A study published in Psycho-Oncology suggests that the way a couple communicates about cancer-related concerns plays a role in worsening or improving symptoms of depression related to problems with sex and physical intimacy in women living with metastatic disease.
Both medical and surgical breast cancer treatments (e.g. mastectomy, chemotherapy and hormonal therapy) are known to cause side effects (e.g. distress with body image, decreased libido, and vaginal dryness) that may lead to emotional or physical discomfort with sex and intimacy. For women with metastatic breast cancer (MBC) who remain in active treatment for months or years, the sexual side effects of therapy may have a strong effect on quality-of-life. Because breast cancer is often a shared experience for couples, partners of women with metastatic breast cancer may also feel the impact of these concerns.
Study investigators wanted to find out how sexual problems due to metastatic breast cancer and its treatments are associated with symptoms of depression in both women and their partners, and whether certain communication styles influenced depression and relationship satisfaction.
Couples were recruited from a group participating in another study that focused on how couples adapted to MBC-related pain. At enrollment in the study, the women were starting treatment for MBC, in reasonably good physical health, felt some pain in the week before joining and had lived with their partner for at least 1 year.
In total, the study population included 201 women with MBC and 196 male partners; altogether, 191 couples participated together. All participants were asked to complete surveys, which they returned to the researchers by mail. The surveys collected data on
- the negative effects of cancer on the couple’s willingness to be physically intimate, such as fear of causing or experiencing pain and decrease in sexual desire
- how the couple communicated about cancer issues (including whether they most often used mutual constructive (MC) communication or demand-withdraw (DW) communication. In MC communication, both members of the relationship want to openly discuss a problem; in DW communication, one person pressures the other to talk about a problem the other wants to avoid)
- symptoms of depression
- quality of life
- relationship satisfaction
- information on the participant’s age, race, education, employment, marital status, length of relationship and diagnosis details
A data analysis showed that sexual problems are an important quality-of-life concern for couples dealing with MBC and are related to symptoms of depression in both the women and their partners. Based on answers to questions assessing general relationship satisfaction, 22.5 percent of the women with MBC, 21.6 percent of the partners and 10 percent of the couples were labeled as experiencing “marital distress.”
In addition, the researchers learned:
- For women with MBC, greater sexual problems led to greater symptoms of depression when the couple used DW communication; however, when couples did use MC communication, these women did not experience greater symptoms of depression
- For partners, talking openly about the issue did not always prevent greater symptoms of depression when the couple reported sexual problems
The findings of the study may be limited because the surveys did not ask participants if they were currently sexually active, did not include same-sex couples, and focused questions about communication on how the couple discussed cancer-related issues, in general, rather than sexual problems specifically. It is also possible that participants who were more depressed at the beginning of the study reported more sexual problems in their surveys. This means that more problems with physical intimacy might not have led to an increase in depression if sexual problems were caused by pre-existing depression.
What This Means for You
If you are a woman living with metastatic breast cancer, it may comfort you to know that communicating about treatment-related sexual concerns with your partner may improve or eliminate depressive symptoms that you might be experiencing. The findings of this study support the need for more research examining how forms of communication can impact a couple’s ability to cope with sexual problems related to side effects of MBC and its treatment.
If MBC is impacting your sexual experience, consider talking openly with your partner about your worries and needs. It may help both of you understand each other more deeply and cope with intimacy issues more completely. If you think you need the support of a professional, a social worker, patient navigator, nurse or other member of your healthcare team will be able to recommend someone.
For more information on how breast cancer treatment can impact your physical and emotional relationship, and for resources to help you manage side effects, see LBBC’s Guide to Understanding Intimacy and Sexuality.
Milbury, K, Badr, H. Sexual problems, communication patterns, and depressive symptoms in couples coping with metastatic breast cancer.Psycho-Oncology.2013; 22 (4): 814-822