Breast cancer can be devastating for a woman, threatening to destroy not only her life, but also alter the lives of those she loves. Treatment for breast cancer can be intensive when surgery, chemotherapy, radiation, and anti-hormonal therapy are involved, and the physical and psychosocial effects in the time following diagnosis and treatment can be profound.
A major area of concern for breast cancer patients is altered sexuality. Sexuality encompasses both physical and psychological aspects, including:
- Self-esteem
- Body image
- Emotions
- Physical appearance
- Ability to achieve sexual intimacy
- Level of sexual functioning
Unfortunately, patients are often reluctant to speak of their concerns, thinking it may seem trivial to their medical provider (Holmberg et al., 2001). As medical professionals, we often fail to explain the possible effects treatment will have on sexuality, perhaps skimming over the subject during initial diagnosis, but also infrequently addressing it in the months that follow (Wilmoth, 2001).
This lack of communication limits the ability to formulate standards of care for treating these symptoms properly.
Perhaps one of the most devastating consequences resulting from breast cancer is the alteration, or loss, of one or both breasts. It is an emotional and physical loss for many women, as their breasts have possibly represented a source of nourishment for their children, a source of pleasure for their partner, and the defining feature of both their femininity and sexuality. Not surprisingly, studies show that women who undergo lumpectomy or immediate reconstruction following mastectomy have less psychological distress compared to those requiring mastectomy who cannot immediately or ever have reconstruction (Al-Ghazal, Fallowfield, & Blamey (2000).
In addition to the physical ramifications from surgery, chemotherapy often causes alopecia, further stripping patients of their dignity and femininity. Weight gain, which is thought to result from a decrease in serum estradiol, depression, decreased metabolism, or decreased activity secondary to fatigue, can also negatively impact a woman’s sexuality.
Younger women with breast cancer run the risk of temporary or permanent ovarian failure as a result of adjuvant chemotherapy. Certain chemotherapy regimens can damage ovarian function by decreasing follicular production or causing the ovaries to become fibrotic (Chapman et al., 2005). Consequently, estrogen production decreases, and symptoms of menopause ensue. Common menopausal symptoms include decreased libido, vaginal dryness, and dyspareunia, which can lead to decreased sexual arousal, desire, and inability to achieve orgasm (Knobf, 2001).
One area greatly affected is intimate partner relationships. Interpersonal relationships play a vital role in a woman’s ability to cope with the physical and emotional distress of her disease. The degree to which a relationship thrives or breaks down can greatly impact a woman’s sexuality, both in the present and the future.
Many couples struggle to recognize and express what has happened to a woman’s body, existing sexual dysfunction and the frustrations it has caused, as well as the gift of health but also the real fear of recurrence (Ganz et al., 2003).
A two-part study conducted by Wimberly and colleagues (2005), found the less a woman perceived her partner as being affected by her scars, the more secure and attractive she felt. In the same way, the more emotionally involved the partner became, the less emotional distress the woman felt. Finally, and most interestingly, was the discovery that a woman’s level of “psychosexual adjustment” was largely determined from the first post-surgical sexual experience, with a more positive first encounter yielding a much better outcome for women in the long term.
The number of breast cancer survivors continues to increase. In a culture often void of frank discussion of sexual topics, yet one completely saturated with sexual imagery, we are left with a paradox to overcome. Because many patients are reluctant to speak about issues of an intimate or sexual nature, it's the responsibility of the healthcare team to broach the subject. Breast cancer survivors deserve the chance to live at the level of physical and emotional functioning they experienced prior to their diagnosis.
How is your team doing at addressing sexuality in your oncology setting? Is medical staff following up on this important subject once patients initiate or complete therapy?
References
- Al-Ghazal, S.K., Fallowfield, L., & Blamey, R.W. (2000). Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple
mastectomy and breast reconstruction. European Journal of Cancer, 36(1), 1938-43.
- Chapman, D.D., & Moore, S. (2005). Breast Cancer. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer nursing: principles and practice (pp. 1022-1088).
Sudbury, MA: Jones and Bartlett Publishers, Inc.
- Ganz, P.A., Greendale, G.A., Petersen, L. Kahn, B., & Bower, J.E. (2003). Breast cancer in younger women: reproductive and late health effects of treatment. Journal of
Clinical Oncology, 21(22), 4184-93.
- Holmberg, S.K., Scott, L.L., Alexy, W., & Fife, B.L. (2001). Relationship issues of
women with breast cancer. Cancer Nursing, 24(1), 53-60.
- Knobf, M.T. (2001). The menopausal symptom experience in young mid-life women
with breast cancer. Cancer Nursing, 24(3), 201-11.
- Wilmoth, M.C. (2001). The aftermath of breast cancer: an altered sexual self. Cancer Nursing, 24(4), 278-86.
- Wimberly, S.R., Carver, C.S., Laurenceau, J., Harris, S.D., and Antoni, M.H. (2005).
Perceived partner reactions to diagnosis and treatment of breast cancer: impact on
psychosocial and psychosexual adjustment. Journal of Consulting and Clinical
Psychology, 73(2), 300-311.
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