Sexual intimacy is one way couples bond and reaffirm their affection for and their attractiveness to one another. For patients living with a breast cancer diagnosis, those affirmations are more important than ever.
But getting intimate can be complicated when your libido is compromised by the very drugs you hope will cure you.
Women living with a breast cancer diagnosis often face a double whammy. Not only must they endure the treatments that follow this shattering diagnosis — often chemotherapy, sometimes coupled with a lumpectomy or a mastectomy — but they also face significant changes in their sex drive and their willingness to experience sexual intimacy.
“Chemotherapy puts women into sudden menopause, which causes a drop in their estrogen levels and a significant drop in their libido,” says Dr. Steven Cohen, an oncologist at Bryn Mawr Hospital of the Main Line Health network.
“Premenopausal women often have tumors that are a little more aggressive than women who were post-menopausal to start with, so they will end up getting intravenous chemotherapy for three to four months. The drop-off in estrogen caused by chemotherapy can have a more substantial effect on sexuality than breast surgery itself, and it often comes up in conversations with patients,” he says.
Dr. Gordon Schwartz, director of the Jefferson Breast Care Center at Thomas Jefferson University Hospital, agrees that some of the medication to treat breast cancer can interfere with a woman’s ability to enjoy intimacy. “Reducing estrogen levels causes vaginal dryness which can make intercourse uncomfortable,” he explains.
Add anti-depressants to treat the inevitable mood changes that accompany a diagnosis like breast cancer, and those drugs can decrease libido further.
Cohen says vaginal lubricants can be helpful, as can low doses of vaginal estrogen either through a cream or a vaginal insert, oral estrogen or the estrogen patch. “The problem with estrogen replacements is there’s the theoretical possibility it can bring cancer back a little more quickly,” he explains.
“There’s no study that shows an increased risk of recurrence, but all the packages carry a warning.”
Prescribing vaginal estrogen is controversial, says Schwartz, “but I do it under certain circumstances. I think as doctors, it’s our job to treat a patient’s quality of life. If the patient is truly miserable because she has no hormones, I think there’s no reason why we cannot give her hormones to bring back some good feeling.
“That’s the difference between being a doctor, and being a scientist.”
The majority of women whose treatment for breast cancer mandates a mastectomy choose to have breast reconstruction, an area of specialty for Schwartz for the past three decades. During that time he’s been known to tell his patients that only God can make a breast.
“Plastic surgeons can do a good job, but they cannot create the same responses to being touched as a normal breast can,” he says. “The breasts we make may look good, but they don’t feel the same.”
Mastectomies and reconstructive surgeries can significantly change a woman’s self-image. “In the days before breast reconstructions became popular, the patient looked at herself as having been mutilated,” Schwartz says. “Even now, it can take a woman a long time to walk past a mirror without crying, though breast reconstruction has gone a long way towards relieving that angst.”
Reconstruction is not a factor of age, he adds. “We’ve done one even on a woman well into her 80s, which proves that breast reconstruction has everything to do with self-image.”
Schwartz recalls one of the most attractive women he ever operated on. “She had both breasts removed, didn’t have reconstruction and doesn’t wear a falsie,” he says. “She jokes that she’s as flat-chested as she was at age 12 — but she and her husband are quite comfortable with that.”
Another patient got divorced several months after having a mastectomy. “I asked her why, and if the mastectomy had much to do with it,” he says. “She said it did. She told me the son-of-a-bitch had been cheating on her for years. After she came through the mastectomy, she felt she finally had the courage to throw him out. She became a stronger person for having had that experience.
“It’s an unusual take, though,” he concedes.
In all the years he’s been performing breast surgery, Schwartz says he doesn’t know of a healthy relationship between a husband and wife that’s been disrupted as a direct result of the patient having undergone a mastectomy. “A healthy relationship is not based on the presence or absence of a breast,” he says. “I hope it’s more than that!”
Dr. Sandray Schnall, an oncologist at Bryn Mawr, recommends that breast cancer patients seek help from support groups, with or without their partners. She also recommends one-on-one discussions with their partners to help them understand what a woman is going through, both on a physical and on a psychological level.
“The patient needs to know that their partner will support them and tolerate the ups and downs of treatment,” she says. “Hopefully life will return to ‘normal,’ after a breast cancer diagnosis, but it will never totally be the same.”
South African native Lauren Kramer is an award-winning writer based in Western Canada.