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Sexual problems have been linked to mastectomy and lumpectomy
-- surgeries that remove all or part of the breast. Losing a breast can
be very distressing. A few women even lose both breasts if there is a
need for a preventive mastectomy, or if a woman has a second tumor
later on.
The most common sexual side effect from these procedures is
feeling less attractive. In our culture, breasts are often viewed as a
basic part of beauty and womanhood. If a breast is removed, a woman may
feel less secure about whether her partner will accept her and still
find her sexually pleasing.
The breasts and nipples are also sources of sexual pleasure
for many women and their partners. Touching the breasts is a common
part of foreplay. Some women can reach orgasm just from having their
breasts stroked. For many others, breast stroking adds to sexual
excitement.
Surgery for breast cancer can interfere with pleasure from
breast caressing. After a mastectomy, the whole breast is gone. Some
women still enjoy being stroked around the area of the healed scar.
Others dislike being touched there and may no longer even enjoy having
the remaining breast and nipple touched.
Some women who have had a mastectomy feel self-conscious being
the partner on top during sex. This position makes it easy to notice
that the breast is missing. Some women who have had mastectomies wear a
short nightgown or camisole, or even just a bra, with the prosthesis
inside during sexual activity. Breast prostheses are becoming more and
more natural-looking, and one type actually glues onto the body. Other
women find the breast prosthesis awkward or in the way during sex.
A few women have long-term pain in their chests and shoulders
after radical mastectomy. (This type of surgery removes the breast and
the chest muscles under it.) It may help to support the chest and
shoulder with pillows during sex. It may also help if you avoid
positions where weight rests on the chest or arm.
If surgery removed only the tumor (segmental mastectomy or
lumpectomy) and was followed by radiation treatment, the breast may be
scarred. It also may be different in shape, feel, or size. While the
woman is getting radiation, the skin may become red and swollen. The
breast also may be a little tender. But breast and nipple feeling
should mostly be normal.
There is no physical reason breast surgery or radiation to the
breasts should decrease a woman's sexual desire. It does not change her
ability to have sexual pleasure. It does not lessen her ability to
produce vaginal lubrication, to feel and enjoy normal genital
sensation, or to reach orgasm. If a woman is past menopause and has
been taking estrogen replacement therapy when breast cancer is found,
her doctor may advise her to stop taking the hormones. Lower hormone
levels may then cause the lining of the vagina to be thin, tight, or
dry. These symptoms may be helped by water-based lubricants or a
vaginal moisturizer. If not, a doctor can often prescribe a hormone
cream for these problems. (See our document Menopausal Hormone
Replacement Therapy and Cancer Risk for more
information.)
Breast reconstruction
After mastectomy the breast can be rebuilt so that it looks
very much like the other breast. Breast reconstruction may restore the
shape and size of the breast, but it cannot restore normal feeling
(sensation) in the breast. In a reconstructed (rebuilt) breast, the
feeling of pleasure from touching the breast and nipple may be
decreased or even absent. The nerve that supplies feeling to the nipple
runs through the deep breast tissue, and it may be cut during surgery.
As a result, the preserved or rebuilt nipple has much less sensation.
Sensitivity on the skin around the nipple may also be less intense,
although some feeling may return over time. With time, the skin on the
rebuilt breast gets more sensitive, but usually does not give the same
kind of pleasure as before mastectomy.
Breast reconstruction can help a woman enjoy sex more because
of the boost it gives to her feelings of wholeness and attractiveness,
even though it may not fully restore the physical feelings of pleasure
she used to feel from having her breast touched. To learn more, you may
want to read Breast Reconstruction After
Mastectomy.
The table below is a summary of how some of the common cancer
treatments can affect sexuality and fertility.
Female Sexual Problems Caused by Cancer
Treatment
|
Treatment
|
Low Sexual
|
Less Vaginal Moisture
|
Reduced Vaginal
|
Painful Intercourse
|
Trouble Reaching Orgasm
|
Infertility
|
| Chemotherapy
|
Sometimes
|
Often
|
Sometimes
|
Often
|
Rarely
|
Often
|
|
Pelvic radiation therapy
|
Rarely
|
Often
|
Often
|
Often
|
Rarely
|
Often
|
|
Radical hysterectomy
|
Rarely
|
Often*
|
Often
|
Rarely
|
Rarely
|
Always
|
|
Radical cystectomy
|
Rarely
|
Often*
|
Always
|
Sometimes
|
Sometimes
|
Always
|
|
Abdominoperineal (AP) resection
|
Rarely
|
Often*
|
Sometimes
|
Sometimes
|
Rarely
|
Sometimes*
|
|
Total pelvic exenteration with
vaginal reconstruction
|
Sometimes
|
Always
|
Sometimes
|
Sometimes
|
Sometimes
|
Always
|
|
Radical vulvectomy
|
Rarely
|
Never
|
Sometimes
|
Often
|
Sometimes
|
Never
|
|
Conization of the cervix
|
Never
|
Never
|
Never
|
Rarely
|
Never
|
Rarely
|
|
Oophorectomy (removal of one tube
& ovary)
|
Rarely
|
Never*
|
Never*
|
Rarely
|
Never
|
Rarely
|
|
Oophorectomy (removal of both tubes
& ovaries)
|
Rarely
|
Often*
|
Sometimes*
|
Sometimes*
|
Rarely
|
Always
|
|
Mastectomy or radiation to the
breast
|
Rarely
|
Never
|
Never
|
Never
|
Rarely
|
Never
|
|
Tamoxifen therapy for breast or
uterine cancer
|
Sometimes
|
Often
|
Sometimes
|
Sometimes
|
Rarely
|
Always
|
|
Aromatase
inhibitor therapy for breast cancer
|
Sometimes
|
Often
|
Sometimes
|
Sometimes
|
Rarely
|
N/A (only given to women after
menopause)
|
|
Androgen therapy
|
Never
|
Never
|
Never
|
Never
|
Never
|
Uncertain
|
*Vaginal
dryness and size changes should not occur if you have
one
working ovary left or if hormone replacement therapy is given.
Last Medical Review: 11/10/2008
Last Revised: 11/10/2008
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