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Sexuality and Breast Cancer

By Julie Auton

I grimaced at my reflection in the bathroom mirror at my workplace.

"What's wrong?" my coworker, Sylvia, asked.

"I look awful," I confided. "My eyebrows fell out because of chemotherapy, and I can't draw them in correctly. It looks ridiculous.

She regarded me with a reproachful look and said, "Be thankful you're alive! Who cares about your eyebrows?"

Well, I did, for one. But, of course, I knew Sylvia wouldn't understand because she was not battling cancer and still had her eyebrows. Frankly, I wanted to suggest she shave off her eyebrows to see if it would bother her. But I kept my mouth shut.

Of course, she was right -- I was grateful to be alive -- but the reality was that there were days -- many days -- in which I felt like a freak of nature, which chemo can produce. Cancer treatment attacks every physical aspect of what it means to be a woman -- the loss of breasts; the loss of hair, eyebrows and eyelashes; the loss of vibrant skin color; and the loss of a menstrual cycle. When you're stripped of everything that defines femininity, it's hard not to feel down now and then.

It was depressing, watching the world around me of young, healthy women who were full of life, with rosy cheeks, long glossy hair and thick eyebrows compared to my pale skin, bald head and hairless face. Adding to that, I was newly married and had to show up at an office every day, so I wanted to look my best.

Although I eventually got back on a more even keel emotionally and didn't obsess quite as much about my eyebrows, I thought about the disconnect between cancer patients and the outside world. Like every experience in life, unless you live through it, you can't fully understand all the nuances of a situation. Sylvia shamed me for being shallow, not realizing that I was experiencing a deep loss for my life before cancer.

Cancer patients have to grieve

Betty Castellani, director of the Cancer Center at DeKalb Medical Center in Atlanta, supported my feelings.

"Cancer patients have to grieve," she says, "because life is never the same after diagnosis. After treatment, you can return to the same life as before -- or even create a better one -- but grieving is essential.

"When a life-threatening situation like cancer erupts, it presents for someone the first time they have to face their mortality. Most people start in denial mode and want to run away from this horrible thing that’s after them. Consequently, they need to be able to talk about their fears and the impact of the disease on their life. That requires a lot of talking about it, things they need to discuss over a period of time."

Castellani continues, "People who love you may not be able to send the right message, but rather, often dismiss how you feel. Even among many professionals, there's an inability to understand or willing to take time to deal with the emotional side-effects of cancer. That's why patients need support groups or therapists or ministers.

"However," she warns, "not all support groups and counselors are a good fit. If it's making you sad or frustrated or anxious, or it's not effective, select another group that will enhance your life."

Obviously, the loss of femininity, beauty and sexuality that result from chemo can present complex problems for women of any age, but it's particularly challenging for young women for several reasons -- society's emphasis on youth and beauty, the risk of being unable to bear children in the future, the fear of not being "marriage material," and the difficulty of sex when a woman is in her peak sexual years.

"I've known women to experience major rejection when their husband moved to another bedroom because they saw their wife as 'damaged,' " says Castellani. "And even if a husband is supportive, cancer treatments make women feel unattractive as well as cause them to physically feel badly. For some, everything about sex seems to be gone. Because women patients are taken off estrogen, an active sex life can diminish because you are no longer interested or it’s physically painful. It can be tough on a marriage -- you don’t feel sexy; in fact, everything about you that felt sexy is altered. Patients look in a mirror and face a daily reminder that they're not a whole person anymore." But sexuality and breast cancer don't have to be polar opposites.

Castellani recommends taking steps to get back on track. If sex is painful, use estrogen cream or other products to combat dryness, for example. If a patient wants to avoid sex altogether, she needs to talk with her husband, which, Castellani says, could take a couple to a better place by learning how to communicate for the first time.

For single women, there's the concern that no one will ever love them because they are "damaged goods," Castellani says. "Some young women even question taking chemo in case they won't be able to bear children after treatment."

Realize you're valuable

On top of these major concerns, "society pressures women to look perfect -- to get a boob job, be bone thin and grow long hair," she points out. "Women need to have more respect for themselves, to realize they are valuable, unique and stronger than they thought.” The good news, Castellani says, is the breast cancer movement has progressed over the years. "Women in general have emerged from being afraid to talk about cancer -- as if it was something to be ashamed of -- and instead are saying, 'If I survive this, it will be the best thing that ever happen to me.' "

Much of the change from victim to empowered survivor mentality is because of the increased awareness of the disease from the media, breast cancer walks and other fund-raisers, and organizations such as the Susan G. Komen Foundation. "Instead of being ashamed of having breast cancer, many survivors are proud they survived and continue the activism to fight for other women," she says.

