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Becoming Sexually Active after Breast Cancer

By Becky Zuckweiler, MS, RN

Resuming your sexual activity after breast cancer surgery can make you feel quite vulnerable and uncertain about how to proceed. I was first faced with this situation at age 30 when I had a preventive bilateral mastectomy with immediate silicone implant reconstruction and a second time when I was 43, and I had ruptured implants removed with no reconstruction. The first time was emotionally challenging and it did not seem to make the second time any easier, but my husband and I got through it together.

The first challenge you may face as you start to resume your sexual relationship is letting your partner see your bare chest for the first time. My husband saw my chest even before I did because he had to change my dressings and drain my drainage tubes the evening of my surgery. Neither of us was ready to think about how I looked, let alone talk about it.

I was in shock and totally removed from myself, and my husband was completely focused on my needs and was not ready to look at his own reaction to the changes in my body. So, although Jim had seen what my chest looked like, we still had not really considered my chest as it related to our lovemaking. We did not even get close to dealing with how my surgery would affect our sex life until my drainage tubes were out and my chest had healed enough to tolerate a fair amount of touch. It was very important to me to have my husband initiate sex again. I needed him to ask if we could make love. Normally, we both felt comfortable initiating sex, but that first time after surgery I felt far too vulnerable. We made love for the first time a couple of weeks after my surgery. His initiation reassured me that he did not find me disgustingly ugly and that we could still be sexual together. I couldn’t have cared less how good or bad the sex was that night; all I needed to know was that it would still be part of our lives. It was a while later that we faced looking at my chest as part of our sexual experience. One night, while making love, Jim stopped what we were doing and sat me up facing him, and took off my top. He looked directly at my chest and just held me as I cried. Neither of us spoke a word. Our actions and the loving, acceptance that filled the room said it better than any words could have. This is one area in which no one can write a script for you. We all have our own ways of feeling sexy and desirable, and have our own levels of comfort with regard to initiating sex and revealing our body. You need to trust that the love between you and your partner will pave the way for both of you to accept how your body looks and be able to return to pleasurable lovemaking. My advice is, don't wait too long. The anticipation of the first time may cause you to become overly anxious.

Tact is a very important part of building and preserving good interpersonal relationships. We all know that sometimes concealing our thoughts and feelings or telling little white lies is the kindest way to go. But if we take it to an extreme and use tact to avoid sharing our feelings, we are merely avoiding having to deal with emotionally difficult issues. The strength of your relationship, your communication skills as a couple, and your partner's ability to use tact are all going to influence how much you want to open up this issue. I personally appreciate some sense of protectiveness from my husband, but do not want him to be overly careful with me about potentially hurtful realities because I think it limits our relationship by putting tight, unspoken rules into play that can create tension or, at least, guardedness. This guardedness can lead to less emotional connection and leave both of you feeling less loved and understood. The first time I tried to wear a sexy evening dress after my surgery, my husband said I looked nice. A year later when I was trying to select a dress to wear to my husband’s company Christmas party, he confessed that he thought my evening dress was inappropriate for me after my surgery. He told me that he hadn't wanted to hurt my feelings or discourage me when I first bought it, because he knew it was my attempt to overcome my surgery. I needed his frankness. I was not angry with him for not telling me right away, though, because I knew he loved me and was just trying to support me and help me adjust to all the changes.

Whether you have lost one or both breasts, after surgery there are some changes to your body that will have to be compensated for sexually. A woman’s nipples and breast skin have a lot of sexual nerve endings. The nipples are set up neurologically so that when they are stimulated they send sexual pleasure sensations to the genitals. When the breast is removed, this powerful sexual source no longer exists. This can be experienced as a great loss to the woman for her own pleasure, as well as her partner's. Some women lose not only sexual sensation in the breast area, but are also left with skin pain that makes the area very uncomfortable to touch. The nerve endings in the breast and surrounding area may feel raw. This painful sensation tends to decrease gradually over many years, but it can come and go from day to day. This pain makes it very difficult for your partner to know whether or not to involve your chest during lovemaking. You are not able to provide one simple rule about what is or is not comfortable and pleasurable because it can change constantly.

This is another reason that open communication is so important. You need to be able to talk about the changes in your body's sensations. Accepting pain rather than discussing the matter can lead to a whole new set of problems. Sex is supposed to be a time when you share bodily pleasures, not a time to endure misery. If you try to disguise pain instead of telling your partner what you need, you will find yourself stiffening your body as a way to brace against anticipated pain. Stiffening your body is exactly the opposite of what you should be doing to achieve full sexual pleasure. You need to be able to relax and give your body over to the sensations, instead of controlling what is happening with your mind. When we use our mind too much during sex we complicate the experience and cheat ourselves and our partners.

If you find that you have lost sexual sensation and/or have a painful sensation in your chest area, ask yourself what other things you and your partner can do to make up for the lost chest pleasure. Your lips are also an erotic part of your body that have a neurological connection to your genitals just as your nipples did, but the connection is usually not as intense. Pay attention to your body and it will tell you what it likes. This is an important time to explore your senses and discover how they can enhance your lovemaking. Your senses of taste, touch, sight, smell and hearing can all add to your sexual pleasure. Good wine, warm baths, soft materials, romantic movies, incense, perfume and music are all examples of how we can open our senses to increase our enjoyment of sex. Sexual passion is a natural, normal way to express our love and desire to be closely connected to our partner. This may be one of the most emotionally difficult aspects of your recovery, but over time you and your partner will be perfectly in-sync just as you were before your surgery.