Physicians Can Help Patients Resolve Their Fears of Intimacy After Breast Cancer Treatment

NEW YORK--After treatment, many breast cancer patients have fears and misconceptions that hamper their sexual activity, and their partners may have them, too, Marisa Weiss, MD, said at a Cancer Care teleconference. Women may assume their partner finds them unattractive, while their partner may be afraid of causing injury.

Dr. Weiss, a radiation oncologist who practices at Paoli Memorial Hospital, Paoli, Penn, wrote, with her mother Ellen Weiss, a book for breast cancer survivors titled Living Beyond Breast Cancer (Random House, 1997). She also founded a nonprofit education and support organization for breast cancer survivors, also called Living Beyond Breast Cancer. [To join the mailing list, phone 610-668-1320 or access online at www.lbbc.org.]

"Some of you may not have had sex for months, maybe a year or two, even though you may have had a very active sex life before. Now you’re trying to recapture some of life’s pleasure," Dr. Weiss said, addressing the breast cancer patients listening in during the teleconference.

Patients can have much to overcome to recapture what was once a normal sex life, Dr. Weiss said. Women often see themselves as changing dramatically after treatment, including their image of themselves as a sexual being.

Dr. Weiss cited factors that can impinge upon a woman’s sexual response. "You may have lost your hair. You may have lost your breast, or your breasts may be painful and swollen, and you don’t want them touched. It reminds you of what you’ve been through. Or you may have had reconstruction involving extra incisions." Depression can interfere with libido and is just as common after treatment as after diagnosis, she said.

‘Hurled Into Menopause’

"If you’ve gained weight or been hurled into menopause--either prematurely or because you’ve had to stop hormone replacement therapy overnight when you were diagnosed--that’s cold turkey menopause," and it affects sexual feelings and functioning, she pointed out.

Partners can also be worried, anxious, and even guilty. They may worry about contracting cancer themselves or being exposed to radiation. They may feel guilty that somehow they caused the cancer by being too aggressive during sex. They may also be unsure about when to start touching their partner again or where to touch her or how much she wants, she said.

Dr. Weiss mentioned several practical steps a woman can take to improve her sexuality after cancer treatment. Good lubricating agents are crucial, she said. Before sex, the lubrication should be used on the labia and penis as well as in the vagina, she said.

Physicians might also consider offering testosterone in some cases to restore libido. "Changes in the hormonal milieu can have a profound effect on libido. Testosterone can help if a woman’s level is below the normal range," she noted.

Vaginal tone can be restored through vaginal exercises. Doctors sometimes provide plastic dilators, but Dr. Weiss called these "straight, hard, and uncomfortable." She recommends instead that women use a rubber dildo, available at adult stores, "to practice and get the vagina in condition, get it exposed to friction on a regular basis, and keep the walls of the vagina separate from each other." She said she gives women a prescription for a dildo to take with them to the adult store, to ease their embarrassment.

Women’s worries about sex may not be the same as those of their partner, she said. "That is a mistake that many women make. Don’t assume that your partner does not find you attractive just because you don’t find yourself attractive."

She urged women to come to terms with their body after surgery. "Accept the naked you. None of us has ever loved our body completely." Still, a woman should not have to show all if she is not ready, and with dim lighting, bedcovers, and lingerie, she does not need to.

Communication is the key to improved sex, Dr. Weiss concluded, but some women may need a lot of support before embarking on frank conversations with their partners. Women can seek help from support groups, help-lines, and their physicians before discussing their sexual feelings with their spouse or lover.

If necessary, they can take their partner with them to the doctor to clear up misconceptions. However, she cautioned that not all doctors feel comfortable talking about these issues, and suggested that nurses and social workers could help.