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Relationships, Intimacy, and Sex for Young Women with Breast Cancer
Valentine’s Day is a celebration of love and intimacy, but a breast cancer diagnosis can get in the way.
Breast cancer patients can find a lot of information about breast cancer on the internet. Whether it’s questions about treatment, side effects or statistics, Google has been a go-to for many impacted by the disease.
While your doctor should be your primary source for answers about your breast cancer, patients often feel uncomfortable discussing more personal questions related to the diagnosis and side effects.
Don’t keep your symptoms to yourself.
Conversations about your sex life and intimacy are already uncomfortable topics to discuss with your physician. For young women facing a breast cancer diagnosis, these subjects are particularly sensitive.
“Why don’t I feel like having sex anymore?” can be a hard question to ask your oncologist, or even feel inappropriate. “How will a breast cancer diagnosis and treatment affect my dating life?” might feel like a trivial question when thinking about cancer. But your social support system and relationships are important throughout your diagnosis and treatment and should not be ignored.
“Women are sometimes uncomfortable physically, but more often emotionally with the look and feel of their chest/breast area after treatment,” said Dr. Ann Partridge, BCRF investigator, Professor of Medicine at Harvard Medical School and Director of the Adult Survivorship Program at Dana-Farber/Brigham and Women’s Cancer Center. “It is so important for them to be patient with themselves as they adjust in their survivorship. It may be helpful to speak to a mental health provider, particularly someone who specializes in sex and intimacy after cancer.”
Dr. Partridge's team recently launched the Young and Strong web portal, which provides information and support to young breast cancer patients.
New guidelines help doctors and patients navigate survivorship
In 2016, the American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO) published guidelines on Breast Cancer Survivorship Care. The purpose of the Survivorship Care Guidelines is to provide recommendations to assist primary care and other clinicians in the care of survivors of breast cancer.
From these guidelines, BCRF’s Dr. Marc Hurlbert and Dr. Margaret Flowers summarized several issues related to relationships, intimacy, and sex. These topics included body image concerns (such as scars, hair loss, loss of breasts), sexual health (like vaginal dryness or loss of libido resulting from hormone treatments), and unique challenges for young women (such as loss of ovaries that may increase the urgency to start a family).
Although doctors are encouraged to ask about all potential effects of your treatment and diagnosis, including changes in your sexual intimacy, you should bring these up at your appointments, if you are experiencing these changes. Even if your doctor doesn’t have the answers, he/she will be able to refer you to someone who can help.
Younger women are at increased risk of depression after breast cancer.
Depression and anxiety impact relationships and intimacy with 22 percent of breast cancer survivors reporting these conditions, according to the AACR/ASCO Survivorship Care Guidelines.
The risk of depression is even higher in younger patients. Since symptoms of depression are often not clear, the patient and her doctor may not immediately recognize them. A person may just feel that things are different and express a desire for life to return to “normal,” but may not be able to put these changes into words.
Depression can often be treated with therapy, and sometimes medications. Be sure to discuss symptoms such as loss of interest or pleasure in doing things, feeling hopeless or depressed, lack of energy, changes in appetite, feelings of guilt or anything out of the ordinary with your doctor.
Sometimes, opening the door to communication about how you are feeling can lead to quick resolutions before they become deeper problems. Like this anecdote from Marisa Weiss, chief medical officer of breastcancer.org:
"One of my patients had told me that her breasts had been a crucial part of her sexual life before the discovery of her disease. She had breast cancer in both breasts, treated with l lumpectomy and radiation. Her breasts looked great—but her husband was ignoring them completely. I scheduled an appointment that included her husband and was able to reassure him that her breasts would not be harmed by fondling, kissing, or whatever; that he could not catch cancer; and that she was not radioactive. They quickly resumed their former lovemaking habits."
New challenges are common after a breast cancer diagnosis and treatment. Talking about your concerns with your doctors, partners, and loved ones can help. But it’s hard. Every situation is unique, and answers can be hard to find. The Pink Agenda, a partner of BCRF, wants to make these experiences a little bit easier to navigate. You can comment with your questions on Facebook or Instagram with #AskTPA.