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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.

Psychology of the diagnosis of a potentially life-threatening disease

Obviously, 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 afterward. The initial emotional upheaval can make it difficult to function or think straight for a week or two, and can even lead to mood disorders such as anxiety and depression. These lift gradually as you work through 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.

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, diarrhea and feeling more irritable than usual. Feeling 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, visualization, 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. 

Reversible and irreversible physical changes during and after treatment

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 biopsychosocial, 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
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 estrogen state.Hair loss aggravating body image concerns
Anxiety related to cancer diagnosis
Treatment-related weight gain, fatigue, and peripheral nerve function problems
Pelvic floor problems
Radiation treatment Temporary painful skin inflammation
Loss of nipple sensation
Endocrine therapy Premature/early menopause

Decreased Libido
Genitourinary syndrome of menopause (GSM), a term that encompasses any urinary, genital, or sexual dysfunction related to a low estrogen state.
Sexual pain due to hormonal insufficiency
Treatment-related muscle pains, fatigue, weight gain, and hot flashes with sleep disruption

 

Skin-nipple-areola sparing mastectomies and newer forms of breast-conserving surgeries, where cancer surgery is integrated into a breast lift or reduction, can be discussed and there are treatments for hot flashes, 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 absolutely appropriate to do so.

Effects of cancer diagnosis and treatment on the non-affected partner in a relationship

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.

In interviews with cancer survivors, an article in Healthtalk says: “Some people said that once they had recovered from their illness and were no longer so dependent on their partner, there had been challenges in restoring equality in their relationship. Sometimes people felt their personality had changed after having cancer and this had altered the dynamics within their relationship.”

With a life-threatening diagnosis, it is obvious that the dynamics in 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 others’ perspective. In a number of relationships, this dichotomy leads to either strengthening or breakdown of the relationship. Being rudely reminded of our own 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 a possible recurrence, or that they feel ‘defective’. 

Saving your relationship

Cancercare lists the following as important steps to take with your partner:

  • Talk 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 with your partner: If you are both able to be 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 deep 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.

Psychology of recovery of sexual health after cancer

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 normalization of existence.

For those who have travelled the breast cancer journey, they have 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 the 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 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. Find out what works for you now, instead of trying to recreate what you have. It takes time to recover from a cancer diagnosis, and Vencill proposes doing this exploration without a partner first to explore your own baselines and comfort levels.

Bottom line

It’s important to be your own advocate when it comes to sexual health post a 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.

References

Vegunta, S., Kuhle, C. L., Vencill, J. A., Lucas, P. H., & Mussallem, D. M. (2022). Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship. Journal of clinical medicine11(22), 6723. https://doi.org/10.3390/jcm11226723

Dr. Justus Apffelstaedt

Dr. Justus Apffelstaedt

Dr. Justus Apffelstaedt is a specialist surgeon with a particular interest in breast, thyroid, and parathyroid health management, as well as soft tissue surgical oncology. Dr. Apffelstaedt has published about 50 peer-reviewed articles in scientific journals both nationally and internationally. He has also presented about 60 invited papers at national and international scientific meetings. Additionally, he has had about 100 scientific papers read at national and international scientific meetings.

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