Breast Cancer Impacts Sexual Health

Let’s talk about it.

Illustration by Roberto de Vicq de Cumptich.

Illustration by Roberto de Vicq de Cumptich

Adapted from A Breast Cancer Alphabet by Madhulika Sikka, out now from Crown.

Cancerland is a place where, as the late Christopher Hitchens put it, “there seems to be almost no talk of sex.” In the case of breast cancer, he was right. Now I don’t want to get all cancer competitive on you, but the discussion of prostate cancer is often accompanied by concerns about its impact on a man’s sex life. With breast cancer, if there is any discussion of sex at all, it is likely to be if you are of childbearing age, and it is more likely to be about fertility than it is about sexuality. Your sex life doesn’t come up much.

If this is not an issue for you, I applaud you.

If this is an issue for you, let’s talk about it. When the complete embodiment of your womanhood—your breasts—becomes diseased, this is not an easy thing to deal with. In fact, sex is so far from your mind that you might be asking yourself, Why is she bringing this up at all? The National Cancer Institute reports, “About half of women who have long-term treatment for breast and reproductive organ cancers … report long-term sexual problems.” So if you are going through any sexual challenges during treatment, you are in good company. But every year, hundreds of thousands of women are treated for breast cancer and come out the other side. While sex may be on hiatus during treatment, it doesn’t have to stop forever.

Lots of things can affect your sex drive when you are diagnosed with breast cancer. First, you’ve been diagnosed with breast cancer! There is nothing that can prepare you for the number that does on you mentally. This is news that you need time to cope with, and really, all your attention can be focused on that for as long as you need.

Second, if you have breast surgery, you hurt. You hurt physically because some or all of your breast or breasts have been removed. That is a whole lot of hurt, not to mention bandages and drains and general yuckiness.  I’ve tried to think of any way to interpret this immediate post-surgical period as sexy, but I really can’t. Please let me know if I am wrong. You hurt emotionally too. Not only are you in mourning for the previously healthy you, but you are in mourning for a part of your body that may have helped define your sexiness, appeal, attractiveness. It is really hard to get aroused when you are in that kind of state.

Third, you might have to undergo chemotherapy and/or radiation. How do I begin to describe the unsexiness of that? Your body is being pumped with toxic chemicals and countless other drugs to counter the effects of the toxic chemicals. Here are some of the side effects that were possible from the particular chemo that I was taking:

  • Fluid retention with weight gain, swelling of the ankles or abdominal area
  • Peripheral neuropathy (numbness in your fingers and toes)
  • Nausea
  • Diarrhea
  • Mouth sores
  • Hair loss
  • Fatigue and weakness
  • Infection
  • Nail changes, including in extreme cases nails falling off

Nothing sexy about any of that list!

So you go through the weeks and months of surgery and recovery, followed by chemotherapy and recovery, maybe followed by radiation and recovery. During that time you will want to be loved and hugged and calmed and comforted, and maybe you will want to have sex. But maybe you won’t. This is where understanding comes in on the part of your partner. Your partner may not feel that you are deformed or unsexy or un-attractive. In fact your partner may be working hard to convince you of the exact opposite, that you are as beautiful and lovely as you were when love first struck, that a surgery like this, and the resultant nine-inch scar across your chest, and your baldness and your bloating, changes none of that. Your partner means it. You just might not be in a condition to hear any of it.

A Breast Cancer Alphabet.

Flowers. A romantic dinner. Sexy lingerie. These are just a few of the tropes that we’ve been convinced will put us on the path to wonderful sex. There is something horribly transactional about this idea, though of course in some cases they might work, though perhaps not in the way a certain ad for a men’s drug posits it: you and your partner sitting in separate bathtubs overlooking the ocean!

When dealing with breast cancer, eating a romantic dinner while wearing sexy lingerie surrounded by flowers may not be particularly effective. So often the reality of living with breast cancer—or any cancer—is not even a topic of conversation. My fellow cancer traveler Suleika Jaouad, diagnosed with cancer at age 22, has eloquently talked about the impact of cancer on a young person’s sex life, and much of this is applicable to anyone of any age going through cancer. You NEED TO TALK ABOUT IT. Yeah, I’m aware that is another cliché—women like to talk, men not so much. Talk to your partner, talk to your doctors, talk to fellow cancer patients. Fixing your sex life is just as legitimate as any medical conversation you are going to have.

One of my doctors did bring it up with me actually.

DOCTOR: How is your sex life?

ME: Um, nonexistent.

DOCTOR: I know it’s hard but …

ME: It’s really hard, I feel like crap.

DOCTOR: I know, but it’s like a muscle, you have to keep using it!

There you have it, the view from a medical professional. So while not many people talk about it, a lot of the cancer literature will deal with the question of intimacy. It’s important enough that the National Cancer Institute lists intimacy as one of the parts of your life that can be severely affected by a diagnosis of cancer. And that is the first step, recognizing that your sex life, sort of like your taste buds and your energy level and your hair, is affected by your treatment. Like all of those things, it comes back. It just comes back on its own timetable. And I speak from experience.

Adapted from A Breast Cancer Alphabet. Copyright © 2014 by Madhulika Sikka. Published by Crown Publishers, an imprint of the Crown Publishing Group, a division of Penguin Random House, Inc. Reprinted with permission.