Emotional Aspects of Breast Cancer

Sexuality: Concerns about sexuality are often very worrisome to a woman with breast cancer. Several factors may place a woman at higher risk for sexual problems after breast cancer. It is important to remember that some treatments for breast cancer, such as chemotherapy, can change a woman's hormone levels and may negatively affect sexual interest and/or response. A diagnosis of breast cancer when a woman is in her 20s or 30s is especially difficult because choosing a partner and childbearing are often very important during this period.

Relationship issues are also important because the diagnosis can be very distressing for the partner, as well as the patient. Partners are usually concerned about how to express their love physically and emotionally after treatment, especially surgery.

Suggestions that may help a woman adjust to changes in her body image include looking at and touching herself; seeking the support of others, preferably before surgery; involving her partner as soon as possible after surgery; and openly communicating feelings, needs, and wants created by her changed image.

Sexual impact of surgery and radiation: Because breast cancer is the most common cancer in women (excluding skin cancer), sexual problems have been linked to mastectomy more often than to any other cancer treatment. Losing a breast, or occasionally both breasts, can be traumatic.

The most common sexual side effects stem from damage to a woman's feelings of attractiveness. In our culture, we are taught to view breasts as a basic part of beauty and femininity. If her breast has been removed, a woman may be insecure about whether her partner will accept her and find her sexually pleasing.

The breasts and nipples are also sources of sexual pleasure for many women. Touching the breasts is a common part of foreplay in our culture. A few women can reach orgasm just from the stroking of their breasts. For many others, breast stimulation adds to sexual excitement.

Breast surgery or radiation to the breasts does not physically decrease a woman's sexual desire. Nor does it decrease her ability to have vaginal lubrication, normal genital feelings, or reach orgasm. Some good news from recent research is that within a year after their surgery, most women with early stage breast cancer have good emotional adjustment and sexual satisfaction. They report a quality of life similar to women who never had cancer.

Treatment for breast cancer can interfere with pleasure from breast caressing. After a mastectomy, the whole breast is gone. Some women still enjoy being stroked around the area of the healed scar. Others dislike being touched there and may no longer even enjoy being touched on the remaining breast and nipple.

Some women who have had a mastectomy feel self-conscious being the partner "on top" during sex. The area of the missing breast is more visible in that position.

A few women have chronic pain in their chests and shoulders after radical mastectomy. During intercourse, supporting these areas with pillows may help. Also, avoid positions where your weight rests on your chest or arms.

If surgery removed only the tumor (segmental mastectomy or lumpectomy) and was followed by radiation therapy, the breast may be scarred. It also may be a different shape or size. During radiation therapy, the skin may become red and swollen. The breast also may be a little tender. Breast and nipple feeling, however, should remain normal.

Sexual impact of breast reconstruction: Breast reconstruction restores the shape of the breast, but it cannot restore normal breast sensation. The nerve that supplies feeling to the nipple runs through the deep breast tissue, and it gets disconnected during surgery. In a reconstructed breast, the feeling of pleasure from touching the nipple is lost. A rebuilt nipple has much less feeling.

In time, the skin on the reconstructed breast will regain some sensitivity but probably will not give the same kind of pleasure as before mastectomy. Breast reconstruction often makes women more comfortable with their bodies, however, and helps them feel more attractive.

Effect on your partner: Breast cancer can be a growth experience for couples under certain circumstances. The relationship may be enhanced if the partner participates in decision making and accompanies the woman to surgery and other treatments.