Clinical Psychosexual Therapist
First, it’s important to say that not everyone will experience problems with their sexuality or sexual functioning, and it is only considered a problem when it is causing distress for the woman, her partner and impacting negatively in their relationship.
Sexual problems/changes are very common following treatment for breast cancer; research suggests that overall quality of life and general wellbeing are often lower for women (and men) who do experience sexual difficulties.
Treatments used for breast cancer such as chemotherapy and endocrine therapies (Tamoxifen and Aromatase Inhibitors) reduce the circulation oestrogen in the body which is important in managing oestrogen/progesterone positive breast cancer.
This reduction of oestrogen can cause vaginal dryness; vaginal atrophy; vulvar discomfort; urinary changes such as frequency or increased risk of urinary tract infections, hair and skin changes, hot flushes and weight changes.
Having said this, it is very important to talk to your doctor or specialist breast nurse to ensure that nothing else is happening, because many conditions and diseases that affect the vulva may have nothing to do with the reduced circulation oestrogen and therefore important to have symptoms assessed before commencing any personal and the over the counter treatments.
Common issues of concerns: (no specific order)
Changes to one’s sexuality and sexual function are not always discussed and when these changes are spoken about, information is limited, usually being related to fertility and reproductive concerns and not necessarily about sexual desire, libido or sexual intimacy;
Some words of encouragement
It may be challenging to discuss sex or sexual activity with a potential stranger (such as health care professionals)… But, we know that one of the most common side effects of cancer treatments are changes in sexuality and sexual activity.
You are definitely not alone
You may require support and information like learning about treatment options for your illness, which will help with demystifying the issue because we all know that the more we just think about and not talk about something, it becomes ‘bigger than Ben Hur’ as the old saying goes.
It takes courage and motivation, small steps towards addressing what’s happening in your sexual life. If there are relationship concerns then seek support through counselling as dealing with unresolved conflicts and problems will also improve your sexual interest and motivation to source help in this area.
It can seem like a huge task especially after experiencing all the treatment which potentially leaves its mark on body image, fatigue, financial, relationship changes, all of which can impact negatively on you.
Remember to ask your counsellor his or her experience in working with those with sexuality and cancer-related issues…not all psychologists or counsellors are experienced in these areas.
Clinical Psychosexual Therapist
Sexuality for Women after Breast cancer
Part Three: Maintaining Healthy Sexuality
Illness/Treatment impact on Sexuality
If you have breast cancer, or undergoing treatment, it’s important to have an understanding of how treatment (surgery, chemotherapy, radiotherapy and endocrine therapies) may affect your body.
These ‘changes’ often include induced menopause with a consequence of an impact on your sexuality.
Such awareness can be very empowering…it will help you to feel more in control and it will provide you with the information for you to check with yourself, partner, GP or health care profession, to see if you need support, further information or treatment from referral to a specialist.
Sexual problems/changes are very common following treatment for breast cancer
Much research of sexuality has shown that there may be an overall reduction in the quality of life and general wellbeing for women who experience sexual difficulties.
Treatments for breast cancer, such as chemotherapy and endocrine therapies, reduce the circulation of oestrogen in the body which is important in managing some types of breast cancer. However, this reduction of oestrogen can cause vaginal dryness, vaginal atrophy, vulvar discomfort, urinary changes such as frequency or increased risk of urinary tract infections, hair and skin changes, hot flushes and weight changes.
Having said this, it is very important to talk to your doctor or specialist breast nurse to ensure that nothing else is happening, because many medical conditions that affect the vulva may have nothing to do with the reduced circulation oestrogen.
As such, it is important to have symptoms assessed before commencing any personal or over the counter treatments.
One of the more common changes is a medical condition called Vaginal atrophy, where the vaginal mucosa and tissue becomes thinner. A physical examination and discussion with a health care profession would be ideal to look at the appropriateness of medical intervention.
