A Sexy Toolkit for Breast Cancer Survivors

Recovery from a devastating disease like breast cancer is a long and challenging road that frequently involves making peace with lots of change—different bodily sensations, altered abilities, different goals and perspectives. Rather than a return to “business as usual,” recovery is often a process of accommodation.

All that adaptation and accommodation applies to sex as well. Sometimes, the goal is not so much to regain the “before” experience as to redefine, along with your partner, what sex means “after” cancer. To start from now with patience and hope, because whatever your starting point, you will improve. That’s the resounding message from other survivors who have faced the same journey: “Don’t give up,” and “You are not alone.”

As you reconstruct the contours of your life, of which sex is a critical part, here’s a toolkit that might help you get started and might also help sex to be more comfortable.

First, some ideas to consider as you begin to reclaim your sexuality:

Self-image is a huge hurdle for most women who’ve had breast cancer, even after reconstruction surgery. Everything feels different, and sometimes there’s no feeling at all. According to a 2011 study of 1,000 survivors of breast cancer, co-author Mary Panjari, of Australia’s Monash University, found that women with body-image issues (and who doesn’t have issues with body image?) were much more likely to report sexual function problems.

Perhaps it’s comforting to know that, while you struggle with the psychological and physical scars of your illness, for most partners, the way you look isn’t a problem. “In our study, we asked women if they thought their partner felt differently about their appearance and the majority said, ‘No different.’ But the women felt differently about themselves,” says Panjari. Again, you're not alone, and there are steps you can take:

  • Consider finding a support group for cancer survivors, and not just for advice on sex. Some women like them; others don’t, but at least give it a try.
  • Consider couples therapy. As a couple, you need to figure out a path forward, sexually speaking. He may worry about hurting you or pressuring you. You may be consumed by how you look or experiencing loss of desire and sensitivity, vaginal dryness, numbness. And your medications may exacerbate your condition. Finding a sex therapist who can walk you through these changes could be your best gift to yourself and your relationship.
  • Exercise when you feel ready. A regular workout will help you tone muscles, lose weight, and feel stronger and more capable. It gets more blood to your brain and your bottom, and it releases endorphins, the feel-good neurotransmitters in your brain. Simply feeling confident and capable can help stimulate your sex drive.
  • Masturbate. This primes the pump. You can get lubrication going and see what feels good where. “Masturbation is a normal form of sexual activity and release,” says Dr. Marisa Weiss, founder of Breastcancer.org. “I tell my patients it's a form of exercise and conditioning for the vagina—which has suffered considerable change and lack of use during breast cancer treatment.”
  • Remember: Breasts are only one part of a whole-body experience. Don’t focus on the tree when you have an entire forest to explore.
Now for that toolkit. These are items every postmenopausal woman should have on hand—they’re just more important for breast cancer survivors.
  • Vaginal moisturizer. This is for regular, daily use, not just for sex. It conditions the vagina and keeps the tissue healthy and moist
  • Lubricant. Use this lavishly in your vagina for extra lubrication during sex.
  • Pillows. Lots of pillows for soft support where you need it. If a position feels ouchy, try cushioning the area with a pillow.
  • Erotic movies and other scene-setting paraphernalia—candles, incense, music.
  • Sexy attire. If you need to start out—or stay—clothed for a while, get sexy lingerie that covers the strategic parts.
  • Read the information about vaginal comfort and genital sensation on my website: middlesexmd.com and the very helpful blog posts about sex after cancer by our own medical advisor, Mary Jo Rapini.

Self, Meet Body

You’ve been through a lot. After surgery or chemo or radiation therapy, you may feel like you inhabit the body of a stranger—it doesn’t look, feel, or behave like the body you once knew so intimately. You may feel as though your body has betrayed you. You may disassociate from your body—it’s there, but you aren’t. Or, you may grieve over the loss of your former self, scar-less, energetic, attractive.

Recovery is a long and challenging road, and like any journey, you’ll probably find the way littered with unexpected difficulties as well as sweet surprises. Initially, however, it’s mostly uphill.

You may find that your body simply doesn’t respond the way it did “before.” You may find your self-image seriously shaken by the scars, the hair loss, the weight gain. You may find it hard to care about anything because you’re exhausted—or depressed. Feeling attractive and desired is an important component to sexual responsiveness for women, and you may feel anything but.

This is a fragile time. You’ll need to become acquainted with your new body and to accept and even embrace it with all its limitations. And maybe this acceptance will open the doors to a new kind of sexual partnership as well. Maybe one that’s more honest, that expects less, that laughs more.

First, however, you need time to heal and to regain energy, and this can take months. Go easy on yourself. “I think the one gift I’ve had from breast cancer is that I’ve never made myself go back to the same level of pushing as before,” writes Dr. Su Kenderdine, in a Q&A at breastcancer.org. Rest is as restorative as exertion, she says.

Second, pamper your body. Do the small things that make you feel sexy—get a manicure, buy lingerie and nice sheets, take long soaks in the tub, style your hair (or buy a wig you like), get a makeover. Lavish your body with good energy, and your sexual responsiveness may pick up, too. “Eroticize your body,” says Sabitha Pillai-Friedman, a well-known sex therapist and breast cancer survivor. “We have scars. Our bodies have changed. It’s very important for us to sort of look at ourselves. We can look at ourselves with scars, but we can also look at ourselves with the scars enhanced with sexy lingerie. Right?”

Third, get to know your new body. You may discover new erogenous areas as well as reawaken old ones. How does it feel to stroke your belly? To massage your ears? The back of your neck? The inner thigh? The feet? Harness the power of all your sex organs—your skin and sense of touch as well as your mind. Fantasize. Read sexy stories.

“Your vagina responds to your mind and your feelings about yourself, so if you feel like ‘damaged goods,’ too heavy, or in any way undesirable, your vagina will stay relatively dry and unresponsive,” writes Dr. Marisa Weiss, president and founder of breastcancer.org.

Surround yourself with positive thoughts. Visualize yourself as attractive and desireable. Confidence is sexy.

Fourth, get a vibrator and some lubricants and use them by yourself first. “Once we’ve had surgery and treatments… our body’s response changes, so we need to really figure out what works for us before we can share our bodies,” says Dr. Pillai-Friedman.

Prime the pump, so to speak. Arousal may take more or a different kind of stimulation, so find out what works for you now. Also, self-pleasuring will wake up sleepy nerve pathways and improve blood flow to your genitals.

Finally, don’t neglect your partner. Talk about how you feel and what you’re doing. Essentially, you’re working hard to regain something important both to your relationship and to your own sense of well-being—your sexuality. If you lay the groundwork well, everyone benefits. And in the meantime, don’t withdraw. Keep the intimacy alive with lots of touch and cuddling.

Also, don’t make assumptions about what your partner feels or thinks. Don’t project your own discomfort with how you look or assume that if he touches you he wants sex. It’s highly likely that he or she is looking for cues from you and will accept whatever makes you comfortable. If you’re not sure how he or she feels, ask rather than guess.

When you make love again, experiment with positions that might be more comfortable. If you’re on top, you can control the depth and speed of thrust. A spoon position is close and loving, but also visually more private. Use pillows, props, supports. Use lots of lubricant. Wear something sexy—and you don’t have to take it off if you don’t want to. Don’t forget to laugh.

Who knows. This might be the start of something newly beautiful.