Many things are discussed with breast cancer patients at the point of diagnosis and deciding on a treatment plan, but one thing that often isn’t discussed is the impact on a patient’s sex life and body image, and the psychological and relationship issues that can fall out from that.

One breast cancer patient, Rebecca Angus, suffered sexual issues due to her breast cancer diagnosis and treatment, and below, explains what that was like, and the importance of speaking about it.

Everyone knows the journey from diagnosis, to treatment and recovery from cancer can be an incredibly stressful and traumatic period for a breast cancer patient. While wider conversations around the impact of breast cancer on mental health continue to grow, not as many people seem as comfortable to talk about how breast cancer affects a person’s sex life, their sexuality and relationships. 

When Rebecca started weaning her young son in May 2018, she just assumed the hard lump she found on her breast was scar tissue. Within a week, she had gone from a visit to her GP for an ultrasound to surgery to remove what was diagnosed as Stage 3 early advanced breast cancer.

Aged just 33 and with no genetic history of the disease, Rebecca thought she was too young to get breast cancer. Three years later, while the cancer has been removed, the recovery process continues to impact Rebecca’s life in countless ways, including the intimate relationship between her and husband.

While health professionals are open to discussions around mental health in relation to treatment, many breast cancer patients may not feel comfortable talking about sex and the impact breast cancer has on their sex life. This becomes particularly important for breast cancer patients once they experience hair loss and other sometimes dramatic bodily changes, sometimes including a mastectomy. It’s one thing to feel beautiful while living with cancer, but it’s another thing entirely to feel ‘sexy’.

As a trained podiatrist, Rebecca was keen to understand every stage of her diagnosis and treatment and spoke with each medical professional – including her surgeon, oncologists, nurses and GP – to make sure she made the right choice for her at every step. Building these relationships with her health practitioners, like her oncologist, had a direct positive impact on Rebecca’s quality of life. “If I went up to [my oncologist] and said, ‘Look, I’m not having a good day. I’m not myself right now.’ I know that she would get onto that pretty quickly,” Rebecca said.

In Rebecca’s experience, discussions around sex when it involves cancer patients is often only brought up for purely medical reasons. “Sex is explored at the beginning of chemotherapy education. However, it mainly focuses on fertility preservation, ovarian suppression and contraception during treatment,” Rebecca said. There seems to be a gap when it comes to discussing the health benefits of engaging in sexual activities, which could be crucial for anyone struggling with their mental health. Additionally, there is often very little discussion about the physical impacts on your sex life that breast cancer treatments can have. 

While at the start of her treatment Rebecca was just living one day to another, as she recovered, she continued to notice her increased fatigue brought on by treatment. Medical restrictions on how she could engage in sexual activity also dramatically affected her sex life . For instance, during chemotherapy, she could only engage in protected sex if she wanted to be intimate with her husband.

“You’ve got this cancer in your body that has tried to kill you, so you don’t have the best relationship with your body at that stage,” she remarked of her own feelings throughout the early treatment stage. “There are a lot of rules around when and how you can have sex as well. Your body for a while is not your own, it belongs to health professionals.”

As she continued treatment, on top of the fatigue, Rebecca also had a loss in sensation in one breast from surgery as well as scars, hair loss and weight gain, that left her feeling not as physically attractive as she was before her diagnosis. 

More obstacles appeared, from a full-body rash to vaginal dryness and low libido levels. Her hormone therapy even brought on menopause, which she wasn’t prepared for only being in her early thirties. “I had no idea what that meant except that I would get hot flashes and mood changes.” 

Rebecca soon realised that maintaining a good sexual relationship with her husband was not only necessary for their relationship overall, but for her quality of life. “You are very vulnerable during your treatment, and you need so much support and love,” she said.

While not everyone who goes through cancer treatment will have the same struggles with their sex life as she has, especially single people or people in same-sex relationships, who might have entirely different experiences, she maintains, “Having a good sex life within a relationship is so valuable for anyone with cancer.”

As for how she feels about sex three years into recovery? “It’s something that I want to work on with my husband. He understands how I feel and my insecurities about certain issues.” While sex without lubricant isn’t an option, sex or masturbation is crucial for her mental health, strengthens her relationship with her husband and maintains physical suppleness and elasticity.

While we still have a long way to go, now is better than never when it comes to allowing people to feel comfortable talking about how breast cancer affects their sex lives. Sharing experiences and tips or treatments can make things easier, especially when for many it is so closely connected to mental health. “I think it’s really important to normalise these conversations. You can get help from your psychologists, gynaecologists and oncologists – your specialists are there to help you,” Rebecca said.

The Breast Cancer Trials Q&A Event – Let’s Talk About Sex is free to register and takes place virtually on 30th September 2021 between 5-6.30PM AEST. The panel will be moderated by esteemed journalist Annabel Crabb and features Dr Belinda Kiely, Professor Fran Boyle, Professor Kate White and Ms Rebecca Angus. Please go to this link to register for the event: https://www.breastcancertrials.org.au/qa-registration

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