It’s complicated. But that’s sex, right? It makes everything complicated. But it also reminds you of “normal” times, like “before breast cancer.” Know what else is normal? Not wanting that kind of intimacy at all, or even deciding to wait. Some find that they have no side effects from treatment that affect their sexual health, while others find that their sex drive drops. One study reported that 50% of patients reported facing some type of sexual difficulty, which can include pain. (Don’t need more of that.) Whatever you’re feeling about sex, know that it’s “normal.” So, instead of telling you what to expect if, or when, you decide to get physical, we’ve outlined some common but unexpected issues that may come up for breast cancer patients, their sex lives and sexual identity.
Life after breast cancer treatment.
1. Feeling like your body “failed” you with cancer
Body image isn’t just about the scale or doing the deed with the lights out. After a breast cancer diagnosis, some feel their body has “failed” them.
“Growing up, we think nothing will happen to us and that we’re untouchable, right—these things won’t happen to me,” says Stefanie Peachey, MSW, RSW, AccFM, director of Peachey Counselling and Family Support in Burlington, Ont. We’re taught to exercise, eat well and monitor stress to be healthy. But that’s not a cancer-free guarantee. Even when genetic factors are known, breast cancer isn’t predictable enough to be preventable. It can be tough to fight those angry thoughts when things like pain and scars serve as reminders or even triggers.
When cancer happens, the effects are both physical and mental. “In going through chemotherapy, a person’s physical appearance changes, especially with the fact that you’re going to lose your hair,” says Cathy Ammendolea, breast cancer advocate and board chair for the Canadian Breast Cancer Network. “That can be traumatic. It’s a psychological component because hair loss is associated with chemotherapy. Chemotherapy is associated with having a cancer diagnosis. A cancer diagnosis is solely associated with a fatal illness.”
And hair loss has been shown to lower self-esteem, body image and self-confidence.
But like any relationship, the one we have with our bodies can change—even for the better. (Read more on how treatment affected one woman’s personal experience with treatment, including hair loss.)
“The hair is going to come back,” says Ammendolea, who was a breast cancer patient in the 2000s. “I work very hard to ensure that those step-by-step thoughts are further educated so that people don’t fall into a deep sense of hopelessness.” She is a volunteer for patient support, too.
Peachey says to “listen to your anger. We think of anger as a ‘bad’ emotion—you’re not supposed to feel it. But all our emotions are valid.” This feeling, she says, is tied to fear, frustration, uncertainty, and worry. “But anger is the easiest to express.” She compares the combination of emotions to an iceberg. The 10% you see is anger, but the other emotions happen under the water.
Knowing this, look at your anger and think about the next steps, says Peachey. “It’s worth saying, ‘What can I do to help this feeling? Or what can I do to dig a little deeper and figure out what’s going on? What do I need to address?”
Academic research points to forgiveness. Rebuilding the relationship with the body is about being open with our fears, whether that’s grieving the pre-cancer body or caring for the peri- and post-cancer body.
Eating for you: Finding the goodness in food after breast cancer treatment.
2. Having to make fast fertility decisions
Any couple trying to have children knows that sex isn’t just about sex. And when the topic of having kids comes up earlier than expected (say, instigated by breast cancer treatments), it can be a lot to digest, whether in a relationship or not.
For Jaclyn Carter, who went through breast cancer treatment two years ago, she found the process to be isolating. She says there wasn’t a wealth of information about preserving fertility after breast cancer or a community she could join. “It’s crazy to me that you end up in this situation, and there isn’t healthcare support. No option is affordable, including adoption and surrogacy.” (She is happy to share, though, that she is now expecting. She used an embryo from the fertility preservation phase of treatment back in July 2021. She is due mid-July 2024.)
Carter had the support of family and work benefits. But not everyone has access to either or both, she admits. “It’s extremely expensive. And it’s completely unfair that—as a young person starting out your life with a partner or someone who really wants to have a baby but isn’t in a relationship—you’re saddled with this huge bill to try and preserve your opportunity to have a biological child in the future.”
Many patients have family or friends who support their fertility journey through community fundraising and crowdfunding. It’s also worth reaching out to your provincial government office to find out what’s available and to advocate for changes.
As for the emotional side of this, Peachey says, “There’s still such a big identifying piece about what it means to have the ability to carry children, if that choice is made. And so, there’s a grieving process of, ‘What does it now look like to have children?’”
She advises that this process isn’t linear or subtle for the breast cancer patient. It’s about grieving and reframing expectations and plans for having a family.
Self-care for mental health and breast cancer: Can meditation help?
3. The partners’ role during cancer diagnosis and treatment
Regardless of how serious a relationship is, a breast cancer diagnosis can become a “significant other” or a “third partner.” For some couples, it can bring them together in a more supportive way. For others, it can drive them apart as the stress and fear become too much. But for most, it gives perspective and can amplify any strengths or flaws, says Peachey. Thoughts can transform from, “I can’t believe I was pissed off that my husband didn’t empty the dishwasher,” to “I’m so lucky to have them and I love them.” Or even: “Why have I been flip flopping about this relationship? I need to break up with this partner.” She adds: “You have to have a very strong relationship to get through something like this.”
Peachey further explains that a partner should be supportive. The patient shares their needs, and the partner communicates on their behalf. That can mean talking to doctors and nurses about care or telling friends it’s not a good day to visit. That requires collaboration and strong communication from both. “It’s also recognizing that the partner is going to need a lot of support, too. Their life has just changed drastically, as well.” They have their own needs and are processing in their own way.
Support for the partner, though, should come from outside the relationship, she says. It could be a sibling or friend. “It’s this big chain reaction of ‘how do we all help’ without drowning or suffocating the person who’s actually undergoing the treatment.”
Ammendolea remembers how fearful the partners of those diagnosed with breast cancer were, back when she was going through treatment. She says that education has improved in the past 20 years. “People understand that this is not immediately a death sentence.”
Beauty standards: Post-cancer beauty is layered.
4. Dealing with menopause
For breast cancer patients who experience early menopause, sexual drive can dip. It can also cause pain during sex. According to Canadian researchers: “The consequences often include vasomotor symptoms (hot flushes), and vaginal dryness and atrophy which, in turn, may result in cystitis and vaginitis. Not surprisingly, painful intercourse (dyspareunia) and loss of sexual interest (decreased libido) frequently occur as well.” (Hot flushes are the same as hot flashes.)
Good news: Many of these things are treatable with prescription or over-the-counter products. Your doctor can let you know what would work best for you.
A bit of advice: Talk to your sexual partner. Peachey says: “Express what’s going on with you. Allow your partner to ask questions. Explain your needs—and don’t sugarcoat them.” She adds to try quashing feelings of shame and/or embarrassment for the both of you.
What makes uou stronger: Getting fit after breast cancer treatment.
5. Discourse about intercourse
Is it normal to want to have sex? Is it normal not to want to? “It’s very relationship dependent,” says Peachey. “For some people, sexual relationships provide safety and security, whereas others feel like that’s the last thing on the to-do list.”
Because of scars, mastectomies, a rollercoaster of hormones, early menopause, the changing roles in the relationship, unexpected pain and the “having kids” talk, sex is complicated for those going through cancer treatment and those who care about them.
“It’s important for couples to tune in and say, ‘How are we going to overcome this?’ because it is a part of healthy relationships. It’s something to pay attention to, but it doesn’t necessarily have to be a priority.” It’s about what makes sense for you, your body, and your partner.