Sex After Breast Cancer

Yesterday I discussed Christina Applegate's diagnosis of breast cancer, and hundreds of reports on that news have been teeming with information—from the way she was diagnosed to what she can expect from treatment. But nowhere in this burst of coverage have I seen information on a side effect that's rarely talked about: how tough it is for breast cancer patients to maintain an active sex life.

I talked to breast cancer survivor Lisa Martinez about this and how she prepared herself in advance for the sexual difficulties that often follow a disfiguring mastectomy, fatiguing chemotherapy, and drugs that shut off sex hormones like estrogen. Martinez's job as executive director of the Women's Sexual Health Foundation gave her a leg up that many women don't have. "I was fortunate in that I felt comfortable talking about it with my doctors and my husband," the 53-year-old says, "but many women can't. They push it down and bury it, never to reclaim their sexuality again. It's very sad."

While communication is certainly important in dealing with breast cancer, or any cancer for that matter, far too many women have a difficult time talking about their fears and feelings, according to a study presented yesterday at the American Sociological Association meeting. In a survey of 164 breast cancer patients, San Francisco State University researchers found that most tended to focus more on the feelings of their loved ones when disclosing their diagnosis—trying to shield them from fear and disappointment—than on their own emotions. Once a caregiver, always a caregiver, I suppose.

Ultimately, though, a woman may find that in protecting her partner from her anxiety over losing a very sexual part of her body, she has created a gulf between them that's difficult to cross. Martinez, who wound up having both breasts removed, found that she benefited from being well informed and educating her husband on what to expect. As a former operating room nurse, she knew exactly what a mastectomy scar looked like, which helped prepare her when the bandages came off. Her husband took his cues from her. Since she was comfortable with her new body, Martinez says, "for him it really wasn't the challenge it might have been." (If you haven't seen these scars firsthand, you can check out some images here, but be prepared for their graphic nature.) For now, Martinez has decided against breast reconstruction because she's not ready for more surgery. But she says it hasn't impeded her sex life because she and her husband have openly discussed her decision.

Women may also face a loss of libido from the chemotherapy—often due to nausea and extreme tiredness—and may experience vaginal dryness, which can make intercourse uncomfortable, from anti-estrogen drugs like tamoxifen and aromatase inhibitors. Martinez says she and her husband talked about these issues with a helpful nurse practitioner, who discussed such things as over-the-counter lubricants for the dryness. They also scheduled romantic dinner dates on days when she had enough energy, like the week before chemo but not the week after. "My husband understood that I would just be too tired sometimes, but it also helped him to know that I'd get my energy back once I was done with the chemo, and I did!" (Some breast cancer survivors use a prescription testosterone gel to restore their sex drive, though this treatment may have risks.)

Unfortunately, oncologists may have a hard time talking about sexual issues with their patients, since sex isn't their area of expertise. So you might need to do some research on your own if you're facing breast cancer. The Fred Hutchinson Cancer Research Center's website has a wealth of information on sexual problems related to cancer. So does Breastcancer.org. For gritty personal stories about sex and breast cancer, check out a new book called I Am Not My Breast Cancer.