Dr Azura Rozila Ahmad Consultant Medical Oncologist
If you were to ask then 35-year-old Linda Dackman what her biggest fears were, it is likely she would have answered “intimacy.” To the uninitiated observer, her reply did not hold water. Here was this young successful Californian museum public relations director who seemed like she had it all together. Surely, she was joking. But as she recounts in her book Up Front: Sex & the Post-Mastectomy Woman, her struggles with intimacy could not be any more real.
A year before she turned 35, Linda had undergone a mastectomy with the hopes of preventing her breast cancer from spreading to other parts of her body. Her initial experience as a “single-breasted woman” (as she puts it) left her frightened and insecure about her sexuality. She had the habit of immediately blurting out her medical history when meeting with potential suitors – causing things to turn painfully awkward. Once sexually active, she found herself clueless as to how to behave in intimate situations.
Like Linda, many women (both single and married) find intimacy after breast cancer to be an almost impossible feat. But is it really? Consultant Medical Oncologist Dr Azura Rozila Ahmad is quick to reject that notion. “No doubt undergoing cancer treatments can leave women with body image issues and this subsequently may put a huge strain on their relationships but a breast cancer diagnosis doesn’t have to spell the end to intimacy and sex,” she assures.
What maketh a woman?
Delving further into the subject of body image, Dr Azura says, “It is human nature to equate physical attributes such as long, luscious hair and breasts with femininity. So, when patients are left with hair loss, blisters, surgical scars, puffiness, a single breast or in some cases, no breasts at all, they feel as if they have lost the very characteristics which made them ‘woman’.”
Vaginal dryness and extreme fatigue are two other concerns. “Chemotherapy and radiation can do that to a person. You become so exhausted that all you want is to sleep. Also, medication can cause vaginal dryness. As a result, sexual intercourse can turn into an uncomfortable – and perhaps even, a painful – affair. All of these physical changes can deal a huge blow to a woman’s self-esteem because she now fears her partner will not find her appealing anymore.”
What thinketh a man?
Breast cancer patients may view their bodies differently than they did pre-treatment (and worry that their partners will do the same) but Dr Azura offers words of encouragement.
“You and your spouse have gone through a lot at this point. You have had to battle cancer and experience the harsh side effects of treatment while he has had to deal with the possibility of losing you. Post-treatment, you both may feel uncertain about getting intimate. The woman may be insecure and choose to wait for her partner to initiate sex. Meanwhile, the man may decide to wait for her sign of approval because he doesn’t want to pressure her into doing something he feels she might not be ready for,” she explains. “In other words, they are both waiting for the other to take the first step.”
And when they do get intimate, things can be awkward too. “Upon seeing his partner’s body for the first time post-treatment, the man might be surprised or even, puzzled because he doesn’t know what to expect or how to react. His facial expressions however can be misconstrued by the woman. She might think her worst fears have been confirmed – that he finds her repulsive and ugly. But this might not be the case.”
Dr Azura continues, “Women may also have trouble adjusting to differences in their body’s sensitivity post-treatment. Besides experiencing discomfort during penetration as a result of vaginal dryness, women – especially, those whose nipples or breasts were erogenous zones pre-treatment – may not be capable of achieving the same arousal in her breasts as she once did. This can lead to sexual frustration both for the woman and her partner – further straining their relationship.”
Intimacy is possible
Despite all the aforementioned difficulties, Dr Azura assures, “Cancer is undoubtedly challenging to any relationship but I have seen relationships emerge from cancer stronger and more intimate than ever. What matters is how couples handle it.” Here, she offers some suggestions.
“We’re in this together”
Dr Azura cannot emphasize more on the importance of patients involving their partners in their journey with breast cancer. “I always encourage a woman’s partner to be there for her from the beginning of treatment. Some choose not to accompany their wives or girlfriends to medical appointments; they may be having trouble accepting the diagnosis. But treatment will take months and months so it’s crucial for partners to offer their full support and be there for their loved ones all the way.”
Communication is something every couple must practice, even more so for those facing something as serious as cancer. She advises patients to be honest with their partners. “He might be waiting for you to broach the subject of cancer because he doesn’t want to hurt your feelings. So, talk to him. Tell him how you feel. It’s alright to be vulnerable.” Women should also not be hesitant to talk about sex with their partners. “Tell him how you want to be touched; what you like, what you don’t.”
For those who are single, she says, “Don’t be afraid to look for love. When you’re ready, tell him about your history with breast cancer. If he accepts you for who you are, you know you’ve found the one.”
In the bedroom, that is. “A woman’s body is bound to change post-treatment so why stick to the same sex routine? Whether it’s trying a new sexual position, sexy lingerie or vaginal lubricants, couples should be willing to try new things.” She has this tip for breast cancer patients, “Instead of focusing on the chest area where you still may have body image issues, you and your partner can explore other areas like the neck, ears or shoulders.”
Of wigs & reconstructive surgery
Post-treatment, some women might struggle with the drastic physical changes their bodies have gone through. In cases like these, she suggests, “Wigs, scarves and breast prosthesis might help restore their self-esteem. Although breast sensation cannot be restored via reconstructive surgery, your breast shape can be rebuilt. If you are interested in breast reconstruction, there are plastic surgeons who are more than capable of helping you.”
Intimacy is more than just sex
Lastly, both breast cancer patients and their partners need to realise that intimacy is much more than intercourse. Dr Azura concludes, “Intimacy doesn’t have to always end up in sex. Spending quality time together such as giving each other massages or taking long walks can also promote intimacy. So, don’t let breast cancer treatment stop you from rediscovering intimacy with your partner.”