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;
- Hesitancy in resuming sexual activity related to fear and anxiety about how they will feel and respond;
- Vaginal Dryness which is often associated with painful sexual intercourse (called dyspareunia);
- Vaginal Atrophy (thinning of the vaginal tissue), can be persistent and exacerbate vaginal dryness which may not be remedied with personal lubricants or vaginal moisturisers;
- Loss of sexual self-esteem related to body image changes, menopausal symptoms and confidence;
- Changes to sexual response such as reduced arousal, loss of libido, difficulty to reach orgasm;
- Loss of Libido - the desire to want or engage in sexual activity. This is complex to manage because our sex drive is not just related to one thing. A loss of libido often results in discrepancy of sexual desire between the women and their partner, which can in turn, result in frustration resentment and communication difficulties within relationships;
- Menopausal symptoms related to treatment including hot flushes/night sweats, disturbed sleep, poor memory and weight gain, all impact on sexual self-esteem, sexual functioning and general wellbeing (quality of life);
- Loss of confidence and anxiety or fear about resuming sexual activity, and the impact of this on their partner;
- Reduced physical and emotional intimacy is experienced by some women within their relationship;
- Communication about sex 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.
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