There are many different treatments for breast cancer and each of them can have multiple effects on your sexuality in general and your sex life in particular. But sexuality and breast cancer are not fundamentally opposed to each other, and increasingly the medical system is considering, at least a little bit, the sexual side effects of various treatments for breast cancer. Unfortunately talking about sex is still something most health care professionals are not comfortable doing, and you'll likely have to ask if you want to know what to expect from your specific course of treatment for breast cancer. Also, because the medical model focuses almost exclusively on sexual functioning, it is left to you (and partners, if you have them) to really think about the big picture ways that treatment for breast cancer is affecting your sexuality, and how you'd like to deal with that.
You get to choose how much or how little sex matters at any given time in your life. If sexuality feels like the last thing you want to deal with right now, that's okay. If it's the first, that's okay too. Because most of us carry some shame about sex to begin with, it can feel easier to ignore it. But just as sexuality can be a site of shame and pain, it can also make us feel wonderful about ourselves and our bodies, and can be a source of strength when dealing with something like breast cancer treatment.
Every experience is going to be unique, but some of the predictable ways that breast cancer treatment can affect your sexuality and your sex life include:
Fatigue: You may find yourself more often, and more easily, tired. This may be the effect of medications and/or the rigors of treatment. Waiting around is a big part of most medical treatments, and waiting can be exhausting. Feeling too tired to have sex, or even think about sex, is common and understandable. Obviously this can result in having less sex, but it can also have a secondary effect since having sex is, for many of us, a time when we feel connected to our bodies and to our partners, and when we go for long periods without it, we can easily feel less desirable, less desired, and less connected.
Pain:Treatments themselves may cause pain. Pain may lead you to not want sex, or not be sure how to have sex without causing yourself more pain. Treatments may also lead to changes in your body that make certain kinds of sex painful. For example reduced vaginal lubrication is a common side effect of some breast cancer treatments, and without addressing the issue it can mean that intercourse is too painful to engage in.
Changed Body, Changed Body Image:Most breast cancer treatments change your body in one way or another. Changes may be visible to the world (e.g. surgery to remove parts of your body, losing your hair as a result of chemotherapy) or they may not be visible to others. In either case these changes can feel sudden and extreme, and it takes time to catch up. Unlike changes that happen as we age, with breast cancer treatment are bodies are changed by others, sometimes in ways we weren't fully prepared for. Or even if we are, it can still feel like something that's being done to us, without our choice. This element of feeling as if our body is being poked, prodded, and altered, may bring back memories of other times we felt as if our bodies, or sexuality, was being controlled by others.
If you have a partner they can also be affected by the ways your body is changing. They may have fears about causing you physical pain, or making a situation worse, or simply reminding you of the breast cancer with their desire to touch you. They may feel as if they knew how to touch you before, but now they are starting from scratch, and fearful of knowing the right way to touch.
Change in Sensations: Scarring from surgery can result in post-operative pain, but it may also result in temporary or permanent changes in the sensitivity of parts of your body that were previously sites of sexual pleasure. When these changes are so sudden we can be left feeling like sexual pleasure is lost to us for good. In truth what's often required is exploration to discover new places to feel pleasure.
Reduced Desire: All of the above, particularly fatigue and pain can not only have an effect on what sex feels like, but on your desire to have sex in the first place. Additionally, breast cancer treatments may result in changes in hormones which are involved in sexual desire, and leave you feeling less interested in sex. While there are no easy answers to dealing with reduced sexual desire, if you know you'd like to have more interest in sex, or more sex itself, there are ways to begin to address it.
What You Can Do
We like to believe we can do things on our own, particularly private things that we're raised to be embarrassed about, like having sex or going to the bathroom. Dealing with breast cancer treatment and trying to lessen the negative sexual effects really does require some help. You'll need to get at least one of your health care providers on board. Someone who is willing to talk to you about sexual side effects of treatments, and who ideally is open to adjusting treatments when possible to reduce the negative sexual effects.
If you have a partner, it helps if they can be in on some of those conversations and at least have a sense of what to expect. You need to take things at your pace, but if you have a partner you need to let them in the loop somewhere, even if it's only as far as saying that you'll share more when you're ready. Partners can easily blame themselves or feel like you're leaving them behind, at the very time when you may be feeling the same. So keeping communication as open as possible is key.
Fatigue isn't something that can avoided, but realizing that it's not "you" but rather what you're dealing with that is leading to a reduced interest in sex can help. It's easy to take responsibility and think that it's our fault. It's also easy for partners to take the blame, or interpret a lack of interest as sexual rejection. Simply naming fatigue and the causes of it can be helpful. Beyond that, if having sex is something that's important, you can think about timing a sex date to the time of day when you feel most awake. You may have always been a sex-at-night person, but now may be the time to explore the wonders of morning sex.
If you're experiencing significant and/or prolonged pain, know that it's something you can talk with your doctor about, and even though it might feel embarrassing at first, remember that wanting to have sex is a completely legitimate reason for wanting to find out how you might be able to manage your pain. And there are some solutions to reducing pain during sex play. With some pain, like that caused by vaginal dryness, there can be relatively easy solutions, such as using a personal lubricant if you want to have vaginal intercourse. Other times it may be a question of finding the right sex position to reduce and avoid pain. The place you're receiving treatment may have resources other than medication (e.g. yoga, meditation) that some people find helps in managing pain and, if not reducing it, at least reducing the extent to which it's affecting something like your sexuality.
Changes in physical sensation and sensitivity as well as changes in body image offer an opportunity to explore your body anew. It isn't that your body is fundamentally different, although it has changed. Ignoring those changes and just hoping you can keep things going as they were won't end as well as trying to discover sexual pleasure in your body as it is. Whether or not masturbation was a regular part of your sex life before breast cancer treatment, if you're interested in being sexual and having sex, sex educators would say that touching yourself is the best place to start. If you are experiencing your body as changed (on the outside, on the inside, or both) you will need to explore your new body and how it responds to touch. Places that used to feel good may not feel as good, and may find new areas of sexual sensitivity that you hadn't discovered before. Give yourself, and if you have a partner, your partner, the right to not somehow magically know everything about your body during treatment. For some people this can evoke an earlier time in life when they were discovering their sexual selves for the very first time. This becomes an opportunity to explore the many different kinds of sex beyond intercourse, something you may not have ever done before, but which can bring many benefits in the end.
If you are experiencing less desire for sex than you had in the past, remember that it's both predictable and completely reasonable. If you're okay with your lack of desire, don't make it into a problem based on some idea of what healthy sex should be. Healthy sex is staying tuned into your own experience and body. A reduction in desire during treatment does not mean that it's permanent. If you're in a relationship and this is a concern, agree to check in with each other at specific times (e.g. three weeks from now, two months from now, etc…). If you have reduced desire and you'd like to do something about it, certainly one place to start is by talking. Talk with your partner, talk with your health care providers, find out if there's something in your treatment that is known to affect desire, and whether or not there are alternatives. Expanding your definitions of what sex is can also be hugely helpful (although it's a lot easier said than done). Often times we feel stuck because we have a narrow idea of what real sex is.