Most medical studies paint a distressing picture of the sexual impact of breast cancer:
- It makes women feel less attractive.
- It reduces women's libido and sexual satisfaction.
- Seventy percent of women report sex problems after treatment.
- Breast removal (mastectomy) makes women feel disfigured, which kills libido. And even a breast-sparing lumpectomy may leave scars that have a similar emotional impact.
- Many studies show that breast-cancer treatment causes long-term sexual harm.
Any cancer, of course, can impair sexuality. The initial diagnosis is traumatic. Then, once treatment starts, its side effects typically include desire-killing fatigue, depression, hair loss and nausea. But breast cancer is particularly problematic because a woman's breasts are so intimately connected with sexual attractiveness and erotic play.
Hope for Lovers After Breast Cancer
Regrettably, most studies of sex after breast cancer explore only the problems, not their resolution. On top of that, most long-term studies survey women just six to 12 months after treatment — not very long-term at all, if you ask me.
But a few studies have focused on how couples can return to lovemaking after breast cancer. These show that in a loving, supportive relationship:
- Sexual frequency and satisfaction usually return to prediagnosis levels within a year or two.
- A man's reaction to his partner's cancer-related emotional distress plays a significant role in the woman's sexual recovery.
- Among women who lose a breast to mastectomy, reconstruction often hastens the return to satisfying lovemaking.
Researchers at UCLA, USC and Georgetown surveyed 863 breast cancer survivors two years after treatment. All were sexually active at diagnosis, and all had undergone surgery, with some also opting for radiation and/or chemotherapy. Among the half who had mastectomies, one-third had reconstructions.
Compared with a control group of cancer-free women, the participants' libido, erotic responsiveness, orgasms and sexual satisfaction were pretty much the same. In other words, breast cancer survivors recover not just physically but sexually within about two years.
Relationship Satisfaction Is Crucial
Still, a subset of survivors noted residual sexual issues:
- Discomfort baring the affected breast to a lover.
- Discomfort having a lover touch it.
- Discomfort having sex in the nude.
- Vaginal dryness and genital irritation. (Chemotherapy suppresses vaginal lubrication.)
The women who reported post-treatment sex problems, however, also reported low levels of relationship satisfaction in general. Among women who rated their relationships supportive and satisfying, few complained about sexual dissatisfaction two years after treatment. Indeed, women in the happiest relationships often said the cancer had contributed to increased sexual satisfaction.
In another survey of 139 married breast-cancer survivors 20 months after diagnosis, UCLA researchers found that sexual activity and satisfaction hinge on a couple's ability to support each other through the experience. When the man was open to discussing the woman's feelings and shared his own reactions, the pair returned to prediagnosis intimacy. But when the man avoided talking about the cancer's emotional impact, the woman was likelier to report continuing sexual dissatisfaction.
But What Would I Know About It?
My wife, Anne, was treated for breast cancer 22 years ago, so I've had personal experience with the sexual impact of the disease. I agree with the recovery studies cited above. As with other relationship shocks, breast cancer demands your willingness to discuss the situation — and to provide generous emotional support.
In addition, I'd advise:
- Don't expect sex during treatment, or for a month or two afterward. During treatment, however, kissing, cuddling and gentle massage — particularly foot massages — can help the woman feel loved and cared for.
- If your partner has a lumpectomy, reassure her she is still beautiful and sexy.
- Reconstruction surgery in the wake of a mastectomy can make a woman feel more sexually comfortable. But many women are clear they don't want that. Support whatever your spouse decides to do.
- When you return to lovemaking, apply lubricant generously.
- Breast cancer survival brings a deeper appreciation of life's fragility; it's possible that dynamic will likewise make sex feel more deeply satisfying than ever.
If breast cancer and its aftermath become a sticking point in your relationship, consider sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research or the American Board of Sexology.
Michael Castleman, publisher of the website GreatSexAfter40.com, writes about sex for AARP.
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