Sex after Breast Cancer

Strategies for Success

Any concerns you might have regarding sexual relations should be discussed and doing so early in your recovery will create more openness and honesty between you and your partner. Waiting until just prior to the first sexual encounter may be a set-up for unmet expectations, disappointments, and intimacy problems down-the-road. Honesty is the best policy. You need to be up-front about your level of desire, what it takes to arouse you, and how you can best reach orgasm. Explore and communicate how your feelings as a sexual person have changed as a result of your diagnosis and treatment. Issues you might want to address include:

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FAQ

What if I don't feel comfortable being seen naked?

If you’re feeling self-conscious about how you look or are concerned as to how your partner will view your change in appearance, you may wish to wear a camisole, nightgown, tube top, or other garment. This doesn’t have to be a forever thing. As you ease back into sexual intimacy, you may become more comfortable with your body and choose to forego cover-ups.

You may want to consider making love by candlelight or putting a colored bulb in the bedside lamp. Of course, you can always make love in the dark.

What if I don't want my breast or chest touched?

If one breast has been removed, you might be distressed when your partner caresses your remaining breast. If both breasts have been removed, you might not want any attention to your chest during lovemaking. If you’ve had a lumpectomy, mastectomy, or breast reconstruction, you may have numbness in the breast, lack of nipple sensation, or in some cases, no nipple at all. You may prefer not to be touched. Breasts which were once a source of pleasure for both partners suddenly become a reminder of the cancer. Neither partner may want to include them during intimacy, even after treatments are complete. Communicate your feelings! It’s okay to not have your partner touch your breasts if it bothers you. At such a time when you might like your partner to resume caressing your breast(s), be sure to let him/her know.

What if sexual intercourse is painful?

Pain during intercourse is most likely related to vaginal dryness. Dryness can occur as a side effect of chemotherapy medications or the onset of menopause.

You may also experience pelvic nerve neuropathy as a result of chemotherapy. Damage to the pelvic nerves may result in:

  • Decreased sensation in the vagina and clitoris, making arousal more challenging
  • Decreased vaginal lubrication which may result in dryness and painful intercourse
  • Difficulty achieving orgasm

Overcoming vaginal dryness will take a little planning. You can keep lubricants such as KY Jelly, Astroglide (both available in drugstore chains), plain vegetable oil, or aloe on hand for when you engage in sexual relations. Lubricating during sex will help eliminate painful intercourse. If you are dry through the day, Replens (available in drugstore chains) can be used on a more frequent basis. Talk to your doctor about hormone preparations such as Estring (vaginal estrogen ring), Vagifem cream, or bio-identical hormones. With your history of breast cancer, many doctors do not recommend estrogen preparations, particularly if your breast cancer is hormone receptive.  Interestingly, the more often you have sex, the more easily you will become lubricated.

If dating, how will my new partner react to my mastectomy?

It can be awkward to approach the topic of mastectomy when you are dating and exploring intimacy. Honesty is probably the best policy. When you feel comfortable with your partner, explain that you have had a mastectomy and why. It’s helpful to discuss it up front before entering into an intimate situation. You are who you are, and if you are comfortable and confident about your body, this will help your partner to accept you and feel at ease in your personal and sexual relationship.

If I want to, can I have children in the future?

Your fertility may be affected by chemotherapy treatments. If you’d like to have a child in the future, speak to your physician prior to starting treatments. You may be able to harvest eggs to be stored for pregnancy down the road. Often times, fertility decisions need to be made quickly prior to the start of cancer treatments. It can be very stressful to make such important decisions in a short time-frame. This is an important discussion between you and your partner and should not be influenced by outside sources. Once you make your decision, put it to rest and feel comfortable that you’re doing what’s best for the two of you.

What if I'm just not interested in sex?

Unfortunately, as of yet, there are no sexual enhancement drugs on the market for females. Cancer treatments may wreak havoc on your level of sexual desire, arousal, or ability to reach orgasm. Yet, recapturing your sexuality is an important piece in returning to a whole person. With your partner’s help, resume familiar foreplay and patterns one step at a time. You may have to work up to intercourse. Be patient with yourself but keep trying.

What if my anxiety about sex interferes with relations?

It is natural that you might feel anxious about resuming sexual intimacy. You might experience mood swings as a side effect of cancer treatments. Other sources of anxiety can affect interpersonal relationships such as the fear of cancer recurrence, a change in work-life related to treatments and doctor appointments, or social isolation during cancer recovery.

Remember to communicate your feelings to your partner. Prior to relations, you can practice relaxation techniques such as soft music, a warm bath, or meditation. Massaging each other using scented oils can relax you, provide physical stimulation, and create intimacy. Aromatherapy can help create a soothing environment. A diffuser can be used with favorite scents, or a candle can be lit. If you can’t overcome your anxiety and suspect there may be an element of depression, talk to your doctor. You may need an anti-depressant to get you back on track to feeling yourself.

What if I'm too tired to have Sex?

As soon as you are able, return to a regular exercise program. Exercise will reduce stress, help energize you, assist with keeping your weight in check, and promote a healthy sleep schedule. It can also help reduce anxiety and depression. Studies show women who exercise after breast cancer decrease their risk of reoccurrence.  Plan sexual relations during the time of day when you feel the best. Eat a healthy, balanced diet to restore your nutrients and return your sense of well-being.

Proper sexual positioning can be helpful in reducing pain during sexual intercourse.

Sexual Positions

The Missionary Position

The missionary position (man on top, woman on the bottom) can be painful as the penis is thrust toward the back of the vagina. It may be more comfortable to assume a face-to-face position. Your partner lies on his back with you sitting on top.

Alternate arousal methods can be tried to enhance sensation in the vagina and clitoral area. Masturbation, oral stimulation, and use of a vibrator can be considered to increase arousal and intensity of orgasm.

If you’d prefer that your partner not directly view your chest, you can assume sexual positions to minimize his direct view. If you were used to specific positions previously, you may want to be flexible and consider others to enhance your comfort level as you re-establish intimacy. In any case, make sure you’re comfortable during sexual relations.

The Spoon Position

In the spoon position, the woman lies on her side with her partner curled against her back. If trying to shield one breast, she can lie on the same side as the breast she’s trying to conceal.

Standing Position

The woman can lean on something firm, such as a chair, with her partner behind her.

Kneeling Position

The woman can kneel on all fours on the bed or other surface with her partner entering her from behind.

The journey through the diagnosis, treatment, and recovery from breast cancer is no easy road. Once you emerge on the other side, get on with your life as a stronger, healthier, hopeful person!