Behind Closed Doors
Expert advice on intimacy for female cancer survivors and their partners
Focused on Health - June 2009
By Rachel Winters
The difficult journey of a cancer survivor can inspire couples to celebrate life and live it to the fullest. For some couples, however, cancer treatment’s physical toll can interrupt this celebration of love and newfound vitality, especially when it comes to intimacy.
“The majority of the women I see say that their partners are very understanding throughout their treatment,” says Mary K. Hughes, R.N., C.N.S., a clinical nurse specialist in
M. D. Anderson’s Psychiatry Department. “However, some women who have completed their treatment, have trouble with intimacy and say that they would like to be more interested in sex.”
At some point in their life, nearly all women experience trouble with intimacy that can be attributed to a wide variety of issues, including having a negative body image. Intimacy issues after cancer treatment also are often due to body image issues caused by physical changes to the body - from surgery, chemotherapy or radiation, or by the effects of certain medicines.
In the information below, M. D. Anderson’s experts provide tips for cancer survivors, and others, who may want to be more comfortable in their own skin and more intimate with the person they love.
Maintaining a healthy relationship
Any couple’s ability to maintain a healthy relationship relies, in part, on their ability to interact, relate and be intimate as they make challenging and life-affirming transitions throughout life.
For the partner of a cancer patient, that means being an active part of their companion’s treatment.
“It is helpful if the partner can be there – go with the woman to her appointments and offer to drive her to chemotherapy,” Hughes says. “Being there is a crucial part of support. A woman is much more likely to feel confident and have a renewed interest in sex if she feels safe and supported. Partners also need to acknowledge that life is happening and that it’s hard,” Hughes says.
“It’s important for partners to continue reassuring and complimenting her because a woman initially might have a hard time believing that her partner finds her attractive,” says Leslie R. Schover, Ph.D., a professor in M. D. Anderson’s Department of Behavioral Science and a licensed clinical psychologist.
While a woman might not be physically well enough to be intimate during treatment, she still needs to hear, and believe, her partner’s supporting, loving words.
“If your partner tells you that you are beautiful and strong, they mean it,” Hughes says.
Women also should try their best to be open about what they are feeling and should not be afraid to speak their mind or feel guilty about saying what they need, or don’t need, emotionally or sexually.
Conquering body image together
Once a woman has been treated for cancer, she may develop a negative body image due to a missing breast, or because of scarring.
“Some cancer survivors have fear or insecurity about their bodies, which can inhibit them sexually,” Hughes says.
While some women are okay with letting their partner see their scars, others may want to hide them. Although it is natural to have a difficult time accepting a change to the body, it is extremely important that women not project their own negative feelings onto their partner.
“What the woman needs to remember is that she is usually more upset about the changes to her body than her partner is,” Schover says.
“I have talked to a lot of partners, and the truth is that they are just happy that the woman they love is alive,” Hughes says. “They are not concerned about a scar or an imperfect breast. A woman shouldn’t think that her partner isn’t comfortable with her new body – sometimes it’s the woman who is uncomfortable.”
An important first step for a woman to be comfortable with her body is to look in the mirror, observe her body as a whole, and then look at the breast, scar or imperfection.
“It’s very different looking at a scar or a breast from the vantage point of a mirror, the way someone else would see it,” Hughes says. “It often looks worse to the woman simply because she is looking down at it.”
Looking in the mirror and viewing your body as a powerful, beautiful object, however, can be a therapeutic activity for any woman. Looking at your stomach or thighs in the mirror and regarding them as strong, important parts of the body that support you and help to move you through life may offer a different perspective.
The difficult decision about reconstruction
Women who have undergone surgery as part of their cancer treatment might be offered a variety of options to reconstruct their breasts.
“It’s important for women and their partners to know that decisions about reconstruction can be delayed indefinitely,” Hughes says. “While the woman is in the process of considering reconstruction, it is best for her partner to leave this decision entirely up to her.”
A breast cancer patient may or may not choose to have breast reconstruction. If she does opt for reconstruction, she has to make the difficult decision between having implants, or using her own tissue, or a combination of the two.
“Partners shouldn’t give women advice about what type of reconstruction, if any, she should get,” Hughes says. “Even if the partner feels his mate might be more attractive if she had a D cup or an implant, they still shouldn’t say it. The best thing the partner can do is support the woman’s decision no matter what.”
Breast cancer survivor offers advice to women and their partners
Jenee Bobbora, 38, a married mother of one and advocacy worker for women with inflammatory breast cancer in Houston, had a double mastectomy in October 2003. Jenee chose not to have reconstructive surgery and has been without both breasts for more than five years.
“I’m not opposed to having reconstruction, and some days I do think I’ll do it, but for now I’m just so busy I haven’t gotten around to it,” Jenee says. “Not having breasts hasn’t affected my life that much.”
Although Jenee does wear prosthetic breasts in public, her double mastectomy has not interfered with her intimate relationship with her husband.
“I attribute a lot of my positive attitude to my husband’s support,” says Jenee. “He has made it a non-issue, and he’s never made me feel like it mattered. He’s just a really loving, kind-hearted guy.”
Jenee’s advice to other women who have had or will have mastectomies is to focus on the positive, and to learn to really appreciate life and what is important about it.
“I can’t say that I have no issues about not having breasts because of course I would prefer to have my natural body. But I can’t change my situation, so I have to make the best of it,” Jenee says. “Sometimes when I’m watching television with my husband and there’s a commercial on with a lot of breast exposure, I wonder what he’s thinking, but I really do believe that, like me, he’s grateful that I’m alive, and that we have each other.”
Bringing life back into the bedroom
Some women who have undergone chemotherapy experience sexual issues such as vaginal dryness, a loss of sensitivity in the clitoris, or a loss of libido.
“Chemotherapy can make some women feel less feminine or sexual,” Hughes says.
It isn’t just cancer patients, however, that experience these problems. Many women, for a variety of reasons ranging from menopause to medication, also may have physical intimacy issues.
“Without understanding how to avoid pain, many women lose interest in sex because it is traumatic and painful,” Schover says.
Partners of women who are experiencing a loss of libido due to side-effects of chemotherapy, or who are having libido issues for any reason, need to be understanding but also know that with time and work, the woman’s libido may improve. Partners need to trust the woman to communicate if something isn’t comfortable and to continue treating her body as they did before treatment.
“Partners shouldn’t be afraid to approach the woman sexually or express their desire,” Hughes says.
While loss of libido can be a difficult issue for cancer survivors to manage, open lines of communication and patience can make a hard transition much easier.
“Women who are having trouble with their level of desire need to look at making love like sitting down to a lovely meal without being particularly hungry,” Hughes says. “If you start to eat and really focus on enjoying it, it becomes a wonderful meal.”