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Real Women, Real Intimacy Issues »
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Sexual Dysfunction
Sexual dysfunction is a common side effect of breast cancer treatment, and its causes are often both physical and psychological. On the physical side, chemotherapy can cause the ovaries of premenopausal women to shut down and stop producing estrogen, triggering early menopause. Menopause may cause vaginal dryness that makes intercourse more painful than pleasurable, reducing a woman’s ability to have an orgasm.
When the ovaries shut down they also stop producing testosterone—often called the “hormone of desire”— which can lower libido (the desire for sex). In addition, fatigue, pain, nausea, vomiting and hot flashes that can accompany chemotherapy, radiation and hormonal therapies can put a damper on libido at any age.
The psychological impact of breast cancer treatment can make sexual dysfunction even more complicated. When a woman’s breast, so strongly associated with sexuality, is altered by surgery, her body image and self-esteem may cause her to question her attractiveness and desirability. Factor in the stress of a breast cancer diagnosis, fear of recurrence, depression and anxiety about a partner’s emotions, and it’s no wonder that sexual dysfunction is a common side effect, regardless of age.
There is good news, however. “While there’s no magic solution for getting older before your time, there are approaches to help reduce the side effects of chemotherapy-induced menopause [that affect sexual health],” says Tracey F. Weisberg, M.D., medical director of the Maine Medical Center Breast Care Center and a practicing oncologist at the Maine Center for Cancer Medicine & Blood Disorders in Scarborough, Maine. “These are essentially the same approaches used to help older women who experience sexual side effects as they go through natural menopause, and some are holistic and natural. They include vaginal lubricants, antidepressants for hot flashes and vitamin E.” She notes that vaginal estrogen also is an option for reducing vaginal dryness in breast cancer survivors at any age, but “absolutely” no oral estrogen.
Managing the emotional fallout from breast cancer treatment is more complex. “Support groups are a good resource for women to talk to one another,” Dr. Weisberg acknowledges. “And as a doctor, I try to listen and be available to patients.” Consulting psychotherapists, sex therapists and social workers who specialize in working with breast cancer survivors are other options. Most comprehensive breast care centers or gynecologists can help women connect with these resources.
Is age a factor in a woman’s willingness to broach the subject of sexual functioning in the wake of breast cancer treatment? “In my experience, younger women are no more likely to ask about sexual side effects than older women,” Dr. Weisberg says. “Age isn’t really the issue when it comes to sexual functioning; it’s more about the quality of the relationship.”
The limited research that exists regarding the sexual side effects of breast cancer treatment seems to bear this out. One study of women with breast cancer aged 35 to 68 reported that “women who sought information about the sexual side effects of cancer treatment and who had strong intimate relationships appeared to experience a more successful adjustment.” That underscores the importance of asking for help. When a woman is about to undergo breast cancer treatment, sex may not be high on the priority list of things to talk about.
Yet sexual intimacy can be one of the most life-affirming experiences available, and can contribute greatly to our quality of life. Seeking support, involving your partner in treatment decision and openly communicating feelings, wants and needs regarding sex during and after treatment can be vital to maintaining that bond.
This article was frist printed in Lifeline.
Think your experience is uncommon? Want to speak with someone who has gone through a similar one? Call the YourShoes Support Center at 800-221-2141 and speak with a trained peer counselor who is a breast cancer survivor.