors of what her sexual satisfaction after breast cancer will be, rather than whether or not she has lost a breast.

The most common culprit in causing sexual dysfunction may actually have very little to do with the loss of a breast, but with the premature and severe menopausal impact of chemotherapy or hormonal therapy. Women who are experiencing problems with vaginal dryness may find relief by using products such as Astroglide, Moist Again, K-Y Jelly, or Replens. It’s important to talk to your doctor about these sorts of concerns, because they generally have an array of suggestions and solutions that can help.

The majority of women can benefit from brief sexual counseling after a diagnosis of breast cancer. Further, a joint session with the woman’s partner can be crucial in facilitating open communication about sex for the couple. Unmarried women may benefit from individual counseling or from attending a support group. Single women may need advice on how to meet new dating partners and when to talk about their history of breast cancer. It may be particularly helpful for single women to hear about other women who entered into new relationships after having had breast cancer. Single women should find some comfort in the fact that one large survey of breast cancer survivors found that women who developed a new relationship after their breast cancer were the most sexually satisfied group – compared to all of the other women in the survey.

Single women who are trying to create a meaningful relationship after breast cancer may find it helpful to take small steps like:

• Making friends with people before thinking about becoming intimate.
• Role playing a bit. If you feel awkward about how you will tell someone you’ve had breast cancer, practice in front of your mirror, or ask a friend if you can use them to work on how best to convey this message.
• Make honesty a part of the plan. When the time is right, it’s important to let a potential partner know what to expect.
• Put yourself in the other person’s place. How would you feel if a man you were dating told you he’d had prostrate cancer? Would you still feel good about dating him? How willing would you be to cope with potential medical and/or sexual problems?
• Keep people who can’t cope away from you. Don’t let someone else’s inability to deal with a life threatening illness make you feel bad about yourself. You truly are better off without that sort of person in your life.

Older women should not be stereotyped as being asexual. Most women over age 65 remain sexually active and are concerned about their appearance. Regardless of a woman’s age, losing a breast can be a very traumatic experience. Health care professionals need to understand this dynamic and make sure they are presenting the option of breast conservation in the same way they would to a younger patient. Older women have legitimate concerns about their body image, intimate relationships, and feelings of femininity – and these need to be addressed and respected.

Returning to an enjoyable sex life is an important part of survivorship for many women. Women who have experienced breast cancer have every right to want and expect they will come through it with a positive body image. No one wants to feel that losing a breast means losing their femininity. Each woman will look for and find the answers she is seeking in her own time and place. Some women glide through the experience as though nothing much has changed. Others take a long time to adjust to their new body, or to how they feel about their body. Women who have gone through the experience and been able to regain their emotional and physical balance often find it helpful to focus on things about themselves that they find attractive rather than dwelling on the parts that have been changed. As with so many health-related issues, physical exercise can play an important role in helping women regain their physical and emotional equilibrium.

Something as seemingly simple as wearing frilly, feminine camisoles, panties, or blouses can go a long way to helping some women regain their sense of “normalcy,” wellbeing, and femininity. Certainly, there are women who can no longer wear plunging necklines or other more revealing types of clothing, but many women faced with this dilemma have discovered how to create a look they find pleasing by experimenting with scarves, light weight sweaters, and fashionable shawls. As is so often the case, what we think everyone else is noticing exists in our own minds, and really isn’t a concern to others. If you feel good about yourself it’s likely other people will respond to you in a positive way. Absolutely nothing is sexier or more vital than a woman who exudes confidence and self-esteem. This is something none of us should let cancer steal away!

Having breast cancer does not decrease your value as a woman; in fact, most women find they come through the ordeal a better person. Learning how to recapture your pleasure in living and the fun in your life can definitely make a difference in the quality of your overall experience. You may not feel better about your body overnight – but it’s important to spend time getting the support you need and nurturing yourself so that the self-doubt becomes a memory and not a way of life.