Sexuality & Breast Cancer

Sexuality is an important part of your life.

We tend to think about sexuality as breasts and vaginas, but there is SO, SO much more to sexuality. Whether we are in a partnered relationship or by ourselves, sexuality and orgasms have many health benefits from improved sleep to floods of feel-good hormones like dopamine and oxytocin! There are so many positives to staying sexual even while undergoing treatment for breast cancer, or after all the immediate treatments have concluded. 

Breast Cancer Screening

Let’s back up with a reminder that the smart defense against breast cancer begins well before you know you have it – with regular screening mammograms and ultrasound if you have dense breast tissue, and self-exams. 

Think about family history and if there are several relatives with breast, ovarian, pancreatic, prostate or colon cancer ask your provider if genetic screening would be appropriate.

Also, get to know your breasts! Where are they lumpy? See how the nipples are normally positioned. Look for changes such as:

• Dimpling, puckering, or bulging of the skin
• A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
• Redness, soreness, rash, or swelling

Stephanie Valente MD, an assistant professor of surgery at Cleveland Clinic says,

“Any changes in your skin, color, any lump or bump that’s new or different that I always tell patients is there for more than three days needs to be evaluated. And any changes in the nipple, so if a nipple is normally everted and it becomes inverted or you’ve noticed any discharge from the nipple, those are things that need to be evaluated.”

Sexuality After Breast Cancer Surgery

Partial or complete loss of one or both breasts is a lifetime adjustment. Even with nipple-sparing surgical techniques, (which are not widely available to most women) the loss of sensation can be extreme and influence how you think about sex.

You and your partner have been through a scary experience. And of course, when an illness threatens your life, considerations of beauty and the erotic get pushed down the ladder of importance. Depending on your energy level, sex may be a welcome way to connect and share intimacy. With good communication and adaptations, your sex life can become what both of you want it to be. 

Communication is Key

Women have reported that losing their hair was a surprisingly big blow to their self-image and confidence. The good news here of course is that it will grow back with time. But in the meantime, how you feel about your reflection can and does impact your sexuality. It’s best to name what you’re feeling, then normalize it, and not judge yourself. Instead of denying your feelings, expressing them helps you process and move on. The process itself is important.

Here’s an example, “I feel so awkward about being bald and I worry that my partner is turned off. I know that this is normal and that other women feel the same way. It feels better knowing I can share this with you and you understand and want to be close. “

Intimacy and sex aren’t the easiest of topics in the best of times, but when you feel like you’ve been hit by something very large, and then dragged around by it for a while, summoning the emotional energy to talk about it can be hard. You have lots of company. The best advice is to go slow and talk it out. Your body has been a source of pain and worry, so the road back to it being a place of pleasure is going to take time. Counseling or sex therapy can provide help for many couples. The Breastcancer.org online community offers chat boards for support at https://community.breastcancer.org/member/register

Side Effects of BC Treatment on Libido

As well as dealing with body image and the grieving the loss of your old self, the treatments you have undergone, such as chemotherapy, radiation, and hormone therapy can affect your interest in sex and your responsiveness. There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In the early 2000s, the aromatase inhibitors such as Arimidex (anastrozole) came into use, especially for post-menopausal women. 

Loss of libido, vaginal dryness, and painful intercourse are all common side effects of these hormonal therapies to treat hormone-receptor-positive breast cancer. Some chemotherapies can cause short-term ulcers (sores) in the body’s mucous membranes (mouth, throat, vagina, rectum). Radiation therapy often causes red, irritated skin and overall fatigue. Radiation symptoms do begin to resolve a month or so after treatment ends. 

The vaginal dryness also impacts your day to day life and can make wearing underwear extremely painful. For my patients I recommend that they use one of many non-hormonal vaginal moisturizers that contain the active ingredient hyaluronic acid which acts as a moisture magnet in the vagina.

Vaginal moisturizers must be used 2-3 times a week and are not lubricants for sex. They keep the vagina moist day and night. 

Here are the 3* I recommend to patients:

• Hyalo Gyn
• Revaree
• Replens

No, all of this does not sound like a good time. But treatment does end, and side effects do go away. Illness is an opportunity for us all to practice resilience and adaptability, and as any person over 55 will tell you, we’re going to need those skills down the road for sure.

Breast Cancer in Men and Transgender People

Male breast cancer is very rare. Less than one percent of all breast cancer cases develop in men, and only one in a thousand men will ever be diagnosed with breast cancer. It is mainly diagnosed in men over 50. But because it is so rare it can also be more deadly. Breast cancer in men is usually detected as a hard lump underneath the nipple and areola. Most men do not look for lumps, and would not think to get one checked out even if they noticed it.

Breast cancer risk in transgender people receiving hormone treatment has been reviewed in a nationwide cohort study in the Netherlands. The researchers care for patients at a clinic in Amsterdam which treats over 95% of the nation’s trans community. They reviewed clinical records and identified 2,260 trans women and 1,229 trans men and results suggest that the gender-affirming hormone therapy used for trans women increases their breast cancer risk. Breast cancer education would be useful for these individuals, and breast cancer screening may eventually be shown to be helpful. As well, gender-affirming hormone therapy used for trans men may reduce their breast cancer risk. These individuals, however, still must be educated about breast cancer and screened.

* I do not work for any of these manufacturers