By: Dr. Amy Jones, DO, Ob/Gyn
Breast cancer changes one’s life. I don’t think there’s anyone on earth who would argue that. But what many don’t realize is how the diagnosis and treatment can manage to seep into every crevice of life. Physical effects are for the most part widely discussed. Sexual and emotional effects, though, are variable and less predictable. It’s harder to talk about the impact of breast cancer on one’s sex life or body image, but there is no doubt that it can be devastating. Rarely discussed is the cumulative effect of physical and emotional side effects of breast cancer and breast cancer treatment on our sex lives and our feelings about our own sexuality.
Breast cancer is the most frequently diagnosed cancer among women and ranks second after lung cancer in women’s cancer deaths. October is Breast Cancer Awareness month, so I’d like to take a moment to develop our awareness about sexuality and sex during and after breast cancer treatment.
For many women, one of the most damaging long-term side effects of breast cancer treatment is the negative change in body image. Breasts, though indisputably not definitive of our gender or femininity, are for many women tethered to their identity as a woman as well as to their sexual confidence.
Losing one or both breasts can feel disfiguring to many women and can quickly snowball into shame. The onus is on all of us as a cultural whole. Our cultural schemas matter in the way they influence the way women think and talk about their bodies. We as individuals are responsible for the messages we promote. The adage “think before you speak, ” I would add “and act,” needs to become a personal mantra for each of us.
We’ve touched on effects of surgery. Let’s turn our attention to effects of medical treatment, chemotherapy and radiation. Both are necessarily toxic. Their entire purpose for existing is to kill cancer cells, which replicate rapidly. Therefore chemotherapy drugs preferentially target rapidly replicating cells. Unfortunately other rapidly replicating cells, including hair, skin, nails, the lining of our intestines, and, surprise, the lining of the vagina, are unintentional casualties of the war on cancer. Again, what some consider to be a symbol of one’s femininity, her hair, is shed without choice or ceremony, and her body image suffers another detrimental blow. Sexuality too is secretly ambushed by chemotherapy as the vagina can becomes dry, sensitive, fragile, easily irritated. Sex then becomes almost unbearably painful.
On the flip side, numbness is often another side effect of cancer treatment. Body image is not only about appearance. It is strongly connected with our ability to be and feel sexual, in other words, our sexuality. And sexuality in turn depends heavily on our ability to feel sensation. Without that we have difficulty becoming aroused or enjoying the pleasure of sex.
So let’s review. After recovering from the shock of a cancer diagnosis, a woman has to prepare to undergo surgery and quite likely lose one or both breasts. From there she is forced to come to a place of acceptance and embrace her new body, a task with which many of us who have both of our breasts still struggle. Next, her physical and emotional strength is all but eliminated after undergoing treatment. If she can muster the energy for sex in the first place, it either hurts like hell or feels like nothing at all! No wonder so many women choose to give up on sex altogether at this point.
I haven’t even touched on the fact that a woman’s ability to reproduce is thrust to the forefront of her agenda. Chemotherapy often attacks the ovaries and therefore has the capacity to destroy one’s fertility. Suddenly the decision whether to to have biologic children, arguably one of the most important decisions in a woman’s life, is thrust upon her while she fights for her own life.
All of this… and then there is the shame that follows. Her appearance has changed, she no longer enjoys sex, and she is no longer able to bear children.
There are a multitude of helpful resources to support women through their entire journey with breast cancer. I don’t intend to present them here. Rather I hope to shed some light on what these women are truly up against when they enter this battle that has been chosen for them rather than by them… and to offer some hope. I hope that in addition to what seem insurmountable odds, they are not also faced with fragile relationships that crumble when faced with the inevitable adversity to come. I hope that the people in their lives can practice compassion and understanding first, that they can be a source of love and unconditional support, that they stand in awe of a woman’s strength, and know that it is that very strength that makes her a woman.