Sexuality - an added complication

“I was worried about how she’d look afterwards, whether I’d be attracted to her and how this would affect our sex life.”

Breast cancer has all the issues of the other cancers, plus the added complication of sexuality and body image.

• Normal concerns about a ‘taboo’ topic
  “No matter how much you read about mastectomies, the sight of your wife missing a breast is shocking."
  
  ”I was terrified of my wife’s disfigurement and I felt intensely guilty about this.”
  
  “I mourned for her breast.”
  
  The physical effects of breast cancer on the woman you love are a significant aspect of the disease. Apart from the potential loss of all or part of a breast, early menopause from chemo, infertility and the effect of treatment on libido, there are also issues of body image, sexual attractiveness and femininity.
  
  As a couple, you may experience changes in your sexual relationship. This can be caused by physical or psychosocial reasons or both. Some cancer treatments can have a major impact on sex drive. The physical change to a woman can have a profound effect on her body image and this will affect her feelings of sexuality and love-making. Some women find it hard to undress in front of their husband after surgery.
  
  
• Getting past the physical appearance
  “I can’t tell her she’s not different. She is different. The area is not attractive to look at.”
  
  “I had thoughts about her not being whole.”
  
  This can be hard – for some men, very hard. It may require a conscious re-evaluation of your own attitude. You may need to reprogram your thinking. Keep in mind what you know, that you are in love with a person, not with her body.
  
  
• How to deal with it
  Communication, information and patience are the keys to understanding and coping with the physical and psychosocial effects of breast cancer on sexuality.
  
  
  • Sexuality comes and goes. There is a need to heal physically and sexually. If sex is important to you as a couple then you need to take time to re-create the sexual bond.
    
    
  • Information about how chemo can induce menopause can help you and the woman you love cope with the effects of this.
    
    
  • Talk to each other, take things slowly, spend time getting used to being naked together.
    
    
  • Sexuality is not just about sex. Couples may need to take a few steps back and build on intimacy (emotional not physical), strengthen communication, talk about needs. Our brain is our most important sex organ.
    
    
  • Don’t avoid the issue. She may interpret your distance (whatever the reason) as confirmation that she is no longer desirable.
    
    
  • It is still OK to have sex throughout. “We were able to minimise the effects by having sex throughout the ordeal. It reassured me that I was still attracted to my wife and it reassured her that she was still desirable.”
    
    
  • The double bind: “It didn’t matter if I told her 37 times it didn’t change me feelings for her.” You may find it hard to convince the woman you love of your commitment. This can cause hostility and feelings of rejection on your part. You can handle these effectively if you are aware that the situation may occur and have learned methods of dealing with it.
    
    
  • Be aware that sexual attractiveness and body image goes beyond the bedroom. “If we went out and I would wear a hat, he would always tell me to take it off because he thought I looked good without a hat. So that gave me a bit of a boost”.
    
    
  • Talk to a professional if you are having problems adjusting. Studies show that mastectomy patients’ partners who received counselling were less distressed and more prepared to help the woman they loved cope.
    
    
• On the up side
  “Losing a physical part of our relationship has upped the emotional part of it dramatically. We pay attention, and we appreciate each other more deeply. And this has made us whole again.”
  
  “The one thing that breast cancer has done for me is to make me realise that life does not last forever, but love does.”
  
  “There is a tenderness in our lovemaking that can only be experienced by those who have shared great trauma.”
  
  Despite the fear felt by many men and women, studies show that:
  
  • most men coped well with their wife’s mastectomy; better coping correlated with the man’s involvement in the decision-making process, frequent hospital visits, resumption of sexual activity and with the man looking at his partners body after surgery
    
    
  • the quality of the marital relationship stayed the same or improved after mastectomy
    
    
  • 35.7% (of men in the survey) rated the effect of the mastectomy as “somewhat bad”, 7.1% rated it as "somewhat for the good"
    
    
  • there was no significant increase in extramarital affairs among male partners after a mastectomy
    
    
  • sexual relationships were found to be largely the same after breast cancer; couples that expressed their concern showed higher levels of marital adjustment than those who did not express concerns.

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