Breast cancer

Updated 15 October 2009

Sex after breast cancer

The breast is a symbol of femininity and sexual identity, so when a woman loses her breasts to cancer, the loss is more than merely physical, and the impact can be devastating.

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Breasts are more than tools for breastfeeding. They are a symbol of femininity. So when they’re taken away the emotional impact is immense and, sadly, often overlooked.

When women lose their breasts to cancer they lose more than just a physical part of themselves. Often, the emotional consequences - for both the patient and her partner – are overlooked.

Professor Alessandra Graziottin, Director of the Centre of Gynaecology and Medical Sexology at the H. San Raffaele Resnati in Milan, Italy, spoke passionately at the FIGO World Congress of Gynaecology and Obstetrics about the impact breast cancer can have on a woman’s sexuality.

She pointed out there are many functions of the breast:

  • It is part of the female sexual identity
  • It is a cosmetic and aesthetic identity
  • -
  • It has a maternal function
  • It is, of course, also the carrier of a potentially deadly disease

Female sexual identity
“Breast cancer often deeply wounds the female body image, and can have a devastating impact on a woman’s sense of her femininity,” said Graziottin.

She was referring not only to the impact of the loss of a breast due to cancer, but also the development of lymphedema (arm swelling follow breast cancer surgery), and the chance that chemotherapy can trigger premature menopause.

In cases where the breast has been reconstructed, many women report that they have no sensation or feeling in that breast – which directly impacts on sensuality and therefore sexuality.

This, she pointed out, was especially problematic for younger women, and – less predictably – those who are less educated, because of the impact of what she dubbed the ‘silent breast’ on the woman’s sex life and relationships.

Cosmetic and aesthetic
“Many reconstructed breasts look good because they are the right shape, but if there is no feeling in the breast then it’s only serving the function of social acceptability. Feeling is necessary for sexual function,” she said.

Graziottin is a staunch advocate of what she called “nipple-sparing technology”, which involves preserving the nerves in the breast during surgery so that when the breast is reconstructed, there will be some sensation.

“If we can spare the nipple, the cosmetic and erotic perception will be better too.”

The maternal function
Graziottin pointed out that a key issue for most women is that cancer means no breastfeeding – there has been a suggestion that breastfeeding may increase the risk of a recurrence of cancer, or of secondary breast cancer. She said, however, that there are more studies disproving this than there are to support this school of thought.

She added, however, that she agreed with the usual recommendation of postponing pregnancy for up to five years after breast cancer surgery and chemotherapy, and strongly recommends avoiding pregnancy during treatment.

On the other hand, if loss of fertility is a threat, she recommended women find out about different methods available to preserve their ability to have children later, should they want to.

“This is not because chemo will necessarily cause malformation of the baby, but because the woman is facing the threat of death during chemo and she is not physically or emotionally prepared to deal with a pregnancy at that time too,” she said.

The sexual and sensual function
An unfortunate side-effect of chemotherapy is that it often quells desire due to problems with lubrication, orgasm and sexual pain.

If premature menopause is also a factor, then the accompanying vaginal dryness, hot flushes and decreased libido can also lead to a woman feeling less attractive and therefore more sexually dormant.

“This often leads to depression. Nearly half of all women suffer depression within the first year of diagnosis and treatment of breast cancer. Depression and loss of desire then also contribute towards sexual dysfunction and ultimately relationship problems,” said Graziottin.

Premature menopause
Premature menopause is a little-known side-effect of breast cancer treatment. Graziottin said is sometimes misdiagnosed, as the symptoms may be seen as stress-related from having cancer.

There is conflicting research regarding hormone therapy to counteract this.

“The vast majority of women with breast cancer are told, or feel, lucky to just be alive,” she said, urging the doctors at the conference to be watchful about acknowledging that each patient needs to be holistically considered.

“The earlier the diagnosis, the better - and I advise all women to educate themselves on this disease and all treatments available to them” she concluded.

(Amy Henderson, Health24, October 2009)

Read more:
Breast self-examination
All about breast reconstruction

 

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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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