Sexuality and Relationships for Breast Cancer Survivors & their Partners

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Dear Sex Counselor,

I work with breast cancer patients and have some questions regarding cancer and sexuality/relationships. Can you tell me a bit about how breast cancer affects a long term relationship? How to discuss feelings about the diagnosis? What if she’s worried her partner will be turned off? What if s/he is turned off, or afraid to touch her? What if she doesn’t want to be touched?


What I find is that breast cancer does affect relationships. Here is some information that may be helpful:

Because women are put quickly into treatment once a diagnosis is made, they often don’t get a lot of time to explore their feelings about their cancer diagnosis with themselves, much less with their partners. They rapidly have to deal with possible surgery, chemo, radiation, or all three, plus the side effects of those. They become engulfed in the task of juggling treatment and possibly work and family, and then have to deal with exhaustion, pain, and other side effects of treatment.

A strong couple may make time to talk about their feelings, but many couples become quickly overwhelmed and just deal with the day-to-day management of the treatment.

Support groups help women understand treatment options, deal with treatment effects, and start adjusting to their new identity of "woman with breast cancer" and then (hopefully) "breast cancer survivor". Unfortunately, their partners don’t have any support group options, and are often left dangling with no one to talk to and no way to process their feelings. When the partner is a man, this is an even more difficult situation. Since men are not always skilled at processing their feelings and worries, many will just bury these in work, hobbies, or increase their emotional distance. Most men rely on their female partners to get them talking about stuff, but in this circumstance the woman is busy dealing with what is happening to her body and mind, and may not have the time, energy or focus to engage in a deep discussion with her partner. Some couples do manage to get some good talking done, and they are much more likely to get through the experience of diagnosis, treatment and survival as an intact and strong couple.

I recommend that women do take a bit of time to talk with their partners periodically. Here is a suggestion for a format:

  • Take time after diagnosis to talk about how she feels about it, ask how her partner feels, and set themselves against the disease as a team.
  • After treatment decisions are made, take time to talk about feelings, fears, and hopes. Discuss ways to deal with possible side effects of treatment, and how to handle her responsibilities if she is too sick or tired to do what she is used to doing. Reaffirm your partnership against the disease, and try to set up ways to reconnect in little ways throughout the treatment.
  • If she has surgery, then after surgery talk about how she feels about her body and her breasts, and have him do the same. Grieve the loss of a breast (or breasts) if that happened, and acknowledge that both of you may see her body a bit differently now. This is a good time for him to think about what he loves about her (other than her breasts) and remind her of those things.
  • When she is feeling well and has some energy to think about intimacy, it’s time to talk about how that is changed by the cancer. If she has an estrogen-receptive cancer, she will be put into instant menopause and will need to deal with vaginal dryness and thinning vaginal skin. This takes some planning and preparation. We have developed a very successful treatment program for any woman who cannot take estrogen, to help her maintain her vaginal health and flexibility. If you are interested in that, a description of the Vaginal Renewal program can be accessed here.
  • This is also the time for her to share with her partner what feels good, what feels numb, and what feels not-so-good when it comes to touch. It’s the time for her to ask her partner about his/her fears (many partners say they are afraid of hurting their partner or that she’s fragile and might "break" if they touch her the wrong way) and help the partner understand what’s happened with her body. If s/he is turned off by her scars or surgery, s/he needs to be very careful about what s/he says. She will be so afraid of being seen as ugly or undesirable, that it’s important that s/he focus on what he finds attractive about her, rather than focusing on what is "ugly" about her.

If a partner is repulsed by her body, then she or he has some work to do. This is very rare, and is usually a sign of other issues between them. Some partners, often men, will be less attracted to their partners or may need to grieve the loss of their breast-fascination, and this should be allowed to happen. But even "breast men" manage to get over this if they have a strong and deep connection to their partner.

Breast cancer changes a woman’s body image forever. Most of us don’t feel all that wonderful about our bodies to begin with, but when one or both of our breasts is "diseased", removed, reconstructed, irradiated, etc., one of the things that make us female is now "defective". Even women who have mastectomy and reconstruction find that their breasts are not the same - the reconstructed tissue is the same shape, but has no sensation, doesn’t move the same, and is like a big piece of flexible clay sitting on her chest. And if she got the tram flap reconstruction, she also has a belly which now has no sensation, due to the scarring that results from the surgery.

So it’s easy for her to become alienated from her body, to feel less like a woman, and certainly to feel less sexually attractive and desirable. This can lead to her feeling like she doesn’t want to be touched, or she doesn’t deserve to be pleasured or touched intimately. I recommend to women who find themselves here that they do some work on accepting their bodies and developing a stronger connection to what is good and strong and beautiful about their bodies. This may mean working with a therapist on body image, getting one of the many good books on loving your body, or starting some kind of exercise program that makes her feel better, stronger and more beautiful.

The process of recovery from cancer includes a process of grieving the changes and losses in body shape and function, and a reconfiguring of one’s relationship with oneself and one’s partner, as well as your intimate relationship. Many couples who actively engage in this process together report a deeper and more intense connection than before the cancer was diagnosed. If you do the scary work of talking about your fears and desires, and listen to your partner with an open mind and heart, the result can be a truly inspiring relationship.

The last thing I want to mention (but certainly not the least) is the importance of couples taking time to laugh and play together throughout the treatment and after. Just sitting and making faces at each other can provide much-needed comic relief. Laughing maintains the systems in our bodies that we need for good sex and healthy relationship. It also helps us heal, so a bit of levity is some of the best medicine you can take.

To download a helpful diagram (pdf format) of ways to reclaim sexuality after cancer, click here.