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How to enjoy sex after breast cancer


1st Jan 2015 Dating & Relationships

How to enjoy sex after breast cancer
Treatments like surgery, chemotherapy, radiation and drugs can kill self-esteem, libido and the enjoyment of sex. Here’s how several women re-established their sexual identities, and the intimacy they craved, after surviving the disease.

"You want everything, and that includes sex"

"I didn’t feel passion, and I missed it"
Nine years ago, Maria, 46, developed breast cancer—one of the thousands of women diagnosed annually. Within a year and a half, she had undergone a lumpectomy, chemotherapy, a double mastectomy and a complete hysterectomy. After surviving the disease and hoping for a return to a normal life, sex was definitely on the agenda for Maria, just as it is for many breast cancer survivors. 
According to a Journal of Sexual Medicine study, 70 per cent of women diagnosed with breast cancer face sexual function problems two years after diagnosis. The report’s lead author, Mary Panjari of Australia’s Monash University, says that 83 per cent of the women in the study (1,011 breast cancer survivors under the age of 70, who had partners) considered their sex life good and satisfying before breast cancer, but noticed a real decline after they underwent treatment. 
Gina Maisano, a two-time breast cancer survivor and the author of Intimacy After Breast Cancer, says it’s not the kind of issue many doctors address. "They think, ‘We’ve saved your life and we’re done; you should be happy.’ But you want your life back, and you didn’t fight this hard to live half a life. You want everything, and that includes sex."
Maisano says one of the difficulties can be that once you are ready to resume your sex life, your partner may need help to switch gears. If he was your caregiver when you were sick, now he has to morph back into being your lover. But by changing your bond from that of needing him to wanting him, you can build an even better relationship. 

Reviving your feelings of passion 

"I joked that technically I was a woman, but I felt different"
Maria is wistful when she speaks about her intimate life before breast cancer struck. Happily married for over 10 years to an energetic man who loves hunting and fishing, the mother of two was diagnosed at the age of 37. After her double mastectomy, she discovered through genetic testing that she carried the BRCA1 gene, which means her risk of breast, ovarian and other cancers is greatly increased. So Maria made the decision to undergo a complete hysterectomy.
In addition to the drastic changes to her body, her sex life changed dramatically. Until her hysterectomy, she’d had her libido. After the surgery, her sexual desire dropped off sharply. Her libido all but disappeared and she stopped enjoying making love to her husband as much as she once had. The couple used to have sex once a week, but after Maria had her breast cancer treatment, that dropped off to once every three months. 
She tries to make light of her situation, but there’s a melancholy that’s difficult to ignore. "I joked that technically I was a woman, but I felt different. Without oestrogen coursing through me, I didn’t feel passion, and I missed it."
"You didn’t fight this hard to live half a life. You want everything, and that includes sex"
After her mastectomy, Maria had breast reconstruction, but she lost nipple sensation, something she’d previously enjoyed. Maisano says it’s still possible to have some sensation in the breast area. "After surgery, the sensations that you felt lower in your breast before are now higher. If you trace around your areola you probably won’t feel anything, but if you go higher, up to your neck, the feeling intensifies. It’s almost as if the nerves are compensating for the lack of sensation in the nipple area."
While Maria has moments of passion, it has been difficult motivating herself to make love. She says she’s lucky her husband has been very understanding. "I’ve told him this is me now, this is what we have to work with and I can’t control it."
Maria and her husband have tried sex toys and lubricants with limited success. She plans to contact a doctor who was recommended to her and who specialises in helping women enter back into a sex life after going through breast cancer. Because of Maria’s reduced libido, frequency is also an issue. She says, "We made a pact two months ago to have sex every week. We’ve had it twice since then. Still, that’s good; the year before we might have done it once every six months." 

