Sexuality for the Woman With Cancer

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Surgery for breast cancer can affect sexuality, too

Sexual problems have been linked to mastectomy and breast-conserving surgery (lumpectomy) – surgeries that remove all or part of the breast. Losing a breast can be very distressing. A few women even lose both breasts.

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 and there’s a loss of sensation. 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. Other women find the breast prosthesis awkward or in the way during sex.

Rarely, women may have long-term pain in their chests and shoulders after breast surgery. This is most often seen if the 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 (breast-conserving surgery: 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 tender or painful in some places. Later on, some women may have areas of numbness or decreased sensation near the surgical scar.

There’s no physical reason breast surgery or radiation to the breasts should decrease a woman’s sexual desire. These treatments do not change her ability to have sexual pleasure. They don’t lessen her ability to produce vaginal lubrication, feel and enjoy normal genital sensation, or 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 called Menopausal Hormone Replacement Therapy and Cancer Risk for more on this. Find out how to get it in the “To learn more” section.)

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 the previous feeling (sensation) in the breast. In a reconstructed (rebuilt) breast, the feeling of pleasure from touch on 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 might be cut during surgery. As a result, the preserved or rebuilt nipple has much less sensation. Sensitivity of the skin around the nipple may also be less intense, although some feeling may return over time. The skin on the rebuilt breast may get more sensitive with time, but usually does not give the same kind of pleasure as before mastectomy.

Breast reconstruction can help a woman enjoy sex more because it may help her feel whole and attractive. But it may not fully restore the physical feelings of pleasure she used to have from having her breast touched. To learn more, you may want to read our document called Breast Reconstruction After Mastectomy. (See the “To learn more” section for more information.)

Last Medical Review: 08/29/2013
Last Revised: 08/29/2013