21 Nov Breast Cancer And Sexuality
I made the decision to write this article after a common question I am asked by new breast cancer patients I have operated on. Fortunately, they feel close to me and that’s why they ask me anything that concerns them. Breast cancer and sexuality are a major cause of concern among women suffering from this disease. The question I often receive as a Breast Surgeon – Mammologist is the following:
” How can the sexual problems of women who are operated for breast cancer be solved, especially if we are at a young age? Everyone talks about quality of life: isn’t sexual satisfaction part of that quality? The chemo was the cause of early menopause that I can’t even treat with hormones. I can’t make love anymore. Can something be done about it?”
This is the psychology of young women whose sex lives have stopped. Breast cancer affects all three basic dimensions that make up human sexuality:
– sexual identity, the biological sex at birth, which also includes the possibility of motherhood
– sexual function, which includes desire, arousal, orgasm, physical and emotional satisfaction
– sexual relationship, as the effects of breast cancer can also be unpleasant for the couple.
Suffice it to say that after breast cancer, 25% of couples divorce, compared to 7% if it’s the man who has the cancer! The impact that breast cancer has on sexuality, in all its aspects, is greater the younger the woman is at the time of the cancer diagnosis. 25% of women with breast cancer are not yet menopausal at the time of diagnosis, with many of them in their thirties and forties. Many are still looking for a stable relationship, have not yet had their first child or have very young children. The burden of a cancer diagnosis is thus part of an existentially very demanding situation and can open up a series of questions. A young 34-year-old woman told me, “It’s not even the cancer itself that worries me, but the idea of my two children that I may not get to see grow up. That’s the thought that keeps me up at night.”
Treatments and effects
Why can breast cancer be so harmful to women’s sex life and sexuality? In younger women, the presence of aggressive cancers requires the use of chemotherapy associated with surgery and/or radiation therapy. Chemotherapy causes damage to the ovaries that can cause early menopause. Then it can happen that in one year the young woman faces three major trials: – breast cancer alone, with all the burden of anxiety and therapeutic gravity? – early menopause, with all the associated symptoms (hot flashes, night sweating, joint pain, loss of desire, accelerated aging of the skin and body in general) – the loss of the “friend” who cannot imagine a life without children, due to early menopause.
Three “mournings” that make it even more difficult to trust life and fight cancer with determination. Therapies can reduce mental and physical arousal. Loss of estrogen can reduce vaginal lubrication, resulting in dryness and painful intercourse. It also changes the vaginal ecosystem (the set of microorganisms that protect the vagina from invading microbes). The chance of developing cystitis may increase after intercourse, which usually occurs 24-72 hours after intercourse.
True or false: can young girls have children after chemotherapy or hormone therapy?
In young women who have not yet had children, or who wish to preserve fertility, it is possible, before chemotherapy, to cryopreserve eggs, providing the possibility to have children after the end of the treatments. Cancer and fertility are no longer two concepts that cannot coexist, as there are options for having children even after treatment.
Breast cancer affects the main organ of femininity and this traumatizes a woman’s sexual identity depending on the type of cancer and the type of surgery required. All research conducted on women with breast cancer recognizes that the quality of life after this diagnosis is satisfactory for 70-80% of women. Sexual function and sexual satisfaction show significant deterioration, especially in younger women who were of childbearing age at the time of diagnosis.
What happens from a psycho-emotional point of view
The drop in sexual desire depends not only on hormone deficiency, but also on depression. It can be further aggravated by the loss of the ability to have children which makes the woman feel inadequate towards motherhood.
How to improve sexuality (and life!) after breast cancer
A woman’s life must and can improve after breast cancer and it depends on the determination of the woman herself.
Daily exercise: keeps the body in better shape, reduces weight gain due to menopause and treatment, reduces general inflammation, reduces the risk of lymphedema and improves mood.
Diet low in fat, animal protein and sugars such as glucose: reduces the risk of relapse and metabolic and cardiovascular risks associated with early menopause.
Go out, be socially active: improves mood and ability to face many difficulties, increases the possibility of being helped by others.
To cultivate spirituality and the search for meaning in life, use of antidepressants such as paroxetine reduce hot flashes, anxiety and depression. They must be used at the lowest effective dose because they can prevent orgasm, phytoestrogens (extracted from soybeans) are natural substances, similar to estrogen but 10,000 times less active, which have an effect similar to tamoxifen (the substance used to reduction of relapses). They have the special benefit of reducing some symptoms (for example, reducing hot flashes by 35-45%). However, the opinion of oncologists regarding the use of phytoestrogens is not clear, vaginal probiotics such as Lactobacillus improve the vaginal ecosystem and defense capabilities against pathogenic microbes.
Psychosexual support for the woman and/or both partners: even the man who wants to help his partner in this difficult existential passage needs information, to listen, to answer his doubts, his fears, his difficulties! Practical advice helps the couple to overcome this difficult period by maintaining a good physical and sexual intimacy.