Sex, body image and breast cancer

Sex Body Image and Breast Cancer

This week we are delighted to welcome Julie from Master’s Pleasing Bitch to our blog to talk about the impact of breast cancer on her sex life and body image. This post contains frank talk about breast cancer diagnosis and treatment including mastectomy surgery

In 2017 breast cancer accounted for 15% of new cancer cases in the UK. The lifetime risk for a woman is 1:7 and 1:870 for men. Despite these statistics I never believed breast cancer could happen to me, until it did.

I’m Julie, a 57-year-old woman who has been writing about sex, relationships and kink for the past 8 years. I’ve shared much of my life online through my blog, including photographs of my breasts. My aim has been to show you can be proud of your body and write about your sex life and relationships after the age of 50. I still believe that wholeheartedly but have to acknowledge there have been challenges.

In 2018 I was diagnosed with breast cancer and subsequently had a mastectomy followed by radiotherapy. This article tells my story and offers general advice about breast cancer diagnosis and treatment as well as how to manage the challenges in accepting a changed body image and sexual identity.  This article is told from my own CIS and UK based point of view, but I hope it will be useful to all.

Types of breast cancer

There are many types of primary breast cancer that fall into two categories non-invasive and invasive. Non-invasive or insitu means that the tumour has not yet spread within the breast or elsewhere. Invasive means some spread has occurred within the breast, to the lymph nodes or elsewhere in the body.

Breast cancer is much more common in women than men (in 2017 there were 54,700 new breast cancer diagnoses in women and 390 in men). However, there is an increased risk for transgender women who are undergoing hormone treatment. This article offers some useful advice for transgender people.

A breast cancer diagnosis

For most people breast cancer is diagnosed following the discovery of a lump, swelling or other change (such as colour) to the look or feel of their breast(s). This is why it is important to examine your breasts regularly. It is something a partner can help you with, since they may notice changes before you do. Not all lumps turn out to be cancer and can easily be checked by making an appointment with your GP.

Sometimes breast cancer is diagnosed during mammography and a lump not yet felt may be detected. It’s important to attend mammogram appointments once you are called, usually at 50 or earlier if you have a family history.

Breast clinics in the UK offer a one stop appointment where a mammogram, ultrasound and biopsy can be provided in the same appointment. Results may be available on the day, or there may be a short wait for histology. Staff at the clinics are very experienced and caring and do their best to put you at your ease. But of course, the process can be very scary. My partner accompanied me as it is usually possible (in non Covid 19 times) to take someone along. I recommend this if available.

My Cancer Journey

I discovered a lump in my right breast in June 2018. It was a stressful and busy time as I was about to move to a new house and had just put in my notice at work. I put off seeing my doctor but luckily was called for my regular mammogram in August. With some relief I attended the appointment and told the mammographer that I had found a lump. It was no surprise to be called to a breast clinic appointment a few weeks later.

I have been reassured that the time lag made little difference to my breast cancer outcome. But I would never again put being too busy before my health and would advise others to do the same.

My breast cancer was an invasive lobular breast cancer, which is the second most common. This starts in the milk producing glands and spreads to surrounding tissues. The tumour wasn’t visible on mammogram even though it was 6cm in size but was confirmed through ultrasound and biopsy.

An MRI scan confirmed that the tumour was too large for a lumpectomy, so a mastectomy was advised by the surgeon. He spent time with me and my partner discussing this and options for reconstruction. It is important to take this time and read the information provided. But it is equally important not to just randomly search for information online as it is not all balanced or reliable.

In October 2018 I went into hospital for a mastectomy, with a plan for a delayed reconstruction in a year or two. Physical recovery took a few weeks, but when I went back to see the surgeon there was good news. The risk of recurrence, predicted through a test called Oncotype DX, was low and there was no lymph node involvement. The cancer had however been oestrogen dependent and so my treatment plan included radiotherapy and a hormone inhibitor for 5 years. But no chemotherapy.

