Although the most serious and immediate effects of breast cancer are experienced by the woman herself, it is important to recognize that this is a disease that affects the entire family. The impact of breast cancer on sexuality is a major concern of both the woman and her partner. Dorothy Rodriguez eloquently summed this up in the book by Jory Graham, In the Company of Others: “Men and women do not leave their sexuality at home when they enter a hospital for cancer treatment any more than they leave their emotions at home. If anything, their needs for physical intimacy and human warmth increase.”
In the past, we have often tended to dismiss this aspect of cancer treatment as trivial compared to the more immediate concern of saving a life. The increased emphasis on the quality of survival, and not just survival per se, has helped change this. In our society, the breasts are so closely identified with femininity and sexuality that it is understandable that many women having a mastectomy suffer diminished self-esteem and worry about loss of sexual attractiveness. A British survey confirmed this; it found that half of all women who had had a mastectomy had subsequent sexual problems; the figure rose to 70 percent among women who had both a mastectomy and chemotherapy.
Very often the problems are due to a woman’s loss of self-esteem and misguided feelings of shame. Fearing that their partner will be repelled by their scar or other disfigurement, they will avoid sexual intimacy. After a while the partner will feel rejected and resentful. Communication breaks down, making the situation worse. Counseling may be needed to restore communication and dispel unnecessary fears.
Of course, cancer therapy may have a temporary debilitating effect on sexual responsiveness. Chemotherapy may cause nausea, vomiting, fatigue, loss of hair including genital hair, and sores in both the mouth and vagina. Radiation therapy may cause fatigue. Hormone therapy may cause vaginal dryness and hot flashes and other symptoms of menopause. Depression is common following any cancer treatment and this, too, can diminish interest in sex.
Yet another factor relates to persistent myths and misconceptions. A man may experience guilt feelings that his fondling of a breast somehow produced the cancer, and therefore will hesitate to touch the remaining one. Although there is no basis for such fears, they need to be faced and discussed. Some men also have the mistaken notion that a breast that has been treated with radiation therapy is somehow dangerous. Of course there is no residual radiation following treatments or removal of radioactive implants; reassurances may help overcome such needless fears.
The overwhelming majority of men 81 percent in a recent survey maintain that their feelings of love and sexual desire are not altered by a mastectomy. But there are men who, even though they want to support their partners in every way, find it difficult to adjust. They simply cannot control or hide the fact that they are repelled by the scar or altered body image. These feelings also should be recognized and discussed. Professional counseling may be advisable for such couples.
Of course, breast cancer also happens to unmarried women. Fears about establishing future relationships are common and, again, should be recognized and discussed. A doctor, a woman in a similar situation, or a professional therapist may be helpful.
The effects of breast cancer on other family members should not be overlooked. Children are concerned about what effect their mother’s illness will have on them and their family structure. They should be told about the nature of the illness and its treatment. Secrets and unanswered questions often provoke more concern than open, frank discussions. Adolescent children may be particularly affected. A daughter may be asked to assume a mother’s role just at a time when she is trying to declare her independence of the family. Adolescent girls also may develop an inordinate fear that they, too, will develop breast cancer. Honest and understandable information regarding risks and other facts about breast cancer can help dispel these fears.
The impact of a mother’s breast cancer on an adolescent son is often neglected, but studies have found that, as a group, they have the most problems in dealing with the situation. Aloofness, behavior changes including delinquency or alcohol and drug abuse, are common signs of trouble. In such instances frank, open discussions between father and son are advised since most boys are more comfortable talking about intimate topics with males than with their mothers.