Similarly, there may be ongoing pelvic pain or pain during sexual activity, (called Dyspareunia). This can occur even with the use of personal lubricants and after having experimented with different positioning during sexual activity.
In this case, a referral to a specialist physiotherapist can be beneficial for an assessment of the vaginal and pelvic floor muscles: it’s not uncommon for some women following chemotherapy and ongoing endocrine therapy, surgery to experience shortening of the vaginal wall (this is called Vaginal Stenosis).
Let’s take a minute to talk about…personal lubricants.
These can be of considerable assistance for some women who experience vaginal dryness.
Some that I recommend are Astroglyde, a water based lubricant for mild dryness, or Pjur, water and silicone based, for more lubrication during sexual activity.
The use of KY jelly (or Vaseline type products) is not usually recommend as a personal lubricant as they tend to have a quick drying time and can result in increased discomfort.
Vaginal moisturisers such as Replens can also help with vaginal dryness.
Maintaining a healthy sexual self-esteem is important for your own wellbeing.
While it can be confronting for many people to discuss sex or sexual activity with a potential stranger, such as a health care professionals, we need to put this into perspective...
...we know that one of the most common side-effects of cancer treatments is the impact on sexuality and sexual activity...
Remember that many women (and men) experience the changes in their sexuality after cancer, so it is important to know that you are not alone.
If you’re in a relationship, remember also that it’s normal to experience the ebb and flow of sexuality and sexual activity related to desire and frequency of sexual activity and intimacy.
Dr Rosie King, an Australian Sex Therapist, talks about creating a willingness to be open to meeting each other’s needs sexual or otherwise. This is important for the relationship to enhance a ‘new intimacy’ between partners.
It’s also important for partners to be aware of, and be educated in the potential consequences of issues, including cancer and cancer treatment, that may impact negatively on sexuality. This will help to redefine and create the motivation to look at new ways of enhancing emotional and physical intimacy.
Most important is to take the pressure off...
This is especially so if you are still struggling with physical side effects of treatment. Create a more playful way of communicating intimacy with your partner, such as a sensual massage, touch that is non-sexual, reconnecting over a meal, going for walks together or having a date night, with or without sex…to share time together.
If you have any questions or concerns, feel free to contact me at inSync for life. You might also like to have a chat to your health care professional, or the Specialist Breast Care Nurse in your area. See our Links page for further information.
Clinical Sexologist / Counsellor
Sexuality for Women after Breast cancer
Part Two: The Uniqueness of You
In part one of this Newsletter, I spoke about the importance of discussing sexual concerns after breast cancer, and gave an overview of some of these issues.
I want to continue this discussion in Part Two by acknowledging that if you have breast cancer and you are reading this, it is significant in that you are taking personal responsibility and accepting a unique opportunity in working towards making ‘intelligent sexual and relationship decisions’.
Remember that positive motivation and understanding, promote wise choices…
Guilt, shame and anxiety about yourself or your past will act like an anchor in your life and weigh you down, and hold you back...they may lower your self-esteem, and negatively affect your relationship and sexuality.
I have had the pleasure of working with some amazingly courageous women who are managing their loss of ‘sexualness’ in relation to their own femininity, body image and sexual partner.
However, I know that for many or perhaps even most, this becomes a very challenging area of their life…
I encourage you to think about… and talk about... what your sexuality and intimacy needs are, for you and if you're in a relationship, for your partner and relationship... What is it that you would need to enhance your sexuality and intimacy......?
...as you do this, remember that we all have unique perceptions based on our own thoughts, memories, feelings, attitudes, values, learning and knowledge. It's all of these things and more that have helped create who we are at this very moment...
These things and our perception of ourselves and our life doesn’t make things ‘right’ or ‘wrong’… Perhaps instead, it's better to think about how 'helpful' our thoughts and perceptions are...
sometimes our perceptions will be helpful to us…and sometimes unhelpful…
However, increasing awareness of our perceptions, beliefs and thoughts of ourselves will open us up to new learning, new possibilities, new ideas…
It's this 'new learning' that will help to enhance personal self-esteem, build confidence, enhance sexual self-esteem, and overall, create a healthy approach to sexual well-being.
