The words, “You have breast cancer” can be very difficult to come to terms with for women and men. Added to this and what follows is the aftermath from treatment, surgeries, and loss of body parts. Our bodies are physiologically designed for sex with nerves to sexual organs in both male and female bodies. Sex is often associated with an emotional experience for many. For those affected by breast cancer living with scars, loss of body parts, debilitating changes to sexual function, self-image, fatigue, vaginal dryness, loss of libido, to name a few, changes in sexual health after breast surgery and breast cancer treatment are often left to the patient to grapple with.
Our guest, Liz O’Riordan, is a breast surgeon, breast cancer survivor, and author who discusses and writes about the topic of sexual health. We invited her for an interview. Liz tells us her medical background and shares her personal experience being diagnosed twice with breast cancer. She shares her Journey of loss of breasts, struggles with her own sexual health, suggestions to deal with common issues breast cancer patients face with sexual health, and shows us products and how to use them to help restore some of the sexual function lost to breast cancer.
When and Where Should Sexual Health be Discussed?
Unfortunately, the topic of sexual health after a breast surgery and breast cancer treatment is not often talked about in the clinical setting. Most breast cancer health care professionals are there to guide us in evidence-based information about the type of breast cancer we have and the treatment and surgical recommendations for our health and long-term survivorship.
The discussion about sexual health is not often part of the conversation because of time constraints and the complexity and sensitivity of the topic. We have to remind ourselves also, they are not the “gurus of everything” as I say toward the end of the video. However, you can at least mention the topic and ask for resources.
What about at home? Liz emphasizes the importance of discussing sexual inhibitions before the act of intimacy occurs. She personally found it separated the topic as something that could be addressed together with your sexual partner without the expectations of either thinking they had to achieve pleasure from the experience.
Patients may be told by their partners, “You are still beautiful to me no matter what”. This often offers little consolation when the person with breast cancer is bald, has scars, is numb, has no libido or experiencing pain during sex.
She states you often do not realize what your breasts mean to you until you have lost one or both of them. Like me, Liz was hesitant to look in the mirror. I understood this completely in the seven months I lived without my breasts. Keeping a the towel close helped by so I could grab it quickly and cover up when I got out of the shower. I did not know the person standing in front of the mirror.
Vaginal Dryness and Sexual Health
Estrogen is a natural lubricant. Even women who have not had breast cancer experience vaginal dryness with age. However, when it happens early on induced as a side effect of Tamoxifen or other aromatase inhibitors sexual relations can be painful. This pain distracts from the pleasure and patients simply don’t care to have sex when partners still have physical needs.
What to do? Let’s talk about those tips to help with sexual health whether you are married, single, in a same sex relationship, male or female. We start out by discussing lubricants. As Liz says, lubricants can be your best friend no matter what and having sex can be more fun when you cannot get wet naturally. Liz discusses the good, the bad, and the ugly of known lubricants that are on the shelves both in the UK and the US. We both recommend water based and oil-based lubricants. Look for the ones containing no chemicals. Place the lubricant inside, internally in your vagina, and also on your partner. It will stop the rubbing and chaffing.
Preparing for Sex after Breast Cancer Treatment and Breast Surgery
Penetrative sex does not always have to be performed to enjoy the act of sex and achieving pleasure. With breast cancer and age, preferences change. Liz uses these terms and sexual actions.
- “Outer-course” vs. intercourse
- Massages
- Manual stimulation (sorting yourself out)
For those preferring or having the need for penetrative sex, sometimes this takes work if you are revisiting the act of sex after treatment or surgery. As Liz states, your vagina is a muscle and becomes tight and stiff and if not used will not stretch very easily. This can make sex painful and awkward the first few times.
Dilators can help with this. These can be purchased online and come in sizes starting smaller and increasing in size to reduce the vaginal tightness. She suggests “stretching yourself up” in the shower using lubricants on a daily basis. Work up to the size that mimics a full erection giving you and your partner the confidence that more natural, less painful sex may be possible.
If you need private time in the shower, ask for it and tell your partner why. Liz suggests it could also be part of foreplay but emphasizes it needs to be done two or three times a week. If the large dilator does not seem to feel comfortable, try a smaller one and masturbate until you reach orgasm. When orgasm is achieved the vagina relaxes making it easier to get a larger dilator in.
This self-massage reminds you, orgasm is possible, it is relaxing, and can help you get to sleep. Liz uses the term, “sort yourself out” meaning, masturbation to orgasm. It is affirmation your body is still capable of this sexual pleasure. Have your “tools” available in the room for when your partner joins you. Lower the lights, light candles, wear some feminine, sexy lingerie to cover scars, and have lubricants, and dilators nearby to set the mood. It may be awkward at first, but as Liz says, you’ve got to give it a go and start the process.
Vaginal Estrogen Creams and Breast Cancer Patients
It is imperative for me to state the importance of speaking to your oncologist and breast cancer care team about using any vaginal estrogen creams. In the U.S. there is not adequate evidence, nor is there a consensus among breast cancer care physicians about the use of vaginal estrogen creams. Ask about your individual recurrence rate, whether you are on Tamoxifen or an AI like Arimidex, because the use of vaginal estrogen creams remains a controversial topic in the U.S. for those with estrogen receptor positive breast cancer. The conversation with your healthcare team is imperative.
Liz clearly states the risk is there, it is low, but she chooses to take the risk. For those of us in the U.S. because of the lack of consensus and number of studies to support estrogen creams, I offer references to studies Liz speaks of in the video. There is no need for you to feel you have to interpret the information in these studies and why I am providing the link here for you to discuss with your breast cancer care team for your comfort, safety, and quality of life. One from the American Society of Clinical Oncology Journal, next from the National Institutes of Health, and finally from the American Journal of Obstetrics and Gynecology. Print them up to reference at your appointment and let your healthcare team guide you.
Liz says it very well, “If you are informed as a patient and you say I want this, I accept the risk, thank you very much.”
More Tips and Products for Sexual Health
The next product Liz discusses is Ohnuts, a stretchy silicone ring to adjust for penetration during sex. I did find this product in the U.S. after some research and am providing this link here to Ohnuts. The purpose is to make the penetration less for the woman to ease discomfort while still giving your partner the satisfaction of full penetration. Also on this site are some additional products discussed in the video like the chemical free lubricants.
In the book Liz authored, you can find more information in chapter 17, Relationships and Sex. It includes a number of topics that you can each read separately. You can then meet together and discuss in a setting outside of the bedroom before you plan revisiting sexual activity after surgery or breast cancer treatment. Openness, honesty, and having the conversation about sex in a new way is key to addressing sexual health after breast surgery and breast cancer treatment.
In Conclusion
For any healthcare provider who is reading this blog or watching this video, I encourage you at the very minimum to ask this question and even present it to your breast cancer patient in this manner, “Do you have any questions about sexual intimacy and returning to sex? I am not a specialist in that area, but I can provide some resources or have you talk to the nurse further about this topic to answer questions or provide those resources.” Liz and I both hope this video and blog can be one of those resources.
Liz, from me to you, with a huge amount of gratitude, thank you for taking time to have this conversation with me so we can provide a safe space for our breast cancer community to read about and discuss this topic. This will be a process for so many who will watch the video and read the blog. You say it well in the quote below the video.
My soul is behind the eyes. I’m still me. Time is a great healer.
Liz O’Riordan