Sexuality for Women after Breast Cancer Series

Part 3 - 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. 

Helena Green
Clinical Sexologist / Counsellor