Breast cancer survivors shouldn’t relinquish intimacy

Women with breast cancer shouldn’t have to relinquish the life-affirming power of sexual intimacy.

Breast cancer brings many challenges that can relegate sexual health to the bottom of the problem list, but helping women preserve or regain that facet of their lives is an important part of a holistic treatment plan, said at the meeting.

Unfortunately, most plans don’t include any discussion of sexual intimacy and many women don’t broach the subject alone, said executive director of the Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, and a clinical professor at the University of California, Irvine.

“We now recognize that cancer can be a chronic disease that our patients can often live with for a very long time. Intimacy and relationships are very important for women, as they progress through their cancer care.”

Breast cancer patients don’t always get the kind of team approach afforded to those with other illnesses. “When a patient has diabetes, the treatment team includes an endocrinologist, a dietitian. There are lifestyle changes, foot exams, eye exams. It’s a team approach designed to target and improve every area the disorder affects. But when we talk about sexuality and breast cancer, the reaction often is, ‘Just be glad you’re alive.’ Women can be told to just say goodbye to that part of their lives.”

It doesn’t have to be that way, said spoke at a session on breast cancer survivorship.

We need to get past this problem with talking about women’s sexuality. Women are embarrassed to bring it up, and when they do they’re often subjected to a paternalistic reaction”that sends a very clear negative message about their feelings and desires, he said.

Addressing sexuality, however, isn’t just about helping women feel good emotionally. It also can be about helping women stay compliant with the drugs that keep them physically healthy.

“One woman came after she stopped taking her maintenance therapy because of the effect it was having on her sex life,” “She told, I’d rather have 5 years of a life lived in color than 10 years of a life lived in shadow.”

He was able to convince her that she could have both the years and the enjoyment of those years.

“I follow what I call a conservative-aggressive approach. We start with the conservative interventions, like addressing vaginal dryness and atrophy with moisturizers and lubricants, getting back on a healthy diet, and exercising. But we don’t send a woman away with a bottle of lubricant and say, ‘Come back in six months,’ like to see patients at least once a month to check on progress, and if things aren’t going well we move on to something more.”

Topical estrogens are the go-to-treatment for sexual problems in women without cancer, but the jury is still out on whether they are good for women with breast cancer. “We now know that topical may not really be just topical. Hormones can be absorbed systematically even in the small doses seen in vaginal preparations.”