Topic: Sex and intimacy after breast cancer

Relevance: Medium-High

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What is this topic about?

The information presented in this review comes from two research studies that looked at issues related to sex and intimacy after a breast cancer diagnosis. One looked at the concerns and information needs of couples when one partner was living with metastatic breast cancer, and how they coped. This study found that sex and intimate relationships changed in unique ways after a diagnosis of metastatic breast cancer.

The other study looked at how breast cancer survivors, their partners and oncology providers included partners in discussions about cancer-related sexual side effects. This study found that partners were not likely to be included when talking about cancer-related sexual side effects, even though survivors, partners and providers all agreed there was value in talking about sexual side effects with the couple together.

Although both studies focused on breast cancer, many of the issues are relevant for people diagnosed with other types of cancer.

Why is this topic important?

As people live longer after a cancer diagnosis, quality-of-life issues such as sexual health become more important. Enjoying sex and intimacy is often disrupted during cancer treatment. Research has shown that sex is a priority for people diagnosed with breast cancer. Most people, including those living with metastatic breast cancer (MBC), report significant sexual concerns. They wish to maintain their intimate relationships and would like support in coping with treatment-related sexual side effects.

Cancer can impact sex and intimacy

Some people with cancer have little or no change in their sexual or intimate experiences. For others, changes can range from annoying  to severe and include physical, emotional and/or psychological effects. These effects can be more significant for those undergoing more intensive treatment such as chemotherapy or those diagnosed with later-stage disease. 

Study highlights

Most breast cancer patients would like their partners to be included when talking with their healthcare providers about sex and intimacy
Existing guidelines offer little, and often different information on whether and how to include partners when talking about sex and intimacy after a breast cancer diagnosis. Research shows that less than half of people with breast cancer were told about possible sexual issues and changes related to their diagnosis.

• Most breast cancer patients (60%) agreed that having their partner present when talking about sex and intimacy was important during healthcare visits. However, they reported that providers did not ask them if they wanted to include their partners.
  • Of those whose partners did not participate in conversations about sex and intimacy, most (71%) agreed it would have been better if they had.
• Partners of those with breast cancer largely agreed they would be willing to talk with healthcare providers about sex and intimacy issues. Similarly, providers said that inclusion should be the patient’s choice.
• Most healthcare providers (75%) agreed that having the patient’s partner present would be helpful.
  • However, providers also noted some barriers to talking about sex: some patients don’t want their partners to participate, some don’t bring partners to their appointments and some felt that their partners' presence shifted the focus away from the patient/survivor.

Sex and intimacy for metastatic breast cancer survivors
This study was done to better understand how metastatic breast cancer affects sex and intimacy.  The researchers looked at changes in sexual activity, methods of coping and information needs by asking people living with MBC and their partners about their experiences. 

Researchers found that:

• more advanced disease and more treatment increased long-term sexual challenges, including loss of interest, vaginal dryness or discomfort, inability to climax and emotional distress.
• people living with MBC needed information on how to cope with the emotional and physical aspects of sexual side effects.

Couples who most enjoyed intimacy tended to approach, rather than avoid intimacy by:

• being flexible in how they had sex or experienced intimacy.
• working together to improve intimacy. At times, this included choosing types of sexual activity other than intercourse.

The researchers pointed out that a partner’s willingness to discuss these difficult issues and find ways to improve or resolve them is important; their level of participation and willingness may affect a patient’s  sexual health. Ideally, you can discuss your concerns and together find solutions that are best for you. Researchers also noted that if your partner is not interested in talking about your sexual concerns, you are less likely to share your need for help with your healthcare providers.

What does this mean for me?

A breast cancer diagnosis and treatment can affect the sex lives of breast cancer patients and their partners. While physical, emotional and psychological challenges to sex and intimacy are common, sex and intimacy can be satisfying after a breast cancer diagnosis. Those who are told about potential sexual changes, offered solutions and referred to a specialist or given helpful information are more likely to weather these changes well.

Consider having your partner join you in discussions with your doctor about sexual side effects and how to improve them. Partners are not usually included in these efforts but when they are, patients and their partners typically benefit. Even if you don’t want to include your partner, or your partner doesn’t want to participate, having knowledge about what to expect can lead to more satisfaction with intimate aspects of life going forward.

Tips for addressing sexual health concerns

To help you deal with cancer-related sexual side effects, consider the following recommendations:

• Talk to your healthcare providers about specific issues related to your diagnosis or treatment that bother you. There may be ways to decrease cancer-related sexual side effects. For example, vaginal dryness may be decreased with lubricants or medications, and certain medications may improve libido.
• Ask for a referral to a sexual health expert. These professionals are trained to help people improve their sexual health.
• Find emotional or psychological support that works for you.
  • Consider therapy, support groups, alone time and journaling, and/or maintaining a strong network of family and friends.
• Talk with your partner about the changes you are experiencing.
  • Many people have difficulty talking about sex and intimacy. It may be helpful to have your partner attend healthcare visits with you so that you can discuss what you, as a couple, are experiencing, and how to better deal with sexual side effects.
• Be flexible in your approach to sexuality. Talk with your partner about changes that might improve your intimacy.

Each person’s intimate experiences are different. Make choices about sexuality and intimacy that are right for you. Remember that you deserve pleasure; only you can define what that means for you. Also, know that your comfort with sex and intimacy may change over the course of your treatment and recovery.

Reference

Reese JB, Zimmaro LA, McIlhenny S, et al., Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Survivors and Partners. Frontiers in Psychology; 2022; 13:864893. Published online Apr 6. doi: 10.3389/fpsyg.2022.864893.

Shaffer KM, Kennedy E, Glazer JV, et al., Including partners in discussions of sexual side effects from breast cancer: a qualitative study of survivors, partners, and providers. Support Care Cancer; 2022; 30:4935-4944. Published online February 17, 2022. doi: 10.1007/s00520-022-06917-7

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 8/8/23