Questions for self-reflection:
To help with your awareness and understanding of your own sexuality, take a few minutes to write down your thoughts about the following…
In Part 3, the final part in this series, I'll go over some ways to support you to develop and maintain a healthy sexuality.
Clinical Sexologist / Counsellor
Part One: Sexual concerns
Sexuality is a very sensitive subject.
When discussing this issue, it’s important to feel as safe and comfortable as you can…be gentle with yourself.
In particular, you will need to be aware that after breast cancer, your body is different in many ways. You may feel different, and you may respond differently to touch, intimacy, and sexually.
Defining your own meaning of sexuality intimacy is really important: we all have our own ways of defining our sexuality, and you need to feel as ok as possible, to talk about the impact that treatment has had on your ‘sexual self’.
By having an awareness of your sexual story, understanding how your body functions and what affects your sexuality, can help to make you feel more comfortable to talk about what is happening for you. It’s quite common for many people to never have had a conversation about their sexuality or sexual self.
So…regardless of your sexual orientation, be curious about creating an intimate bond with yourself or another, both physically and emotionally, consider all the potential possibilities to enhance your personal and sexual confidence: this is the key to being open to address sexual concerns…the key to honouring your own sexual story and continuing your journey of personal sexual growth.
Common issues after Breast cancer…in no particular order
Discussion of Changes:
The changes to one’s sexuality and sexual function are not always discussed by medical practitioners and Specialists, and when these changes are spoken about, information is often limited, usually being related to fertility and reproductive concerns and not necessarily about sexual desire, libido or sexual intimacy.
Loss of intimacy: (physical and emotional)
… and if there has been a long time between sexual intimacy...there may be a loss of confidence and hesitancy in resuming sexual activity related to fear and anxiety about how you and your partner may feel and respond.
This is often associated with cancer treatment, and can result in painful sexual intercourse, which is called dyspareunia.
Vaginal Atrophy: (thinning of the vaginal tissue)
This can be a challenging ongoing issue to manage as it can make vaginal dryness worse, and may not be remedied with personal lubricants or vaginal moisturisers. Many women and medical practitioners are often wary about the use of topical oestrogens.
Loss and Grieving:
...of sexual activity and sexual self-esteem. This issue can be related to body image changes, menopausal symptoms and confidence.
Sexual response changes:
...such as reduced arousal, loss of libido, difficulty to reach orgasm.
including hot flushes/night sweats, disturbed sleep, poor memory and weight gain, all of which may affect sexual self- esteem, sexual functioning and general wellbeing (quality of life).
Communication about sex:
This can be difficult for couples, especially if they have never broached the subject…and this silence can often be mistaken as a lack of interest or rejection.
It’s important to say that not everyone with breast cancer will experience problems with their sexuality or sexual functioning. It is only considered a problem when it is causing distress for the woman and/or her partner and impacting negatively on their relationship. Sexual difficulties such as low libido, difficulty to orgasm are very common in our society, even for women who are otherwise healthy.
I hope that this conversation so far will help you discover more about yourself, and build on what you would like for your sexuality and intimacy, both as an individual, and if in a relationship, with your partner.
Exploring further will help to create a ‘realistic hopefulness’ – understanding of the reality of the situation, but have some hope for the future.
I believe that the more you know about yourself and how you want to be sexuality can build resilience within yourself and in your relationship. In my next newsletter, I will talk about the 'uniqueness of you', to encourage you to start examining your self-awareness about what your needs and wants are concerning your sexual well-being.
Clinical Sexologist / Counsellor
Helena is a highly qualified Relationship Counsellor and Clinical Psychosexual Therapist with extensive experience talking about sex! and supporting others to manage their sexual concerns.