The impact of breast cancer on intimacy
Note from BCNA: The following is a guest post in a series we're bringing you this year.
Jane Fletcher is a health psychologist with over 15 years’ experience working with individuals with breast cancer. She runs a specialist psycho-oncology private practice at Cabrini Health and Epworth Freemasons. Jane holds adjunct appointments with the Szalmuk Family Psycho-oncology Research Unit based at Cabrini Health and with Monash University. Jane continues to offer evidence based intervention to individuals, couples and families at all stages of the cancer experience.. She has extensive experience using cognitive-behavioural therapy, acceptance and commitment therapy, a range of existential approaches and mindfulness based interventions. She is qualified in medical hypnosis and uses this for the treatment of cancer related sleep disorder, phobic and conditioned responses. She has a special interest in sexuality and is experienced in a range of specific interventions for the psycho-sexual issues associated with a cancer diagnosis. Special interests include breast, gynaecological, prostate, bowel, lung and haematological cancers. She also works with those who have tested gene positive for cancer who may require prophylactic surgical intervention. Jane speaks widely, both locally and internationally, to peers and those living with a cancer diagnosis and hold adjunct appointments with Monash University and the Szalmuk Family Psycho-oncology Unit.
Some of you may know Jane from BCNA's information forums.
Some of you may know Jane from BCNA's information forums.
The Impact of breast cancer on intimacy
A diagnosis of breast cancer affects all member of the family unit and can have a huge impact an individuals intimate relationship.
So what is intimacy?
We use the word intimacy often without defining exactly what we are talking about. Intimacy is not just sexual intercourse, it includes emotional and/or physical closeness.
So why can intimacy be an issue post breast cancer?
A diagnosis of breast cancer is a traumatic event and this trauma can impact on an individuals desire for intimacy. Surgery can have a significant effect on the way an individual feels about themselves. Scaring and changes in the way the body looks impact self-esteem. Body image can also be affected by the many side effects of treatment including weight gain and hair loss. These can impact on how attractive you feel and often result in a reduced desire for intimacy.
In addition, the treatments used in breast cancer can effect the sex hormones produced and this may have an impact on a range of aspects of the sexual experience. Libido, or the desire for a sexual experience, may be affected and the reduction in desire for sex may cause tension and confusion in the relationship, especially if the other partner’s desire for sex is higher. This ‘libido mismatch may already exist in some relationships and this situation can often be worsened by the treatments for breast cancer.
In addition, the treatments used in breast cancer can effect the sex hormones produced and this may have an impact on a range of aspects of the sexual experience. Libido, or the desire for a sexual experience, may be affected and the reduction in desire for sex may cause tension and confusion in the relationship, especially if the other partner’s desire for sex is higher. This ‘libido mismatch may already exist in some relationships and this situation can often be worsened by the treatments for breast cancer.
The reduction in desire for sex can also be confusing for the other person in the relationship. People often feel rejected and blame themselves, thinking that they are no longer attractive or loved.
Just thinking for a moment about your own experience, how often have you either raised issues related to intimacy with your health professionals or been asked if there are any issues? Many people report not raising issues as they were not asked if there was an issue. This ‘cone of silence’ just increases the poor communication that exists in this area.
So what can you do to help the situation?
The most effective intervention for any issues related to intimacy involves open and honest communication. The avoidance of assumptions and the willingness to do things differently will help build closeness and further deepen a relationship. Emotional intimacy involves the expression of emotion in a way that lets the other person know how you are feeling. It does not mean being able to know what the person is thinking or feeling but being able to ask questions and listen in a non-judgmental way. A relationship that is based on good communication will have a level of emotional intimacy that will assist in managing the impact of breast and its treatments on physical intimacy.
Physical intimacy is more than sexual intercourse or sexual behaviour. It involves touch and that is essential in the release of one of our pleasure hormones, oxytocin. Touch can be a hug between friends or it can have a more sensual aspect. Touch is an important part our sexual/sensual toolkit. By talking to your partner you are able to expand the sexual/sensual toolkit and discover new things that other person may like and this may be additive to a relationship.
Touch is also an important part of sexual excitement or arousal. Sexual arousal is still possible even if your desire for physical intimacy is low. The arousal response may just take more time. When a woman becomes aroused or turned on, there is an increased blood flow to the walls of the vagina, which caused fluid to pass through the walls and is the main source of lubrication. This lubrication is what makes the vagina wet. The production of lubrication can be reduced by the treatments for breast cancer. Vaginal dryness is a significant issue for many women post breast cancer. If the vagina is dry and we try to have sex, it is going to be painful and pain on sexual intercourse may cause an avoidance response. The use of a good quality lubricant is essential. BCNA’s booklet Breast cancer and sexual wellbeing has a section comparing some of the lubricants available. Your breast care nurse will also be able to assist and will be able to advise where you can buy lubricants locally and you can always shop online. If you find that lubrication does not help then please talk to a member of your health care team.
What to do if you need help?
Sometimes we need guidance to be able to discuss these issues. There are great resources available and a good starting point is BCNA’s booklet Breast cancer and sexual wellbeing. Your breast care nurse is a fantastic resource and if they cannot help they will be able to refer you to a suitably trained health professional. BCNA also have a telephone counseling service available for individuals with metastatic disease and the health professionals involved are skilled in discussing issues relating to intimacy. It can be embarrassing raising issues relating to sexual intimacy but if you raise an issue with a member of your health care team then you are closer to finding some strategies to improve the situation.
