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Sex and Intimacy After a Breast Cancer Diagnosis

Reviewed by: Susan Kellogg-Spadt, CRNP, PhD

Updated August 13, 2013

Whether you are single (dating or not), in a committed relationship or married, your sexual self is part of who you are.

You may have enjoyed a sexually active life before your breast cancer diagnosis. Now, you might find yourself:

  • Dealing with sexual side effects from treatment, such as vaginal dryness or pain
  • Feeling anxious about how your body looks
  • Wondering if your partner still wants to be close with you
  • Worrying because you don’t feel like having sex (alone or with a partner) or being intimate at all.

These concerns and difficulties about sex are normal, normal, normal.

Will It Always Be This Way?

Breast cancer and its treatments often affect sexual health and function, including the emotional and psychological well-being that supports an enjoyable sex life.

Regardless of your age, you might be surprised by such changes. Before diagnosis, you may have associated these issues only with menopause. 

Many doctors and healthcare providers talk very little about the sexual side effects of treatment. You may be reluctant to bring up the subject, out of discomfort with talking about it or to protect your own or your partner’s feelings.   

But take heart:

  • Your “new normal” doesn’t have to include the loss of sexual expression and satisfaction.
  • You can use simple solutions during and after treatment, or while on continuing therapy, to gain the quality of life benefits of sexual activity and intimacy.  

Why Breast Cancer Affects Sex and Intimacy

Breast cancer diagnosis and treatment produce physical and emotional changes that can alter your sexual self-image, comfort, arousal, response or desire.

Surgery may remove one or both breasts and nipples (mastectomy), or part of a breast (lumpectomy).

  • For many women, breasts are important to sexual identity, feeling attractive and erotic play. Adjusting to that loss after surgery can be difficult.
  • For those who have reconstruction, you may be unprepared for the lack of sensation in your new breasts, or for how the breasts look.       
  • You may have pain, scars and numbness from surgery, cording or lymphedema swelling.

Chemotherapy can cause ovaries to shut down, limiting estrogen:

  • Menstrual periods may stop temporarily or permanently.
    • This brings menopausal symptoms that affect sexual function — night sweats, hot flashes, sleep problems, vaginal dryness and depression.
  • Reduced lubrication dries out the vaginal walls, vulva (external genital organs) and the opening to the vagina.
    • Vagina narrows and shortens. Walls become thinner, less elastic and more fragile. Vulva flattens and thins. Levels of pH and healthy vaginal acidity drop.
    • Pelvic floor muscle difficulties may develop.
    • These changes cause irritation, bleeding, burning and pain, especially during penetrative or insertive sex.
    • Once you have pain, you might avoid sex.
  • Nerves and blood vessels which supply sexual organs may be damaged.

Hormonal therapy (tamoxifen, aromatase inhibitors) also causes menopausal symptoms, dryness and pain. Radiation can make skin feel too sensitive to touch.

Hair loss, fatigue or weight changes can affect sexual self-image and interest. Some antidepressants also lower sexual response.

Managing Changes to Sex and Intimacy

There are many good ways to manage these concerns:

 Build comfort with vaginal moisturizers.

  • Use non-hormonal products to hydrate vaginal walls and restore pH balance.
  • Moisturizers make you more comfortable but are not sexual lubricants.
    • Vitamin E capsules may be pierced, then inserted in the vagina at bedtime. You may also squeeze oil onto your finger and insert.
    • Brands include Replens, Luvena and Me Again. *

 Aid your sexual comfort with vaginal lubricants.

  • Lubricants can be used just before sex. They are placed on your and your partner’s (if any) external genitals and on sexual toys and aids. Lubricants provide comfort and pleasure for insertive or penetrative sex.
  • Water-based lubricants include Astroglide, Sylk, Good Clean Love, K-Y Sensitive Jelly and Slippery Stuff. * Avoid products with glycerin, parabens or which claim to be warming or arousing. These can irritate.
  • Talk with your doctor if you have any vaginal pain.

 Vulvar soothing cream helps side effects of estrogen depletion.

