Sexuality, femininity and intimacy

Undergoing treatment for breast cancer can have an impact on women’s sexuality and intimate relationships in a number of ways. Physical changes related to treatment, as well as emotional effects related to treatment, sense of self and relationship dynamics, are common. While some women, especially those with early stage breast cancer, may experience less impact on their sexuality or may adjust fairly easily after treatment, other women may experience more substantial or long-lasting effects. Moreover, dealing with the effects of breast cancer treatment on sexuality, identity and intimate relationships can be challenging because information about this subject is often difficult to access. The range of perspectives shared by women we spoke to, from limited to more substantial impact, are summarized below.

Limited impact on sexuality, identity and intimate relationships

Several of the women we spoke to did not feel that treatment had a big impact on their sexuality, femininity or the status of their intimate relationships. Sometimes this was because they were single, were not looking for a relationship and did not experience emotional or physical impacts that otherwise affected their sexuality or identity. Likewise, some of the women who were married or in relationships were relatively unaffected. Having supportive partners and not feeling that their surgery diminished their femininity were common elements for many of these women.

For example, Deann did not experience any negative impacts on her sexuality. As she explained, “My husband was very good about it … he was great … They said I had cancer and … I was like, “Well, you know, it’s only a boob, you know really right? … It may affect some people but it didn’t affect us.” And interestingly, cancer did not prevent Nalie’s relationship with her current partner, which actually started shortly before she received her diagnosis.

Other women experienced some negative impact on their sexuality and intimate relationships but were able to manage this and get back to normal over time.

More substantial impacts on sexuality, identity and intimate relationships

Women experiencing more substantial impacts on their sexuality and intimate relationships talked about being affected in a number of ways. These included changes to their identity or body image, physical pain or discomfort during intimacy and their partners having fears of hurting them or fears of spreading the cancer. During treatment women described a loss of interest in sex because of fatigue.

After surgery, a number of women noticed changes in the way they felt about themselves or their sexuality. For instance, the loss of one or both breasts and the resultant scarring sometimes left women feeling that they had lost their femininity. Debbra described how she felt that she lost part of her sexuality.

The loss of sensation after mastectomy was another widely-discussed issue.

A number of women opted to have reconstructive surgery after mastectomy. However, while this often provided psychological improvement it didn’t restore sensation.

Some women also experienced impacts on their sexuality from other forms of treatment. For example, extreme soreness after radiation therapy was a common though usually short-term effect that limited physical intimacy. Tina described a period of two years of recovery from soreness before the intimacy returned back to normal.

The loss of estrogen due to chemotherapy or hormone therapy meant that many women experienced loss of libido (sexual desire) and vaginal dryness which can make intercourse painful. Women experiencing these effects described these challenges in varying degrees. One woman spoke how her interest in sexual activity was totally gone after losing her breasts.

Others maintained their interest in sex but had to find ways of managing their symptoms, for example, through the use of lubricants to make intercourse more comfortable. However, while this allowed these women to have sex, for some it was not as spontaneous as they once had been.

Impacts on partners and relationships

While the most obvious and direct effects of treatment on sexuality were experienced by the women, they also spoke about the impact on their partners and, more generally, on their intimate relationships. A number of women noticed that their partners needed reassurance as they were avoiding physical contact for fear of hurting them. Debbra felt that there needs to be more recognition of the impact on men since “they have no support system and also feel that they have to be strong … when they watch somebody that they love … and they have no ability to come up with a solution … it’s really, really difficult for them.”

Other women found that, although their partners did not complain or put pressure on them to have sex, the dynamic between them had changed. Several women talked about this experience as a significant loss.

While the impact of cancer and treatment on relationships could be substantial, many couples were able to work through these difficulties. Sometimes they were able to get back to normal as it had been before diagnosis and treatment. Others had to adapt and find a new normal.

Impact of treatment on dating

Some of the women we spoke to were single and were faced with the prospect of having to disclose their illness and the effects of treatment to potential partners. Ginette, for example, wondered how she would deal with this kind of situations, she has no idea yet.

Accessing information about the impact of treatment on sexuality and intimate relationships

While the women we spoke to shared a wide variety of experiences related to the impact of treatment on their sexuality and intimate relationships, there was broad agreement that information about these potential impacts had not been freely offered by their healthcare providers. Several women felt that their doctors had avoided or glossed over the subject. As Kathryn put it: “They don’t ask. You have to say it which is bad because some people are shy, they’re intimidated, they’re embarrassed and so a lot of things are swept right under the carpet.”