Sexual Concerns and Solutions for Women with Breast Cancer

By Rita Garcia, MA, LMFT

Breast Cancer Awareness Month is intended to spread understanding, provide education and information on access to services.  Just as important, but commonly overlooked, is a discussion on the side effects breast cancer treatment can have on your sexual life.
 
I want to emphasize that the purpose of this blog is not to create distress or inject anxiety about the side effects of cancer treatment.  Just as the goal of this month is to help uplift women with awareness and understanding, this blog is intended to foster awareness, to educate you on what to ask your doctor and what interventions to explore to address the side effects.

How Your Body Reacts During Sex
 
It’s important to first know how the body reacts during sexual intercourse or sexual desire
Sexual arousal can be influenced by touch or by thoughts.  It can occur with a partner or when you are alone.  Sexual desire is associated with the hormone androgen.  It’s found in men and women and one form is known as testosterone.  Women possess a lower amount than men, and it’s produced in the adrenal gland (above the kidneys) and in the ovaries.   

Arousal is followed by an increase in heart rate, an increase in blood pressure. Breathing becomes heavy.  In the genitals the clitoris becomes engorged with blood and will swell.  This contributes to the skin of the genitals becoming a deeper red.  The clitoris and the inner lips are considered the most sensitive to touch.   

There are many nerve endings in the opening of the vagina and the area can be sensitive to light touch.  After arousal the vagina becomes moist, and gets longer and wider.  This action has been compared to stretching a rubber band or expanding like a balloon.  (It will return to its former state after sex.)  As the vagina is stretching, the hormone, estrogen, influences lubrication to increase moisture and aids the flexibility of the vagina.

When orgasming, the nervous system sends messages to the brain, triggering intense pleasure in the genitals; the muscles around the genitals contract.  Some women compare it to feeling waves through their body. 

After orgasm, the body will return to an unexcited state.  The blood drains out of the genital area, and breathing and heart rate decrease. 

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What are the Sexual Side Effects of Breast Cancer and Treatments?
 
It is natural and understandable to not feel sexual from the side effects of cancer treatment. 

• Some chemotherapy drugs causes fatigue, loss of hair and nausea. 

• Certain chemotherapy drugs can cause short-term ulcers in the vagina, causing pain. 

• Some chemotherapy drugs may cause damage to the ovaries, which results in disrupting or stopping regular menstrual cycles and reducing hormone output.  Patients experience a loss of sexual desire, painful intercourse from vaginal dryness, a loss of vaginal elasticity, and premature menopause in young women. 

• Your body image can be affected by your breast(s) being altered (lumpectomy) or being removed (mastectomy).  Women also report a loss of sensation in the area. 

• Vaginal changes from a decrease in estrogen in vaginal tissue can sometimes cause vaginal atrophy, which is an inflammation, shrinking and thinning of vaginal tissue.  

• Women often experience depression from such overwhelming circumstances, which can also affect desire.

• A couple can experience stress and conflict during this difficult period, and sex may be the last thing on their minds.

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Bra Recycling Drive at MMFT during October
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Solutions for Sexual Side Effects of Breast Cancer Treatment
 
The most important thing to remember is that the ability to receive pleasure from sensual and sexual touch is possible, regardless of the treatment.       
 
The first step is becoming aware of these side effects so you can start planning how to address them.  Frequently this discussion does not take place between doctors and patients.  Sometimes there is an assumption that patients receiving chemotherapy are not having sex or there is insufficient time during a doctor’s visit to cover this piece.  The knowledge of these side effects gives you the power to initiate this important conversation. 
           
Lubricants:  During treatment, it is possible to continue having sex; depending on your energy and comfort level.  Non-hormonal vaginal moisturizers and water based lubricants can help with vaginal pain and dryness.  These are products that can be purchased over the counter (i.e. Sliquids or Astroglide). 
           
Remember that the vagina contains a natural mucus that may have become sensitive from chemotherapy treatment and could be irritated by products that contain warming agents, perfumes and artificial colors and flavors. 
 
Hormonal Treatment:  This option is not universally accepted by the medical community, so it is important to speak with your doctor or oncologist for the option that is best for you.
 
Some doctors can prescribe low-dose vaginal estrogen replacement to treat vaginal dryness.  This can include Estring and Vagifem. 
 
As an alternative, doctors can recommend treatment that does not increase hormone levels, such as intravaginal Tamoxifen and intravaginal testosterone.
 
Pelvic Floor Therapy:  Because of the vaginal and vulvar changes you can experience from cancer treatment (i.e. dryness and irritation) some patients can choose pelvic floor physical therapy.  Be aware that this can involve both internal and external manipulation so it important to be aware of your comfort level.  Some patients identify feelings of relaxation and control from the exercises and vaginal pain can be decreased.  Speak with you gynecologist or oncologist about this option. 
 
Counseling and Therapy:  During or after cancer treatment, sessions with a sex therapist (who specializes in treating patients with breast cancer) can help address difficulties in reaching orgasm or in feeling pleasure.  Often negative thoughts, like images of losing a breast or thoughts of being infertile, can stop the process of arousal dead in its tracks: these need to be reframed and explored so that a patient can move forward. 
 
Couples therapy is also recommended to tackle the conflict and stress that couples can experience when a partner is in treatment.  Sometimes this means teaching a couple different ways to feel sexual pleasure rather than focusing on intercourse and genital manipulation.  Massages, gentle touch, hand holding and kissing is encouraged as forms of commitment and reassurance.
 
Patients that battle breast cancer are fighters, and I hope this blog provided more ammo for the battle.  Everyone, no matter the circumstances, deserves to feel sensual and sexual.