Getting Back to Intimacy After Breast Cancer Treatment
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Breast cancer brings a lot of changes to your life, including your sex life.
Although this topic is uncomfortable for many people to talk about, 75% of breast cancer survivors experience persistent sexual dysfunction after treatment. So if you’re struggling with changes to your sexual health after breast cancer treatment, know that you’re not alone, and treatment is available.
Breast cancer treatment often involves several interventions including surgery, chemotherapy, radiation therapy, or hormone therapy. Let’s dive into how each of these treatments can impact your sex life and how you can get back to enjoying intimacy.
Surgery
The most common sexual side effect of breast cancer surgeries is feeling less attractive. After a breast is removed or changed, people may feel insecure and have different or loss of sensation at the breast. Some people like to wear a bra with a prosthesis under a camisole during sexual activity, while others find wearing the breast prosthesis awkward. Work with an oncology physical therapist if you have pain, swelling, or scar tissue at the breast after surgery.
Hormone Therapy
Hormone therapy works by reducing the amount of estrogen and progesterone in the body or stopping these hormones from acting on cancer cells. Along with other side effects, one of the major side effects is menopause. Some impacts of menopause specific to your sexual health include vaginal dryness, vaginal tissue thinning, less elasticity of the vaginal tissues, and narrowing and shortening of the vagina. As you can imagine, these effects can lead to painful vaginal intercourse. Most people will have superficial (outer) pain, especially with initial insertion, but some may also experience pain with deeper penetration.
Typical treatment for painful intercourse includes using vaginal trainers or dilators, a vaginal moisturizing program, and sometimes vaginal estrogen cream.
-Trainers are small devices made of silicone or hard plastic that help decrease pain at the vaginal opening and pelvic floor, increase muscle and tissue flexibility, and re-train your brain that something being inserted shouldn’t be painful. To learn more about trainers and the ones that I recommend to my patients, check out my blog post, “Dilators: What Are They and How Do I Use Them?”.
-A vaginal moisturizing program is excellent for improving tissue moisture and health after hormone therapy. You can use coconut oil, vitamin E oil, or over-the-counter products like Good Clean Love Moisturizer or Replens. Gently massage a small amount of the moisturizer nightly for two weeks at the vaginal opening, then decrease the frequency to your comfort level. Some people find continuing to use moisturizing nightly is best for them; others find that three times per week is enough.
-Local use of estrogen cream at the vaginal tissues helps improve tissue health, decrease pain, and decrease urinary symptoms like urinary frequency or urinary tract infections (UTI). Research has shown that local use of estrogen does not increase the risk of cancer recurrence. Always talk with your medical provider if this option is good for you.
Chemotherapy
Some side effects of chemotherapy that can impact your sexual health include early menopause (see how to address those side effects above in the Hormone Therapy section), decreased libido or desire, yeast infections, and a weakened immune system.
-Libido or sexual desire can be impacted by many factors including decreased energy, nausea, weakness, or feeling unattractive from the physical effects of chemotherapy. Usually, as people feel better from chemo, their libido improves.
-To avoid yeast infections, wear loose clothing and cotton underwear, wipe front to back after going to the bathroom, don’t douche, and don’t wear nylon underwear or tight pants.
-If your immune system is weakened, it’s important to practice safer sex from start to finish to avoid infection or sexually transmitted diseases. Use condoms or dental dams to prevent bodily fluids with oral, anal, or vaginal sex.
Radiation Therapy
Radiation therapy to the breast can cause the breast to become swollen, scarred, decrease sensation, or have a different shape. For some people, this can contribute to feeling less attractive or negatively impacting an erogenous area for them. Working with a Certified Lymphedema Therapist (CLT) can help decrease breast swelling or pain.
Although radiation therapy for breast cancer doesn’t directly impact the pelvis, cancer-related fatigue is a common side effect of radiation therapy that can affect your sex life. Cancer-related fatigue is directly related to cancer or cancer treatment, does not resolve with sleep, is caused by multiple factors, and impedes usual functioning. If you don’t have the energy to get your normal daily activities and work duties done, you probably don’t have a lot of energy for intimacy. If you have cancer-related fatigue, try different positions that you don’t need to use as much energy. These include lying on your side or on your back with legs supported by pillows. Make sure to communicate with your partner(s) about your needs and when you need to take breaks. For more strategies on managing Cancer Related Fatigue, read my blog post, “How To Manage Cancer Related Fatigue.”
Work with a pelvic health physical therapist if you’re having pain or difficulty with intercourse. They will perform a physical exam including a pelvic (vaginal) exam. The pelvic exam will assess the tissue health, reflexes, tone, and how your pelvic floor muscles are functioning, including their strength, coordination, and endurance. Based on the exam findings and your symptoms, your pelvic health physical therapist will provide different types of interventions. To learn more about pelvic health physical therapy, check out my blog post, “Pelvic Health Physical Therapy 101”.
