Body image, sexuality and family planning

It can be tempting to set aside concerns about body image and sexuality while you focus on treating breast cancer. However, like any other side effect, these issues should be confronted.

As an LGB person, you have unique concerns and experiences when it comes to your sense of self. It’s important to address these so that you can have the best possible quality of life, during treatment and beyond.

Breast cancer and self

The way you see yourself is important and a big part of how you feel about yourself as a sexual being. Breast cancer treatment, including surgery and certain medicines, can alter your body and cause side effects, like:

• weight gain or loss
• skin changes
• hair loss
• lymphedema, a condition in which extra lymph fluid builds up and causes swelling under the skin of the hand, arm, breast or torso, on the same side that the breast cancer occurred
• changed look and feel of breasts

Research shows lesbians are more accepting of body shapes that do not fit cultural norms. But everyone responds differently to physical changes caused by breast cancer. Your reaction may depend on your age, how important your appearance and a sense of femininity is to you, and how breasts, hair and other physical features affect how you see yourself.

As an LGB person, you’re more likely to have experienced discrimination, sexual assault and depression. It’s possible that your diagnosis could trigger bad feelings about those or other upsetting experiences you’ve had in the past.

If you’ve shared information about your sexuality with others, how you see yourself and how others see you may have already gone through changes. You may feel anxious about possibly having to reevaluate yourself and represent yourself differently to others after changes from breast cancer treatment.

Consider talking to a mental health professional who is LGB-friendly and specializes in treating people with cancer. Your hospital or cancer center may be able to direct you to the right person.

Reconstructive surgery

Reconstructive surgery, surgery to reshape or rebuild the breast, can have a big impact on your body image.

According to research, when deciding whether to have reconstruction, many LGB women choose survival and physical function over appearance. But others choose reconstruction.

You might make this choice for a variety of reasons, including wanting to conform to beauty standards and wanting to reclaim a part of your femininity that you feel breast cancer took from you. You may also be hopeful that reconstruction will prevent depression, increase feelings of well-being. In addition to surgery, tattoos that look like the areola and nipple can give you more confidence in your new look.

Reconstructive surgery is a personal choice that only you can make for yourself. There is no right or wrong decision.

Intimacy and sexuality

Breast cancer treatments — and the fatigue, discomfort and pain that sometimes accompany them — may weaken your sex drive. Stress can have the same effect.

Research suggests lesbian and bisexual women who have a history of breast cancer have lower sexual desire, lower ability to reach orgasm, more sex-related pain and less sex than lesbian and bisexual women who have not had breast cancer.

Even if the desire is there, you might feel uncomfortable about the changes that your body has gone through after breast cancer treatment. You may be afraid that your partner won’t be excited by, or accepting of your body as it appears now. But you might find that a lesbian partner, because her body is similar to yours, is especially supportive and sensitive to what you’re going through.

Research suggests that women whose female partners have breast cancer are the most important sources of support for their partners as they go through treatment. Try to be open and honest with your partner about what you’re feeling and encourage your partner to do the same. Seeking advice from a couples counselor or sex therapist may also be helpful.

Keep in mind that sex and intimacy are two different things. Holding hands, hugging and doing other non-sexual things with your partner can maintain the intimacy in your relationship, even if you aren’t having sex.

If you’re single, telling potential new partners about your history of breast cancer may make you nervous. It may help to take new relationships slowly. When thinking about telling a date about your diagnosis, practice what you’re going to say in a mirror first. Don’t be shy about ending the relationship if the person can’t handle your diagnosis.

Fertility and family planning

Some treatment for breast cancer can make it difficult or impossible to have children later. Chemotherapy can damagefollicles, the egg-containing sacs, in the ovaries. It can also send the body into premature menopause.

Treatments for hormone receptor-positive, or HR-positive, breast cancer, in which cancer cells grow because of estrogen or progesterone, can also cause you to experience menopause early or force you to delay pregnancy. Surgery, such as an oophorectomy, or removal of the ovaries, causes permanent infertility and is sometimes, though not often, recommended to women with breast cancer.

You should avoid pregnancy while being treated for breast cancer, because the medicines you’re taking could hurt the unborn child.

Getting information from your care team

It is unclear if LGB women diagnosed with breast cancer are told about their options to protect fertility as often as their straight peers. Your doctor may not bring up the issue of fertility.

If you have already come out to your doctors and they don’t bring it up, or if you feel that they assume you aren’t interested in having children because of your sexual orientation or age, it’s OK to speak up.

Ask your doctor about your specific concerns. If your doctor doesn’t respond well, or doesn’t provide the information you need, seek a second opinion to find another provider with whom you’re more comfortable. It’s important to talk to your doctor about fertility issues early on, so that you can look into fertility preservation options, such as freezing eggs or embryos.