Working to regain sexual urge after breast cancer treatment
For many women, a diagnosis of breast cancer spells doom to their sex-life. Agnes Kyotalengerire explores how survivors can keep their intimacy fire with their partner burning
Joseline Bonabana, a breast cancer survivor and a mother of three, says her sex life changed from the time she was diagnosed with breast cancer. “I had heard stories of women who had been diagnosed with breast cancer and had their breasts cut off to save their lives, but ended up dying,” says Bonabana.
“This made me live in fear of dying the next day. I lost appetite and interest in sex. Even after six years of treatment, the desire to have sex was minimal. Every time I tried to have sex, it was painful,” Bonabana recalls.
Margaret Okello, another breast cancer survivor, read the diagnosis slip several times thinking the pathologist had made a mistake. “I walked back to his office and asked him again whether the results were really mine for I had never thought I could suffer from such a deadly condition,” Okello recounts.
Bonabana and Okello’s stories echo those from any other breast cancer patients about the fear and pain that come with being diagnosed with breast cancer and the effects of chemotherapy, with loss of libido high on the list.
Dr James Kafeero, a physician at the Uganda Cancer Institute of Mulago Hospital, says chemotherapy, one method of treating cancer is the most dreaded because of its side effects.
“Chemotherapy is the procedure of using drugs to destroy the fast-growing cancerous cells. In the process, other fast-growing cells in the body like hair, nails, sperms and ovaries get destroyed,” he explains. The side effects include wounds in the mouth, hair loss, and darkening of the nails and the skin.
Dr. Fred Okuku, another physician at the cancer institute, says chemotherapy reduces the hormones produced by the ovaries, especially oestrogen. “This causes lower sex drive and vaginal dryness. It also interferes with the menstrual cycle leading to early menopause,” he explains.
Dr. Okuku adds other side effects of chemotherapy include: weakness, depression, tiredness, change in hormone levels and lack of energy, irritability and sleep disturbances.
Coming to terms
Margaret Okello, a breast cancer survivor, and volunteer counsellor at Cancer Aid Organisation, says the first step is acceptance.
“News of cancer diagnosis and fear of death can pull a woman down. Not to mention the effects of chemotherapy coupled with the challenges of family and work make sex fall to the bottom of the list,” says Okello.
The removal of the affected breast creates a sense of loss causing distress. “Breasts are feminine features and having one’s breasts cut off makes one see and feel unworthy before her husband,” says Janet Nankoma, a senior nursing officer at the cancer institute.
Nankoma advises the use artificial breasts. These come in different sizes and types like silicone gel, foam and fibre-fill. “Artificial breasts can enhance physical appearance,” she advises. She adds that it is necessary to get one with the right size as comfort is crucial.
The other devastating physical effects of chemotherapy may include: hair loss, and darkening of the skin and nails.
Nevertheless, Okello encourages breast cancer patients to take care of themselves and look attractive. “A woman cannot enjoy sex if she is not comfortable. Grooming makes the patient feel good and boosts her self-esteem.
If one loses hair or her nails darken, Okello advises use of wigs or head scarfs and nail polish to disguise the pigmentation.
Though many patients experience loss of interest in sex, Martin Senyonga, a relationship counsellor, says loss of libido is not the end of sex life and that sex is not about intercourse. “You can enjoy intimacy through holding, cuddling, kissing and spending quality time together,” Senyonga says.
Another important step is to focus the mind to think sexually. “A woman’s biggest sexual organ is her brain,” says Dr. Paul Othieno, an oncologist. “If you can get your mind thinking about it, the rest of the process will be smoother.”
Dr. Othieno says a patient may need to re-evaluate what pleases her sexually. “A patient who has had breast surgery may have lost sensitivity in the breasts. It is also possible that types of sexual contact that she enjoyed before cancer may no longer be pleasurable.
But still, Dr Othieno says breast cancer survivors can reach orgasm; all they have to do is talk to their partners about their desire for intimacy and for specific types of sexual contact.
Communication about what feels good and what doesn’t is crucial. Whatever the concerns about intimacy, overcoming them requires open communication with your partner, says Senyonga.
Dr. Othieno says one of the biggest passion-killers is painful intercourse. A common source of pain during sex is vaginal dryness. However, he says women need to learn to ensure that sex is not painful by use of vaginal lubricants.
“Vaginal dryness can be treated with water soluble-lubricants. Do not use non-water soluble lubricants such as Vaseline because it can weaken latex (material used to make condoms) and also provide a medium for bacterial growth, particularly in a person whose immune system has been weakened by chemotherapy.
Okello says often breast cancer patients become withdrawn. As a result, her partner is sometimes afraid to approach her because he does not want to hurt her. However, not approaching her may make her feel rejected.
She says through counselling the couple is encouraged to accept the situation. “We encourage women to have sexual intercourse whenever they feel the urge. Besides, husbands are discouraged from pressuring their partners but instead to give them time for arousal in order to avoid painful sex.
Dr. Okuku warns breast cancer patients against having sexual intercourse if their white blood count is dangerously low as doing so increases chances of infection.
When to break the news
A single woman may find it challenging to tell her new partner that she has or had cancer. Bringing up the topic in the heat of passion is not the best option. Instead, Margaret Okello, a volunteer counsellor at Cancer Aid Organisation suggests introducing the subject, for example, while you are talking about health-related issues.
Making the effort to maintain intimate relationships after cancer can contribute greatly to the quality of life. “Aspects of sexual intercourse may change after cancer but intimacy is still highly valuable,” she says.
Okello says an intimate sexual relationship is an important part of feeling alive and whole. “It is something special with one person. If you lose that special relationship, it is a huge loss. “So do not let cancer take that away from you,” advises Okello.