Emotional recovery and altered body image

During the first few days after surgery I felt strangely euphoric, partly due to the pain killers I was given as well as relief that the operation was over. The chest area, where my breast had been was covered in dressings and I also had a drain at the side under my arm. The reality didn’t really hit home until the dressings and stiches removed about 10 days later. It was hard to look at myself in the mirror. But I did because I felt it was important. This was my body now.

My partner was very attentive to my needs and for once I let him care for me. I was tired and sore, but sad about what had happened. He had been with me through each consultation and was there waiting for me when I came back from surgery, I know he felt powerless to help and found the whole experience extremely upsetting.  Together we tried to work through our feelings about my new altered body and the uncertainty cancer brings with it.

But ultimately once I knew that I was free of cancer it was the emotional effects of the mastectomy that came to the fore. My remaining breast looked huge to me, though still the C cup it always was. He was keen to caress it again, but I wanted him to know and like the flat side. More than once he was in tears as he touched me. I was a little more stoic, though no less upset by the whole experience.

After a few weeks the soft bra insert I was given by my breast care nurse was replaced with a silicone one. This was provided free on the NHS and once inside a pocketed bra looks much like the real thing. But the continued healing process meant my chest area was often itchy and I was left with a fatty area at the side, under my arm. I’d like to say I dumped my bra and went out without it, but even today I feel too self-conscious to do that. Even though I am pretty sure most people wouldn’t notice.

My relationship with my body has changed and I don’t like my breast in the way I did when I had two. I still like to look at photos of naked women and admire their beauty, but struggle with pictures of and adverts for bras I know are unsuitable for me. Thankfully there are companies that make attractive mastectomy bras, often with matching panties. I have also invested in swimsuits and a couple of tops with built in pockets. I’d challenge anyone to be able to tell which of my two boobs is real and which is not. I’ve bought a lighter weight, waterproof prosthesis too. This has been an expensive time, but luckily mastectomy products are exempt from VAT.

One of the ways I’ve used to overcome my anxieties over my body image has been to get back to photographing it. Firstly, I or my partner took photos just for us. Initially this helped us see progress as my body healed, but soon I found I wanted to show myself and us I wasn’t frightened of my body as it now is. After a few months I felt ready to show my chest in a photo on my blog. This led soon after to me joining a group photo of topless people at Eroticon in March 2019. This was quite a big thing, not just because for the first-time people other than my partner were seeing me. But because I was still recovering from the effects of radiotherapy, which had made me quite sore. In my usual way, I warned others ahead of the photo because I was worried it may upset some people. The response to the event and the resulting photos was supportive and encouraging.

Sex after mastectomy and breast cancer

We have an active sex life, and this has continued. My partner was keen to show that I was still attractive to him from the start. The challenges I outline above in no way stopped us from touching, using toys, masturbating or indeed from having penetrative sex. Nor would it stop me from solo activities. To begin with I needed to be careful of the healing wound and later, during radiotherapy of the soreness around my chest. I was also tired and struggled with my libido. The latter is something that has continued due to medication.

I have some numbness around the mastectomy site and under my arm. This means that I am less receptive to touch. But I still experience sensations in the normal way on my remaining breast.

My particular tumour was oestrogen dependent and so I now take medication that is designed to inhibit oestrogen production in the body. This has caused a type of second menopause with symptoms such as hot flashes and vaginal dryness. We use lubricants to overcome the dryness and I try to ignore my lack of libido and just get on with giving each other pleasure.

I am lucky that communication in our relationship is good and that we are able to talk about ways in which we can overcome these difficulties. Health professionals are not always good at asking about sex and relationships and it is often left to the individual to seek out help.

Psychological help including coping with a cancer diagnosis, relationship counselling and sex therapy is available, and it is important to ask for help if you think you need it. Most people’s first port of call in the UK is their Breast Care nurse. I’m sure that writing my blog has helped me to express my own fears and anxieties, but of course not everyone has this outlet. However, I would recommend writing thoughts and feelings down if you feel this would help.

Going through a breast cancer diagnosis and treatment is a scary time. But with the right information and support you can come through to the other side. You can maintain your relationships and continue to have a fulfilling sex life.

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