Treatment & Side Effects
Depending on the type and stage of breast cancer, treatment options are wide and varied. Both the diagnosis and treatment can impact sexuality, intimacy, and personal relationships. Initial reactions to breast cancer often focus on fear of the unknown, management of symptoms related to treatments, and long-term survival. Sexuality and intimacy typically take a back seat, both for you and your partner.
If surgery is involved, treatments include lumpectomy, simple mastectomy, modified radical, or radical mastectomy. Decisions will be made whether to undergo breast reconstruction surgery. Most often, any surgical changes to the breast will evoke feelings of grief and loss. You may feel a loss of femininity and a sense of no longer being “whole”. Your breasts influence your sexuality, and you may feel disfigured and less desirable to your partner. You may be concerned about scarring, change in appearance, and changes in breast sensation. For awhile after surgery, you may experience pain from the procedures and require pain medications. You may have loss of sensation in the surgical area which may be temporary or permanent. One or both nipples may have been removed. If undergoing breast reconstruction, your surgeon may be filling tissue expanders by injection every couple weeks. As your skin expands over the implants, you may experience discomfort, numbness, or pain in your chest and arms. Your psychological reactions to many of these physical changes will impact intimacy and personal relationships.
Radiation treatments can cause fatigue to the point where sexual relations can become unimportant while going through therapy. There may be skin irritation which can cause discomfort during sex. If the radiated skin becomes thick, there can be both pain and a change in sensation. These issues can affect sexual relations down-the-road.
If breast cancer treatment includes chemotherapy, treatment effects are broad and can impact sexual intimacy both short- and long-term. Treatment effects while undergoing chemotherapy can include nausea, vomiting, fatigue, hair loss, dry skin, mouth sores, nerve pain in the arms and legs, numbness in the vagina with effects on stimulation and orgasm, and secondary illnesses related to a compromised immune system. Steroids often accompany chemotherapy treatment and can cause mood swings, weight gain, and acne. If you are experiencing any of the described effects from chemotherapy or radiation therapy, it is important that you discuss them with your medical team so your symptoms can be managed. It is not surprising that most women are unlikely to be interested in sexual relations while trying to manage these side effects.
Long-term, chemotherapy may induce early menopause. Typical side effects can include vaginal dryness, pain during sex, hot flashes, episodic urinary tract infections, urinary frequency and urgency, decreased interest in sex, difficulty reaching orgasm, weight gain, sleep disturbances, and mood swings. If you have hormone-receptive breast cancer, after chemotherapy, your doctor may prescribe Tamoxifen, a drug that reduces the chances of cancer recurrence. Tamoxifen causes many similar effects of early menopause mentioned above. Since it is usually prescribed for a period of five years, it can extend the duration of these symptoms. Depending on the woman’s age when experiencing early induced menopause, side effects may seem manageable or overwhelming. Young women who planned for future pregnancies may feel deprived of their womanhood and grieve the loss of their ability to have children. Even women who are not planning pregnancies may resent the sudden onset of menopause. Desire for intimacy, arousal, and orgasm can all be affected.