Intimacy and sexuality with metastatic breast cancer

If you’ve been diagnosed with metastatic breast cancer and you’re experiencing difficulties in your intimate and sexual life, you’re not alone. At least 80 percent of women diagnosed with breast cancer experience changes in their sex lives, including their ability to have sex comfortably and their desire for sex. While the emotional stresses and physical challenges of metastatic breast cancer can interfere with intimacy and sex, there are ways to manage them so you can still enjoy emotional closeness and physical pleasure.

Sex and intimacy can be connected, but each is a different experience and they can also happen separately. Sexual activity is physical closeness that often includes sexual intercourse or however you and your partner define sex. Intimacy involves emotional closeness. Just as sexual pleasure can happen without intimacy, it’s also possible to have intimacy without sex. If you’re experiencing side effects that make sex, penetration, or sexual play painful or upsetting and you want to stay close and connected to a partner, it can be important to explore sex and intimacy and figure out what feels right for you.

On this page we’ll explain sexual side effects that can happen with metastatic breast cancer and treatment, share real-life stories, and provide guidance on how you can continue to have a satisfying intimate and sexual life.

Treatments and side effects that can interfere with intimacy and sexuality

Standard treatments for metastatic breast cancer, such as chemotherapy and hormonal therapy, can have an impact on your desire for and comfort with sexual activity. These treatments can cause side effects such as

  • Vaginal dryness
  • Joint pain
  • Hot flashes
  • Lower sex drive or libido
  • Anxiety and depression
  • Changes to your body that can lead to body image issues, such as hair loss or breast removal
  • Diarrhea, constipation or other bowel movement changes
  • Insomnia and fatigue
  • Neuropathy, numbness, pain, burning, tingling or loss of feeling in your hands or feet

Visit our sexual side effects page for more information about specific side effects of breast cancer treatment and how to start a conversation with your doctor about getting help.

Women Who’ve been there: Managing sexual side effects of metastatic breast cancer treatment

Metastatic breast cancer can significantly impact intimacy and sexuality for anyone who’s been diagnosed, regardless of age or personal history. Here, two women share their stories about how living with metastatic breast cancer has affected their experiences of intimacy and sex.

Shiana Gregory was 25 when she was diagnosed with metastatic breast cancer. After starting chemotherapy, sex became painful, and her desire for sex diminished. She worried that the diagnosis would seem overwhelming to potential partners. “I wasn’t sure if people would understand, if they would want to put up with it, if it was too much of a burden on this person to deal with a person with stage IV breast cancer,” Shiana says.

After her diagnosis, Shiana reconnected with a high school boyfriend. He had experienced his own health problems, and Shiana discovered that he was understanding about the sexual side effects of her treatment. Although sex isn’t a big part of their life together, they do make it a point to be intimate with each other in nonsexual ways, like cuddling.

Mary Mathis was diagnosed with metastatic breast cancer at age 70. Her treatment has changed several times, with each new treatment affecting her desire for and comfort with sex in different ways. She and her husband “have to make it up as we go,” she says. And for the first time in almost 40 years of marriage, they had to learn how to share intimacy without putting the emphasis on sexual activity. “I just wish there was a little bit more conversation [about sex]. I’m not asking anybody to solve my problems, but it helps to hear that other people have them and what they’re doing about them,” she says.

To read more about Shiana and Mary, visit Sex, Intimacy and Metastatic Breast Cancer.

How to manage intimacy and sexuality issues

A diagnosis of metastatic breast cancer can mean long-term changes in how you experience sex and intimacy. Still, there are things you can do to continue sharing physical and emotional closeness with a partner.

Hear how breast cancer patient Roberta Albany’s experience with sexual side effects made her wiser.

Dating

If you’re single and living with metastatic breast cancer, the idea of disclosing your diagnosis to a new person you’re dating can trigger some anxiety. But if treatment isn’t causing noticeable side effects such as hair loss or a visible chemotherapy port, it’s easier to delay the conversation. Your diagnosis is privileged information, so it’s a good idea to wait until you get to know a person better before making the decision to share. If you discover you’re not really interested in continuing to date the person, you don’t then have to worry about sharing your diagnosis or how they will handle it. The same idea applies to sharing your diagnosis on social media.

If and when you do disclose your diagnosis to a date, it’s normal for questions to come up — and some of them may be awkward or misinformed. But answering questions about your diagnosis can reduce potential anxiety your date may have. One way to feel more prepared for this possibility is to role-play potential questions and answers with a friend.

Maybe you’re already using dating sites and that feels comfortable for you. People living with cancer often use the same dating sites everyone else uses. Because some people want to date others who’ve had cancer, there are specialized dating sites for people with serious illness.

Partners

Communicating honestly is an important part of figuring out what feels right for each of you. Partners may feel guilty, selfish, or insensitive for wanting sex while their loved one is sick. Some worry that sex could hurt their partner. Helping your partner understand how treatment affects your sexual experience can help.

Try telling your partner about specific side effects and their impact. For example, if you’re experiencing vaginal dryness as a side effect of chemotherapy, but you can still feel pleasure some of the time, you could let your partner know that a lack of vaginal lubrication does not necessarily mean you aren’t feeling pleasure. Or if you feel like there’s something you want to explore that might help, such as more foreplay before sex to build lubrication up, talk with your partner about it.

Giving yourself permission to be curious can reduce some of the stress of figuring out what feels right to you. Try exploring each other’s bodies and giving feedback on what does or doesn’t feel good. Let your partner get to know your body after breast cancer, and be open to helping them make adjustments. It can be important to remind your partner that any changes in your sexual desire are caused by cancer and its treatment, and do not mean that your feelings about or attraction to them has changed. Being willing to laugh and be creative with sexual play can help you redefine your sexual intimacy. Sharing feelings about your experiences before and after you have sex can keep the lines of communication open.  

Getting Professional Help

It’s completely understandable if you’re having difficulty coping with sexual side effects. If you feel like you need support, there are many professionals who can help. Ask your doctor to refer you to a sexual health specialist, cancer survivorship specialist or sexual medicine specialist. These professionals can make recommendations depending on what you’re experiencing, such as vaginal dryness treatments or Kegel exercises that strengthen the pelvic muscles used during sex to improve pleasure. Dilator therapy, or using a series of rod-shaped inserts to gently widen and lengthen the vagina to help strengthen it, can make intercourse more comfortable.

Many products that help ease sexual side effects contain estrogen. But for people diagnosed with breast cancer, it’s important to avoid products containing estrogen. Some experts believe estrogen-containing products may encourage breast cancer to grow. Unless your doctor says a particular estrogen-containing product is safe for you, it’s better to avoid these products.  

When it comes to other side effects that can interfere with sex, such as hot flashes, joint pain, fatigue or depression, talk to your cancer care team. They can make recommendations to help reduce the side effects you’re experiencing.

Fertility and Metastatic Breast Cancer

Treatments for metastatic breast cancer can also affect fertility and make it more difficult to become pregnant. If you’re premenopausal (still having menstrual periods) and having children is important to you, there are ways to protect your fertility.

For in-depth information and answers to questions you may have about fertility, visit the Fertility and Metastatic Breast Cancer page.

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April 22, 2018