  • Non-irritating hydrating cream for the vulva and vaginal opening lessens dryness, itching, soreness and burning.
  • Brand: Neogyn .*

If you continue to feel discomfort after using lubricants and moisturizing products, some healthcare providers might recommend topical estrogen cream or pills for vaginal dryness. This use is decided individually and is somewhat controversial, especially if you had hormone receptor-positive breast cancer.

      Stretch vaginal walls with dilators.

  • Medical dilators are cylinder-shaped devices made of glass, plastic or silicone. They come in graduated sizes and stretch the vagina over time to make you more comfortable, even if you do not have penetrative sex.
  • To use, lubricate smallest size dilator (usually sold in sets), relax and insert in vagina. Keep in place five minutes. Repeat three to seven times a week.
  • Every few weeks, increase the dilator size until you can comfortably insert the dilator that is about the size of your partner’s erect penis or other measure. This technique is very gradual and effective at regaining vaginal width and depth and making sex comfortable again.

 Use vibrators to increase stimulation.

  • Breast cancer diagnosis and treatment can leave you needing more stimulation than before to become aroused or have an orgasm. Vibrators emit a strong, pleasurable sensation that can provide the intensity to help arousal and orgasm.
  • Apply lubricant before using by yourself or with a partner.

  Rethink body image.

  • Get to know and accept your body changes.
    • Find ways to feel good about yourself, including your physical self.
  • Use body-mapping to locate erotic zones other than your breasts. Lie naked and explore your body by touch, by yourself or with a partner.
  • If you’re not ready to show scars during sex, wear lingerie, short nighties or camisoles that partially cover you. You don’t have to be naked to be intimate.
  • Improve your food choices.
  • Exercise regularly.

 Help create desire.

  • Strengthening your body image is a good step toward overcoming loss of libido.
  • Think about sex more. Read erotic books, and use fantasy and self-pleasuring methods.
  • Make time for sensual touching, massage and closeness on your own or with a partner.

 Talk with your partner.

  • If you have a partner, the quality of that relationship is important to your sexual satisfaction.
  • Both of you should learn about the sexual side effects of breast cancer.
  • Share what you’re feeling.
    • Talk about what is working sexually and what is not. You might both have some performance anxiety.
  • Partners may worry about hurting you during sexual activity, especially if you’ve had pain.
  • Female partners may also be worried about their own breast cancer risk.
  • Touching helps you stay connected with your partner.

 Ask healthcare providers questions about your sexual health.

  • If you are ignored or don’t get helpful answers, ask again.
  • Go to another provider if you’re not being heard or if the provider is not respectful of your situation.

Finding Pleasure Again in Sex and Intimacy

Yes, sex can be satisfying after breast cancer treatment! Here’s how:

       Forget penetration (for awhile).

  • Cuddle, hug, massage, make out, touch new parts of your body — enjoy sexual activity without penetration.
  • Build sensual response and desire slowly.
  • You and your partner can still share pleasuring each other to orgasm.
  • Wait to enjoy intercourse, if you choose to, after you have no vaginal pain when using a dilator.

 Incorporate sexual fantasies.

  • Use fantasies to fuel interest in sex or charge up a long-time relationship.
  • Reading can include romance novels, fiction with explicit sex or books of women’s sexual fantasies.  
  • You might enjoy watching erotic movies, with or without your partner.
  • Remember — you don’t have to read or watch anything that turns you off.

 Stimulate yourself.

  • What feels good to you and how long it takes to become aroused may have changed after treatment.
  • It helps to figure out what you enjoy on your own before sharing with a partner.
    • You aren’t being disloyal to your partner by masturbating.
    • Self-pleasuring can help you respond more to sex when you’re together.
  • If you’re single, self-stimulation provides the benefits of sex without needing a partner. It also keeps your body ready for sex with a partner if you want it.

Resources about Sex and Intimacy

Online sources for vaginal moisturizers, lubricants,dilators, vibrators and more:

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

* LBBC does not recommend products. Names are included only for reference; all mentioned here are available without prescription, online or in stores. Talk with your healthcare provider about what to use. 

Denver, CO  ·  September 13, 2014

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