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Reclaiming Sexuality in the Face of Breast Cancer

by Michael Krychman, MD, Alyssa Dweck, MS, MD, FACOG, and Susan Kellogg Spadt, PhD, CRNP

Breast Cancer image

Sexual issues are common in breast cancer survivors. Treat­ment, including surgery, radiation, and chemotherapy, coupled with hor­monal medications and the emotional impact of the diagnosis can affect a woman’s sexual response cycle and sexual satisfaction.

How Cancer Treatment Affects Sexuality
Treatment for breast cancer can pose unique threats to a woman’s sexuality. Body-image issues may crop up after surgery, which can negatively affect the way a woman views herself as a sexual being. Radiation can cause skin thickening, discoloration, mobility contractures, and alterations of the texture, feel, and shape of the breasts. Chemotherapy-related side effects, including early menopause, may result in severe hot flashes, sleep disturbances, irritability, and vaginal dryness, all of which may negatively affect sexual enjoyment.

Adjuvant medications, such as tamoxifen or aromatase inhibitors, although beneficial for the goal of breast cancer therapy, have shown varying effects on a woman’s sexual life. These range from minimal alteration to distinct aggravation of menopausal symptoms, vaginal dryness, and threats to bone health. In addition, some breast cancer survivors experience lymphedema, which can hinder mobility and cause discomfort during intimacy.

Treatment for breast cancer can pose unique threats to a woman’s sexuality.

Author of Article photo

Dr. Michael Krychman

Relationship dynamics can change once a woman has been diagnosed with breast cancer. Her partner, who may transition into the role of caregiver or primary wage earner, may have difficulty adjusting to altered family responsibilities and obligations. Single cancer survivors, those with metastatic disease, and those in same-sex relation­ships may also face unique sexual and relationship challenges.

Reclaiming Sexual Vitality
Treat­ing sexual issues after breast cancer often requires a multifaceted approach that involves addressing a woman’s overall health, psychological wellness, and hormonal issues.

Overall Health Identifying and treating simultaneous chronic medical conditions can be helpful in restoring sexual functioning. For example, com­prehensive physical and laboratory testing may lead to the diagnosis of diabetes, hypo-thyroidism, or hyperlipidemia. Reassessing the use of medica­tions that can affect sexual responsiveness, such as anti-hypertensives or anti-depressants, may also be important.

Minimizing fatigue, decreasing stress and anxiety, and maintaining a well-balanced diet can all contribute to overall general wellness. Engaging in mild to moderate aerobic exercise several times a week, ceasing use of tobacco or illicit drugs, and minimiz- ing alcohol consumption can also be beneficial to general health and wellness and can help reinvigorate sexual response.

Author of Article photo

Dr. Alyssa Dweck

Psychological Wellness Managing stress, fatigue, and hectic schedules while making time for structured sexual exercises, such as sensate focus, mas­sage, and communication techniques (occasionally with the help of a trained counselor or therapist), can be vital in managing sexual issues. Sexual inti­macy should be prioritized, and survivors should set limitations with work com­mitments, social duties, and family responsibilities in order to make time for intimacy.

Hormonal Issues For many breast cancer survivors, systemic hormonal treatment is neither a warranted nor a suitable treatment option for menopausal symptoms. Instead, symptoms like hot flashes can be managed with lifestyle changes, such as avoiding spicy foods and caffeine, decreasing alcohol con­sumption, lowering ambient thermostats, and dressing in layers. In addition, some non-hormonal medications (including certain antidepressants) have been shown to help ease hot flashes.

Author of Article photo

Dr. Susan Kellogg Spadt

Non-hormonal vaginal moistur­izers (Replens, RepHresh, Emerita) and water-based vaginal lubricants (Astroglide, K-Y Jelly) help address both vulvar and vaginal dryness and mucosal irritation. Women should avoid using over-the-counter products that contain potentially irritating additives, such as microbicides, per­fumes, dyes, and flavors, in sensitive areas such as the vagina. Arousal oils, like Zestra, may help to initiate arousal when applied to the external vulvar areas of the genitals (unlike lubricants, which are applied directly to the vaginal opening). Commercially avail­able vibrators or self-stimulators can also be helpful for women who ben­efit from extra stimulation to the vagina and clitoris.

Some women use lubricants and moisturizers in conjunction with graduated vaginal dilators to become ready to restart penetrative sexual activity comfortably. These rod-shaped devices come in a variety of sizes and are inserted into the vagina for several minutes per day to gently stretch the inside tissue and muscles, which may have tightened due to can­cer treatments and lack of estrogen.

A Recipe for Success
Sexual dysfunction can compound an already stressful life event like cancer. A com­prehensive sexual medicine evaluation combined with sexual rehabilitation therapeutics can promote healthy sexual functioning by fostering open communication, validating sexual thoughts and feelings, and resolving physical issues. Treatment plans can be viewed as the ingredients each woman can use to create her own individualized recipe for sexual and sensual success.

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Dr. Michael Krychman is medical director of Sexual Medicine at Hoag Hospital and executive director of the Southern Cali­fornia Center for Sexual Wellness and Survivorship (TheSexualHealthCenter.com) in Newport Beach, CA. Dr. Alyssa Dweck is a full-time practicing OB/GYN at Mount Kisco Medical Group (MKMG.com) in Mt. Kisco, NY. Dr. Susan Kellogg Spadt is director of Vulvar Pain & Sexual Medicine at the Pelvic & Sexual Health Institute of Philadelphia (PelvicandSexualHealthInstitute.org) in Philadelphia, PA.

This article was published in Coping® with Cancer magazine, September/October 2013.