"Survival is not how many years you have to live -- but a decision about what you're going to do with your life," says Castellani. "It's seeing life changes and choices as positive, not negative.

"In fact, why would you want to go through a life-altering experience like this, and then want to resume your normal life instead of making it better? This is your chance to make improvements and learn from this.

"It’s been said that pain is fertilizer for the soul because it grows positive things," she adds. "This is your chance to rethink how you view life. Patients have learned they can be a loving person -- rather than seeing themselves as a damaged one -- and others will respond positively."

"We have three choices when we face a crisis," she explains. "We can become transfixed -- in which our plight is on our minds all the time and it monopolizes our lives; we can transfer our problem and blame everyone else and become bitter and angry; or we can be transformed and become the best we can be.

"The cancer support group I lead talks about life," she says. "Life can go on – good things can still happen – we teach that. Taking control and not letting someone else control your life. Learning to say no. Seeing cancer as life changing and life transforming. Hearing the positive stories that life goes on and you can be happier than you ever dreamed possible.

"Most of all, I teach women how to be empowered and not be a victim. Women are often passive and not in control of their lives. They need to express how they feel, and that it's okay to say no, and to take time for themselves, and pursue their own interests. As a result, they can become a more interesting person, which will have an impact on their relationships. To sum it up, you have to be willing to use the bad experience to take you to a better place -- not just live through it.

"Living positively is so much about your attitude. When you feel better about yourself, you tend to take yourself less seriously," she says. "But, you can't do this overnight. You can't jump in and say cancer is not a big deal at first -- you need friends to walk beside you. It's an individual journey.”

The Feminine Mystique Revealed

When my friend, Kathy, was diagnosed with breast cancer, she quickly lined up her medical treatment. Right after that, she put into place another plan of action -- taking care of her appearance. Although this may seem like a shallow concern in the face of a life and death situation, women enduring cancer treatment suffer side-effects that, for the most part, strip away everything our culture defines as feminine and beautiful.

Maintaining a "normal" appearance can be challenging enough after a mastectomy or hair loss. Add to that the harsher consequences of surgery, chemo and radiation therapy -- such as pain, scars, infections, nausea and skin disorders, to name a few -- and minimizing the side-effects can seem overwhelming.

The standard advice from healthcare professionals to combat physical complications is to maintain a healthy lifestyle -- with proper nutrition, regular exercise, plenty of fluids and frequent rest. That said, many breast cancer patients seek additional ways to look attractive, stylish and, if they're in the workplace, professional.

Kathy, who works in the fashion industry, tapped into her personal network and found a hair stylist who shapes hairpieces for actors, to style her wigs. For makeup, she located a permanent makeup artist who filled in eyebrows and eyeliner. And to combat pale skin, she used a self-tanner on her face and body.

Simple ideas like these are often shared among women in support groups and other networks. Many hospitals, as well, offer programs to teach women how make the most of their appearance during treatment.

For example, DeKalb Medical Center in metropolitan Atlanta, offers "Look Good, Feel Better," a free program designed by the American Cancer Society, which teaches women about wigs, makeup and other fashion tips.

Each participant receives a kit -- packaged specifically to complement their skin tone and skin type -- of makeup and skincare products, donated by major cosmetic companies. A professional makeup artist teaches how to apply makeup to overcome pale skin and missing eyelashes and eyebrows, while a professional hairdresser consults individuals on coloring, highlighting and styling wigs. The program also reviews ways to wear scarves and hats, and even turning T-shirts into turbans.

"Women enter the program feeling poorly about themselves, and then leave in a better place emotionally because they've learned how to make themselves presentable," says Claudia Tinkle, DeKalb's program coordinator. "Attitude plays such an important role in how a woman feels physically. If she feels good about her appearance, she has a more positive outlook about getting through the day instead of staying home and hiding. We encourage patients to go on with life as undisturbed as possible."

Although the program is offered to women of any age, Tinkle says most patients are young since that's a critical time when there's a greater emphasis on appearance.

"Younger women are more likely to be in the workforce and want to look professional, or they have small children and don't want to upset them by looking sick. Others are single and still want to feel attractive to men."

Programs like these -- some Nordstrom locations offer a similar program called Chemoflage -- can be a foundation upon which to build renewed self-esteem and confidence. And as any woman knows, when you feel good, you look better. Recreating femininity, beauty and yes, even sexuality are all within your reach.