5 Ways Living With Metastatic Breast Cancer Can Affect Your Sex Life

Having metastatic breast cancer (MBC) affects just about every part of your life. Your sex life is no exception. “A woman with metastatic breast cancer just doesn’t feel like herself,” says Sandy Kotiah, MD, a medical oncologist and director of The Neuroendocrine Tumor Center at Mercy Medical Center in Baltimore. “She may not feel feminine. And, if she is feeling tired and nauseous, sex may be the last thing on her mind.”

When you have metastatic breast cancer, you may often feel like you just want normalcy in your life, Dr. Kotiah says. “Having a sex life offers normalcy.” But, changes in your sex life are also normal. If they happen to you, know that there are many ways to stay close and connected to your partner.

5 Reasons MBC Changes Your Sex Life

Both the cancer and its treatments may have side effects, says Marisa Weiss, MD, a breast radiation oncologist and the chief medical officer and founder of Breastcancer.org. The mental and physical complications of living with MBC can make it difficult to make sex a priority.

“Dealing with uncertainty, anxiety, pain, and frustration can all make the journey difficult,” Dr. Weiss says. “With all of this going on, feeling sexy may not be realistic.” Here are some reasons behind your cancer diagnosis affecting your sex life.

1. Side Effects of Treatment

Women with estrogen-positive breast cancer, which accounts for around 80% of cases in the United States, may be prescribed medication that blocks estrogen. This might cause a big drop in your libido and painful intercourse. “However, there are many solutions to try to ease these side effects,” says Weiss.

For premenopausal women, chemotherapy and other cancer treatments can affect ovary function and trigger symptoms of early menopause. This means your menstrual periods may stop or become irregular, and you may also experience vaginal dryness.

If you have already gone through menopause, breast cancer treatment can make it difficult to enjoy sex, says Mary Jane Minkin, MD, a clinical professor in the department of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine in New Haven, Connecticut. “The medications will shut down your estrogen levels altogether, if they weren’t shut down already.”

If vaginal dryness is an issue, there are effective, nonhormonal products that can make sex much more comfortable. “We really encourage the use of a vaginal moisturizer,” she says.

In addition to moisturizers, there are lubricants and vaginal suppositories that contain vitamins D and E. And, if sex feels uncomfortable, your doctor can prescribe lidocaine — a local anesthetic — to apply around your vagina, which Dr. Minkin says can be very helpful. Have a conversation with your gynecologist to address your issues and find an individualized remedy. Don’t be afraid to bring it up if your doctor doesn’t ask you about it.

2. Body Image Issues

If you’ve had a mastectomy, communicating to your partner what kinds of touch you do and don’t like is important. “Remember, the whole body can be an erogenous zone,” Minkin says. “Let your partner know where you like to be touched or not be touched.”

Many women now have a lumpectomy, rather than a mastectomy, according to Jane E. Carleton, MD, associate chief of clinical affairs at Northwell Health Cancer Institute in New Hyde Park, New York. But, some women will develop hypersensitivity after any breast surgery. It’s important to know that and discuss it with your partner. The majority of women who have a mastectomy now undergo reconstructive surgery, because insurance companies are required to cover it. “The sensation is not the same as before surgery, but reconstructive surgery can make a big difference in a woman’s self-image, and this is so important,” Dr. Carleton says.

If you are self-conscious about scars from surgery and prefer not to have your partner touch certain areas, be clear about this.

3. Emotional Stress/Anxiety/Depression

Just processing your MBC diagnosis can be emotionally draining, Minkin says. If having sex is about the farthest thing from your mind, she suggests raising the topic with your oncologist. Yale’s Sexuality, Intimacy & Menopause Program provides psychological counseling, as well as assistance with physical issues. “More and more hospital centers are offering programs like ours,” Minkin says.

Carleton suggests asking for a referral for counseling. “We have oncologists, social workers, and psychologists on staff who can help,” she says. “We understand that having cancer can turn your life upside down, and we will refer people for counseling, which is really helpful.”

4. Bone Pain and Other Pain in Your Body

Pain anywhere in your body can mean discomfort during sex. Try changing positions or using a wedge or pillow. Sometimes, a pillow under a tender area can help alleviate friction or pressure.

5. Fatigue

Breast cancer treatment can leave you feeling fatigued, Minkin says. Light exercise can help fight fatigue. Try taking a “power nap,” but keep it short and not too close to bedtime. And, rethink your diet, keeping in mind that the foods you eat affect your energy level. Opt for foods that offer sustained energy, such as whole grains, legumes, and vegetables, which are all complex carbohydrates. Aim to avoid simple carbs, such as sugar and white flour. These cause your energy to spike and drop quickly.

Building and Strengthening Intimacy Beyond Sex

Building intimacy with your partner, even if it does not include sex, is important, says Minkin. “Even though it can be hard, it is important to build in time for just you and your partner,” she says.

There are other ways to express intimacy besides having sex. Hugging, holding hands, and gentle back rubs all help you and your partner stay connected.

“Breast cancer treatment can take up a huge amount of time,” Minkin says. “And, after each treatment, you need time to recover. So, just building in time for sex can be a challenge.”

Shifting toward “a more inclusive definition of intimacy and toward nonintercourse sexual activity” seems to help, she says.

Talking to Your Doctor About Sex With MBC

While you may feel a diminished desire to have sex, your medical team can help. “Sometimes, the woman will bring it up to me, and sometimes, I open the topic,” Carleton says. “This is an important topic, and it should not be your individual problem. There are always things that can help. Also, it is important to keep in mind that you are not a cancer patient. You are a person with breast cancer.”

Ask your doctor whether your hospital has resources on sex and metastatic breast cancer or can offer referrals. You can also find resources like the American Cancer Society’s Sex and the Adult Female With Cancer or the American Association of Sexuality Educators, Counselors and Therapists Referral Directory tool, which helps you find a professional nearby.

You may think your sex life just isn’t the same as it used to be, Carleton says, and that’s true. “Our bodies aren’t the same as when we were in our 30s,” she says. “So, maybe it won’t be as intense, but it can still be pleasant. If it creates intimacy with your partner, that is a good thing.”