A breast cancer diagnosis brings a lot of changes to a woman’s life; some temporary, and some permanent. But on top of your physical changes, emotional fatigue, and side-effects from treatment, many women also experience changes in their sex life from lack of desire, body image issues, vaginal dryness, and pain. Maintaining good sexual function and health is important before, during, and after breast cancer. Sexual health is general health.

Here’s what to expect, and what you can do about it.

But They’re My Breasts

Many women, and men, associate a woman’s breasts with sex and sexuality. It’s just a fact, fair or not.

It’s not a surprise that having a breast cancer diagnosis may affect how you see yourself sexually.

There are many options for removing tumors in the breast that don’t involve losing one or both of your breasts. Reconstructive surgery is also an option.

However, if a mastectomy is possible, it’s important to have a conversation early on with your doctor about your concerns of losing your breasts and how you feel It’s better to have these conversations early before they become an issue so you know what to expect and can prepare.

Also, talk with your partner about how both of you feel. Breast cancer affects your partner too. Involving them and sharing your feelings together can go a long way in retaining your intimacy.

Sexual Dysfunction

Sexual function is comprised of a multitude of factors. Things like desire, satisfaction, pain, orgasm, arousal and lubrication are all involved. Going through breast cancer treatment can cause sexually related problems that can lead to sexual dysfunction. Some things like desire may return on their own, but others (like lubrication, or lack thereof) can worsen over time.

Hormone Therapy – Women with hormone receptive breast cancer er/pr/her2 will most likely have hormone therapy before surgery to reduce the size of their tumor, and afterwards to lessen the chance of recurrence.

The two main types of hormone therapy medications are aromatase inhibitors which slow or stop estrogen production, and endocrine therapy which blocks estrogen from reaching cells.

Both types affect estrogen which is essential for vaginal health.

As women enter menopause, they produce less estrogen in their ovaries until they stop altogether During this time of perimenopause, many women experience hot flashes, lack of desire, and vaginal atrophy and dryness or pain from intercourse. These symptoms can continue after menopause

No matter what your age, you may experience similar symptoms when you undergo hormone therapy.

This can be particularly trying for younger women who are in their sexual prime. Loss of desire can be frightening, especially because you feel as if you are losing something else due to your cancer.

But there are treatments for these symptoms, and you should discuss them with your doctor.

Someone from your treatment team should approach the subject early on, but if they don’t you should.

Sexual problems are common with breast cancer treatments, but they are not inevitable, you can overcome them and have a healthy sex life after breast cancer.

Chemotherapy comes along with many potential side effects.

• You may also experience:
• Loss of libido
• Fatigue
• Nausea
• Weight gain or loss

Most of these symptoms will subside once treatment is complete, but it can take time for you to feel like yourself again or want to resume sexual activity.

Chemotherapy, although rare, can cause injury to the ovaries causing temporary or permanent stopping of their function, or temporary menopause.

Radiation Therapy can change the appearance and texture of your breasts, which may affect how you feel towards intimacy. Nerve damage may also occur from extended radiation causing numbness to the area. Because radiation is limited to the breast area, it should not cause any vaginal issues.

Medications

Many medications can affect your sexual desire and vaginal health. Talk to your doctor right away if you are feeling a loss of desire or any pain or discomfort.

If you are experiencing a loss of desire, pain, or dryness, talk to your treatment team. If you’ve just been diagnosed, talk about the possible sexual side-effects now so you’ll be prepared for symptoms.

Know that they are common, you’re not alone, and there is help.

Your doctor may recommend the following remedies or therapies depending on your type of cancer, type of treatment and medications used in treatment:

• HRT – Hormone replacement therapy is usually the best option for post-menopausal symptoms, but not for hormone receptive breast cancer. Instead, for vagina dryness, there are moisturizers and lubricants that prove effective.

In some cases, your physician may recommend an estrogen cream, but those can make certain hormone therapy drugs like aromatase inhibitors less effective. Your doctor may switch you to a different medication.

• Group or individual counseling for you and your partner
• Pelvic floor physiotherapy
• Kegel exercises
• Cognitive behavioral therapy
• Lidocaine for severe vaginal pain

Communication is the Key to a Healthy Sexual Relationship

Bringing up intimacy and sexual problems is difficult and not easy to talk about. But, talking about it is probably the most important thing you can do. So, talk to your partner and your treatment team about any concerns or issues you are facing.

Your physicians and care team can provide expert advice on the subject of sexual function and offer treatments based on your symptoms.

You don’t have to go through this alone, and you can have a full sexual life after treatment is over. But there is no reason why you cannot have healthy sexual relations while you are going through breast cancer.

If your treatments are causing you to shy away from sex for any reason, both physically and emotionally, your doctor can help, so you can get back to being yourself and your relationship.