How do we get over the hump of not feeling like a cancer patient in terms of dating?

It’s so common for people to feel like the experience of cancer has changed them – physically and emotionally. I’ve even had some describe it as being “trapped in an entirely new body” that one doesn’t recognize in the mirror. For those who have completed first-line treatment, that feeling seems to be at its worse after treatment completes. Although some clinicians feel the end of treatment should be a moment of celebration, for many it’s a time when the shock sets in as they realize what just happened, and then try to make sense of what might happen in the future. That feeling of uncertainty resonates beyond one’s own experience – it can touch social relationships and friendships, how one functions at work – or even when someone returns to work. For those not in a relationship, it can even have the effect of killing any interest in dating or socializing. That can be due to the sense of being unwanted (ie, “who would want someone like me…”) to the fear of rejection (“why on earth would I risk it”). It’s as if there’s a big letter C on your forehead, and all you want to do is have it fade away.

The good news is that it does fade with time. The shock of the cancer experience and that sense of stigma does lessen with time for the vast majority – and just like a cloud clearing, one will start to see the road more clearly that’s ahead of you, including the proverbial forks that lead to different choices, and different results. Yet, one does not need to “wait” to feel ready to move on. There are things one can do to help the adjustment along- seek psychological evaluation and assistance in how to re-imagine (or rethink) life after cancer, ramp up your physical activity, explore other ways to live and eat more healthy, and reach out to friends and family. With each passing week, you may be less cancer-focused and more in tune to the life you are leading now. As that happens, you will be able to see your cancer not as an adjective you use (or let others use) to define you, but as the noun it is, and for some, to  be left behind in favor of living in the present.

 Will I want to have sex during chemo?

This is a complicated question; some chemotherapy will result in side effects that will make you less interested in anything sexual. For example, some drugs cause GI upset, including nausea or vomiting; others, like paclitaxel, will cause hair loss. Most will cause you to tire more easily. These “systemic” side effects may do a number on your desire, and they are all quite common. Others will be less likely to cause these kinds of side effects, and many not have that much of an impact on desire. Still others, like anti-estrogen’s for breast cancer, can cause hot flashes and physical symptoms in a woman’s pelvic region, such as vaginal dryness. Still, every person is different, and everyone’s appetite for sex is different too. There is no “normal” sexual appetite on treatment – if you want to have sex, that’s great. But if you don’t feel like it, that’s okay too.

What are ways I can remain sexually active at all stages of cancer treatment?

I like this question because it gets to the heart of sexuality for women. Being sexually activity may not necessarily be synonymous with any one activity at all. Women are complicated, and there are different components of sexual health in women conceptually. Rosemary Basson had a model that was a self-propagating circle where the want of intimacy made a woman aware that certain parts of her body became stimulated when touched, which lead to a state of arousal which heightened desire. When desire was satisfied, the circle would propagate again. Importantly, no one activity (e.g. oral sex or penetrative sex) was integral to sexual health for women. So, emphasis on any of these areas could help a woman remain sexually engaged during treatment. Intimacy is as important as any activity, especially when one doesn’t feel well. So, working with your loved one- whether it be a husband, wife, or partner- on mutually agreeable ways to be sexual during chemotherapy is a great start- learn what things you would like to do versus those you wish you could do. It all starts with a conversation.

Are there ways to regain sensation in my breasts after a bilateral mastectomy?

For women who underwent mastectomy and for those who underwent radiation therapy (following breast conserving treatment), a loss of sensation is a common outcome. Unfortunately, these tend to be permanent. In a study by Jennifer Gass at Women & Infants Hospital in Providence, RI she showed that while over 80% of women considered their breast/chest wall part of sexuality prior to surgery, 60-70% felt it was still a part of sexuality after surgery. No feeling or an unpleasant feeling when touched was reported by 48% of women, regardless of whether they underwent breast conserving treatment or mastectomy and reconstruction.

How can I ease discomfort during sex?

This very much depends on where the discomfort is, and often it requires a pelvic exam to make sense of it. If the discomfort is located at the opening of the vagina (also known as the vestibule), treatment with 4% aqueous lidocaine (water-based) can work. If it happens during thrusts, it may be a sign that your vagina has involuntary smooth muscle spasms that neither you nor your partner can control. These can be treated with vaginal dilators. If its discomfort all the time, then vaginal moisturizers can be effective. It really starts with a good pelvic examination, so make sure you see someone to help you get to the root of the discomfort.

How can I restore my libido?

While the loss of desire is common, it is usually due to another issue in female sexual health and after breast cancer, it is often because sexual acts are no longer fun or provide pleasure. I mean, why would you want something that didn’t feel great. So, for most, finding out what isn’t working after cancer is the first step to improving desire. The goal is to make sexual activities fun again.

I don’t feel comfortable in my body after my breast surgeries. How can I feel comfortable again so I don’t want to wear a shirt when I have sex with my husband?

This is a really common dilemma for women, particularly after mastectomies. Time will help, for sure. And some studies suggest there is much to be gained by talking about it with other women. Indeed, group therapy can increase satisfaction with one’s post-cancer body. I think the first step is to know – it’s okay if you don’t feel comfortable, and it’s okay if you want to wear a shirt or get undressed only when the lights are off. But, make sure your partner knows where you are – communicating how you are feeling is so important, if anything – so that he feels involved in your recovery.

I had difficulty climaxing after I finished active treatment. An oncology nurse told me most women don’t orgasm during their first year of treatment. Every article I’ve read is about self-image, but this seems more like a physical failure, not a psychological one. What is known about cause and treatment of this type of sexual dysfunction? Are others reporting similar issues? Is anyone studying this?

Loss of orgasm is actually quite a common experience, particularly for women treated for breast cancer. Even more common is a change in the strength of orgasm or experiencing a longer time to reach it. It’s not clear why this happens, though some I suspect have a component of a neuropathy tied to it. Fortunately, it can improve with time, so be patient with your clitoris. And by all means, don’t give up on her.