Coping strategies for side effects of treatments 

"It’s totally led by the female"
Laura, 33, was engaged to be married when she was diagnosed with breast cancer at age 28. She underwent chemotherapy, had a single mastectomy of her left breast and radiation, as well as breast reconstruction two years later. When she was prescribed endocrine drugs, she went through menopause, which caused vaginal dryness. And taking antidepressants (her doctor diagnosed her as suffering from depression after her breast cancer treatment) killed her sex drive. Laura had her last orgasm before she was diagnosed with cancer. 
Many women find that certain treatments send them hurtling into early menopause, which causes huge intimacy issues. 
Chemotherapy and radiotherapy can cause pre or perimenopausal women to become menopausal. After the initial treatment, women who are oestrogen receptor positive are placed on endocrine therapies like tamoxifen for as long as five years. These drugs block oestrogen and cause women to become menopausal and experience vaginal dryness, night sweats and the inability to sleep, which in turn affects sexual function. 
Maureen McGrath, a Vancouver registered nurse who specialises in female sexual health, explains, "What causes the vaginal dryness, as well as itching, burning and/or soreness and light bleeding after sex, is a condition called vaginal atrophy. It can narrow the vaginal opening or cause the vaginal walls to become thin, fragile and inflamed, which can make intercourse painful and decrease pleasure."
"It starts with each of you touching each other everywhere but on the genitals" 
McGrath suggests using a combination of three treatments—a vaginal dilator to slowly expand the opening, low-dose oestrogen therapy and a vaginal moisturiser. She says Vagifem 10 mcg, a new vaginal oestrogen tablet, is a low enough dose to be safe and effective, but women still need to speak with their doctors about whether they can use it. 
Laura and her now-husband have only been engaging in oral sex since she underwent treatment. But they are hoping that once she is able to stop taking Lupron injections to reduce oestrogen production, their sex life will start to include intercourse. 
Laura says she’s the one who initiates sex. Her husband has told her he is always interested, so he’s letting her call the shots. To help get things going again, she’s seeing a psychiatrist who specialises in sexual issues. As well, she and her husband are experimenting with sexual exercises known as sensate focus. "It starts with each of you touching each other everywhere but on the genitals, and moves from there to touching genitalia in a non-sexual way, and then to what you would call heavy petting. It ends up with the woman being on top with genitals touching her partner, then penetration and intercourse. It’s totally led by the female." 
Slowly, she says, things are beginning to happen. "In the past few months, we’ve been lying in bed or waiting to fall asleep and all of a sudden somebody touches somebody and we get all hot and heavy." 

Learn to love the new you

"I wanted him to have the image of who I used to be"
For Anna, 55, the trauma of losing a breast after her cancer diagnosis was so profound she wouldn’t let her husband see her naked for three years—even after breast reconstruction. "When we made love, it had to be dark. He never saw my scars or my bald head, just me with my lip gloss and my high heels on. I wanted him to have the image of who I used to be." Until then, she and her husband of 33 years had a great sex life. 
Despite her qualms about her body, Anna says that sex was still deeply important to her. "Sometimes I didn’t have an orgasm but I needed to get close to my husband." 
Maisano jokingly advises getting to know the "new girls" if you’ve had breast reconstruction. "There’s a disconnect between your new breasts and your body. If you take the focus off your reconstructed breasts and start taking care of your entire body, you start to accept them as a part of you and gain confidence. You start to look—and feel—pretty darn good. You begin to appreciate all of you."
You also need to realise that men will have a difficult time knowing how to react when they see your new body. Says Maisano: "If you’re worried about how he’s going to react, he’s going to pick up on it; he’s afraid of what his facial expression is going to look like. Talk about it first. Don’t make your breasts the centre of the sexual experience because they’re not. Sex is a whole-body experience."
Anna finally showed herself naked to her husband. "He was completely accepting. I realised that it was never about him. It was about me. I was never so free as I was that night. My message to other women is: Never give up."

What about new relationships?

Gina is the author of Intimacy After Breast Cancer
Gina Maisano, a two-time breast cancer survivor and the author of Intimacy After Breast Cancer, has been single through two bouts of cancer. She says if you’re just trying to restart a sex life, consider reconnecting with an old boyfriend. However, she says, the "sex buddy" scenario doesn’t work for everyone.
If you do start dating someone new, take it slowly in terms of conversation and in the bedroom. "When you go out with someone, talk about your life. The cancer was only a very small part of it. Get to know the guy and definitely wait to have sex. The sex is better then because you have a connection."
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