Body image & sexuality

Dealing with possible treatment side effects like hair loss, vaginal dryness, little or no libido and fatigue can prove challenging. It may take time to process and accept what is happening to you and how it impacts on your relationship.

Sexual health is an important part of your overall physical health so don’t be afraid to discuss with your medical team how your treatments are affecting your sex life. Intimacy with your partner is an important part of your recovery and a way for him or her to be there for and with you. Things may not be quite as dynamic as they were, but ‘this too shall pass’ and maintaining a good sex life is possible during treatment and recovery.

Breast cancer is hard on the body – physically, emotionally and spiritually. It’s normal to feel ‘changed’, to lack confidence in your body and how you look.

Some women say they feel ‘less feminine’ because treatments have side effects: surgery has removed part or all of your breast(s), chemotherapy has caused some major changes (e.g. hair loss, fatigue, poor appetite or lowered sex drive), radiotherapy has caused changes too (e.g. fatigue and skin sensitivity) and hormonal treatments may have caused hot flushes, joint aches/pains or fatigue.

If you’re struggling with self-image and confidence during or following treatment for breast cancer, seeing a counsellor for a few sessions may help.

We fund three free counselling sessions for anyone who's had a breast cancer diagnosis.

Call 0800 BC NURSE to get set up.

You could lose some or all of your hair as a side effect of chemotherapy treatments. Your oncologist will be able to give you more information about whether this will happen to you.

After starting chemotherapy, your hair won’t fall out all at once. You'll probably lose some gradually at first, and then more rapidly over the next few weeks. There is a government subsidy for wigs/hairpieces/headwear – your breast care nurse or oncology nurse can provide details. If you'd like a wig, local suppliers can help you choose one that's close to your hair colour and style – or help you find something that looks totally new.

You may find that you’ll feel cold, even in summer, so having a beanie for day and night-time use is a good idea.

The good news is that your hair will start growing again even before you finish treatment. It will return initially as very fine, baby-fluff hair, and then grow out. Most women find their hair comes back in a slightly different colour, and is often ‘wiry’ (some call this 'chemo curls') for some time until your natural hair texture returns.

Cancer treatments can cause changes which impact sexual function and intimacy. If you're going through treatment-induced menopause, you might find your sexual desire reduced, and you might notice vaginal dryness/discomfort during intercourse. Other symptoms could be less intense/frequent orgasm, decreased urinary control, altered skin sensation, decreased shoulder/chest mobility and fatigue.

It's normal to also experience some emotional changes, like poor self-image, irritability, depression/moodiness, and disruption of your usual sexual patterns or habits. These changes can create barriers in a relationship, like helplessness and frustration, embarrassment, misinformation and misunderstanding.

It's important that you communicate with your partner during this stage of treatment. If you’re in a sexual relationship – or thinking about one – there’s no reason why your diagnosis should make you stop. However, with all the changes your body is going through, your sexual motivation may be different than it used to be.

Try and talk with your partner about what you both want and how to keep your intimacy going. Maybe intercourse isn’t for you right now, but there are other ways of being intimate with each other. Talk, explore, break down the barriers… and don’t forget the role of humour and fun.

Here are a few tips:

• Try different positions – after surgery you might find your arm/chest area is sore for a while. You can also use cushions to ease discomfort
• Be an ‘active listener’ – discuss your needs and frustrations. Encourage your partner to tell you what they're going through, because they may be confused about sex, afraid of hurting you and need some guidance.
• Talk about your cancer and how it is affecting you physically. You can talk outside of the bedroom – visit a favourite place and discuss non-sexual aspects of your relationship too.
• If you're experiencing vaginal pain or discomfort during sex, see your GP to check that this is not due to an infection. You can use water-based or silicone-based lubricants to help overcome vaginal dryness but avoid oils (such as baby oil) as they can lead to vaginal inflammation. You may notice an increase in bladder infections after sex – see your GP if this happens for you. Ask for a referral to a gynaecologist if your physical issues are not improving.
• If you and your partner are unable to find a way forward sexually, a few sessions with a sex therapist could be really helpful. BCFNZ funds free counselling sessions, and you can choose a counsellor specialising in sex and intimacy issues.

Some women let potential partners know right away, that they have had breast cancer or are undergoing treatment. Others may prefer to wait until the time for intimacy is closer. Do whatever feels right for you. If the person backs away after hearing your news, then they probably aren’t the real deal. The right partner will be understanding about breast cancer – that person will not see your situation in a negative light.

If you’re finding it hard to broach the subject in a new relationship, seeing a professional counsellor can help. Your breast care nurse can provide advice too. You may wish to discuss the impact of your treatment on your sexuality with your medical team (even if you’re not in a relationship).