Breast cancer and sex

Being diagnosed with a life-threatening illness is likely to affect how you feel about sex and your sexuality. At a time when you’re dealing with so much, you may not feel like expressing yourself sexually. Or you may want to have sex to give you a feeling of normality during an uncertain time. Some people say their desire for intimacy, although not necessarily for sexual intimacy, increases. The treatments you receive may also have an effect on your sexual desire and sexuality.

Experts think that sexual response may be affected or disturbed in three main ways. These are:

• pain (in the genital area or elsewhere in the body)
• anxiety and fear around intimacy
• having too much on your mind so that you can’t really think about sex.

There are also factors specific to breast cancer and its treatment that may have an impact on your sexual response (see below).

Pain and discomfort

Being treated for breast cancer will nearly always mean you have some form of surgery, including breast reconstruction. It may be difficult to touch or hug someone if the wounds from your surgery are still healing or if the area around the scar is uncomfortable. If you are in pain you may want to concentrate on feeling well again or you may not have the energy or desire for sex.

If you’ve gone on to have radiotherapy, the area being treated may be tender during and after treatment and may feel too painful to be touched. This can be upsetting if it means you can’t be as physically close to your partner as before, but should only be for a short time.

Pain relief can help with any discomfort you’re feeling, although having to think about taking these before having sex and being intimate may change how you feel about the experience.

You may find it reassuring to know that any pain you experience from surgery or radiotherapy should lessen as the area heals. Alternatively, a change of position during sex or being intimate may also help – for example, one that puts less pressure directly on to the chest area.

It is not unusual to experience a loss of confidence when starting to be physically intimate and have sex again after breast cancer treatment. You may feel tense or afraid and be worried about experiencing pain.

Talking honestly with your partner can help you both to relax. Your partner may be anxious or fearful as well, so talking can help clarify what is happening for both of you.

You may like to talk to your GP (local doctor) if you have specific problems. For some it can help to work with a sexual counsellor to explore any difficulties.

Fatigue

Fatigue is extreme tiredness that doesn’t go away with rest or sleep. It is a common side effect of cancer treatment. It can get worse as treatment goes on and can also continue once treatment has finished. Treatments such as chemotherapy and radiotherapy, surgery and hormone therapies can all affect your energy levels and cause fatigue.

If you’re feeling fatigued you may not want to have sex at all or you may want to take a less active role. This may take a little adapting to if you’ve always been very physical during sex. It’s important to understand your current limits and not push yourself too much. Feelings of fatigue will gradually lessen over time and your energy levels increase.

Menopausal symptoms

Women who experience these symptoms during their natural menopause may be given hormone replacement therapy (HRT). However, HRT is not generally recommended for women with breast cancer because there’s uncertainty about whether it increases the risk of breast cancer coming back.

The vast majority of women who are taking HRT at the time of their diagnosis will be advised to stop the treatment straight away. This may mean they will have menopausal symptoms before having any breast cancer treatment.

Menopausal symptoms are a common result of treatments for breast cancer. Treatments can either stop the effect of female hormones or stop their production altogether.

The treatments most likely to produce these symptoms are chemotherapy, hormone therapy, or ovarian ablation or suppression (stopping the ovaries working either permanently or temporarily). As a result, you may experience some or all of the following symptoms:

• hot flushes
• night sweats
• tiredness
• mood swings
• hair thinning
• loss of elasticity and thinning of the vaginal wall
• vaginal dryness.

These menopausal side effects vary from one person to another.

Side effects of treatment and menopausal symptoms can contribute to many women feeling different about themselves and their bodies. For example, during arousal you may feel less sensation, which means it can take longer to orgasm. Or you may simply feel too tired to have any interest in sex, perhaps as a result of symptoms like night sweats. Although you may lack the energy for oral or penetrative sex, cuddling, stroking or kissing can encourage intimacy.

Younger women being treated for breast cancer often experience menopausal symptoms because of chemotherapy or ovarian ablation and suppression. This menopausal state may be temporary or permanent.

Although the symptoms can be the same as those experienced with a natural menopause, they can be more severe. Having these symptoms at a younger age can make someone feel older than their years, which can have a negative effect on how they feel sexually

Men can also experience symptoms such as hot flushes while taking hormone therapies as treatment for breast cancer.

Vaginal dryness

Treatments that alter the level of the hormone oestrogen in your body can cause vaginal changes such as dryness and/or irritation. This can make penetrative sex painful.

Vaginal dryness is a very common menopausal symptom in women who have had treatment for breast cancer, and one that can be very distressing. The treatments can also have an effect on sexual desire and feelings of arousal.

Pain or discomfort can reduce sexual feelings and desire. However, there are things that can help. Once you know that penetration is not going to be painful or that discomfort can be reduced to a minimum, you may find your desire for sex increases.

The most commonly used treatment for vaginal dryness is HRT but it is not usually recommended for women with breast cancer. However, some specialists will consider prescribing locally acting hormone replacement treatments such as an oestrogen pessary or ring, which can be used for short periods of time.

Vaginal oestrogen may be more safely prescribed for women taking tamoxifen. This is because tamoxifen is thought to counteract any oestrogen entering the bloodstream. If you are taking an aromatase inhibitor, vaginal oestrogen is not usually recommended, but you may be able to switch to tamoxifen. You can discuss this with your specialist.

There are also some simple, practical steps you can take that don’t involve using hormones. Some women say that wearing loose-fitting, cotton underwear and not wearing tight-fitting trousers or panty liners can help by reducing  irritation in the vaginal area. It may help to avoid perfumed soaps or bath products. You can also try to relieve the symptoms with vaginal moisturisers and lubricants.

Vaginal lubricants tend to be shorter acting than moisturisers and are either water- or oil-based. Water-based lubricants include:

• KY jelly
• Yes (water-based)
• Astroglide
• Pasante TLC Lube or Sylk.

Oil-based lubricants such as Yes (oil-based) and baby oil are longer lasting and give additional protection to the vagina if it is dry or sensitive. Lubricants are usually intended to help sexual intercourse but can also help relieve vaginal discomfort and dryness generally.

Vaginal moisturisers such as ReplensMD or Senselle (available from chemists and on prescription) stick to the vagina wall and help to keep the cells moist. They can be used every few days but need to be applied regularly over time for best effect.

If you are having intercourse and use a condom for protection, water-based lubricants are safe to use with latex condoms but oil-based lubricants are not as they can degrade the latex, making the condom ineffective. Lubricants don’t generally cause vaginal irritation.

Which one you prefer is an individual matter and you may need to try a few before finding one that you like.

Some women find that spermicidal gel, or even natural yogurt, can help make intercourse more comfortable. If you can get past the initial dryness, then intercourse itself helps to stimulate the blood flow to the vagina, helping to maintain its suppleness and elasticity. Practising pelvic floor exercises can also help to increase blood flow and strengthen the muscles in that area.

Vaginal dryness and irritation can also be caused by infection, so it is best to visit your GP if you are experiencing problems so they can rule this out.

Content last reviewed May 2012; next planned review 2013