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Sex after breast cancer

Breasts are more than tools for breastfeeding. 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.

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, has spoken passionately about the impact breast cancer can have on a woman’s sexuality.

She points out the breast’s many functions:

• It is part of the female sexual identity
• It is part of a woman’s cosmetic and aesthetic identity
• It has a maternal function

It is, of course, also the carrier of 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,” says Graziottin.

She is referring not only to the impact of the loss of a breast due to cancer, but also the development of lymphedema (arm swelling that may 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 points out, is especially problematic for younger women, and – less predictably – those who are less educated, because of the impact of what she calls the “silent breast” on the woman’s sex life and relationships.

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

Graziottin is a staunch advocate of what she calls “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.”

Maternal function
Graziottin says that a key issue for many women is that cancer means no breastfeeding: it has been suggested that breastfeeding may increase the risk of a recurrence of cancer, or of secondary breast cancer. She adds, however, that there are more studies disproving this idea than there are to support is.

However she agrees 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 urges women to explore 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 says.

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 causes 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,” says Graziottin.

Premature menopause
Premature menopause is a little-known side-effect of breast cancer treatment. Graziottin says this 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.

“Most women with breast cancer are told, or feel, lucky to just be alive,” she says, urging doctors to acknowledge 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 concludes.

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