Most of us go through life thinking that we know our bodies pretty well. We think we know what to expect from them in part because we imagine them as static, only changing in major stages (youth, mid-life, old age). The truth is that our bodies are in a constant state of change. But this is a truth we may not be confronted with until something significant happens with our bodies that we weren't expecting, something like a breast cancer diagnosis.
Even before you receive a diagnosis of breast cancer, the idea that you might have breast cancer (whether you've felt something you think is a lump or it's come up in an examination) can have an immediate effect on how you feel about your body and yourself, sexually speaking. As soon as we begin to talk about our bodies with breast cancer there is a distancing that happens. We talk about, and start to think of, our bodies as foreign, something to be fought. Where we may have experience our bodies as ourselves, now our bodies are something other. Because so much of our sexuality is wrapped up in our bodies, and our bodies are crucial to much of our sex lives, this distancing can have a negative effect on how we feel sexually, and our willingness or desire to be sexual.
Even though all forms of cancer will have some effect on sexuality, when the potential or final diagnosis is breast cancer the connection to sex and sexuality may be more pronounced. Most cultures sexualize breasts. For women they are intimately linked with gender; most women have some story of growing up and being treated as more or less a woman because of the size of their breasts. For people of all genders, breasts may be linked with sexual pleasure, as they are commonly considered an erogenous zone, and breast/nipple stimulation is a popular form of sexual stimulation.
There can also be an effect from the medicalizing of our bodies that happens as soon as there is a potential for a breast cancer diagnosis. Our bodies, our health, our very life, suddenly becomes something out of our hands, and just as suddenly, there are these experts who seem to know more about us than we do. We come to think of this as a fact of life, when it's as much a reflection of how our culture understands illness, health, and bodies. Either way, the effect on our sexuality can be sudden and sharp. As we are asked to give up more and more control of our bodies, the effect can be very dis-empowering, and make it harder for us to think of ourselves as powerful sexual beings with the right and ability to initiate sex or enjoy sex.
The entire process of getting a diagnosis can be physically uncomfortable and painful, which can also understandably make us feel less than sexy. Some people manage to stay connected to their sexual selves through this process while others retreat, either briefly or for longer periods.
Waiting for and receiving a breast cancer diagnosis can come with intense feelings of distraction, preoccupation, anxiety, fear, anger, denial, and more. All of these feelings and experiences are reasonable, and unfortunately most of them are also major turn offs. Even if we intellectually want to have sex, if we aren't able to concentrate on relaxing and feeling pleasure, it's not likely to happen. And since breasts are often a common part of sex play, it may be more likely that sexual activities will turn ones attention back to the diagnosis, and not away from it.
What You Can Do
Give yourself a huge break. Whatever you're feeling, try not to kick yourself for it. Try to take note of the different thoughts and feelings your having without immediately judging them as being inappropriate or appropriate.
Give yourself permission. If you're feeling one way, and if it feels right, then go with it. If you find yourself wanting lots of sex, then have it. If you feel like you need time for yourself and you don't want to be touched, then let partners know that.
Whenever you're ready, think about sex. There's no time that's too soon or too late to think about how a diagnosis, or possible diagnosis, makes you feel about your sexual self. You are the one who should set the pace. When you're ready or find yourself thinking about sexuality and your breast cancer diagnosis, here are a few questions that can help you think through the possible effects and also help you begin to figure out how you want to talk with partners about it:
- How do you feel right now about your breasts in relation to your body and sexuality? How have those feelings changed over time since you were young?
- What are some of your associations with illness and disease? Where, and what, did you learn about cancer when you were young? How much are those associations and early lessons influencing your thoughts at this time?
- If you could get what you wanted from a partner, without having to ask them for it, what would you need right now from them?
- How important was sex to you before your diagnosis? How important is it to you now? How important would you like it to be?
Talk to someone. Sex is one of those topics we aren't encouraged to talk about honestly, but when we carry around worries and mix them with general shame about sex, the result is much much worse. If you have a trusted friend, family member, or romantic partner, sharing as much as you're comfortable sharing is important. Choose your confidants carefully, as there will be those who think you "shouldn't" be thinking about sex ("you've got other things to worry about" they'll say, or at least think). Remember that you get to decide what's important, and for many people sexuality is one of the first things they want to know about.
Bring partners in. If you're in a relationship, it's important to let your partner in. You have to do this in a way that feels right for you, and there shouldn't be pressure to share everything all at once. But if this is a relationship you want to keep, and you are changing the sexual routine, it's important to keep communication open about what you need. If you need time away from sex, but still want attention and love and intimacy, you may have to help your partner understand that. Also, just because you don't feel like being sexual now, it doesn't mean you won't later. And later could be tomorrow. A good idea is to agree that you'll check in at set time periods (or before) just to see how you're both doing, and to take the pressure off if you're both wondering when the next "sex talk" will happen.