Mixed feelings in your relationship due to breast cancer

People often don't spontaneously turn to a psychologist sexologist, but after an informal chat with us, they might. - Katrien Devalez, oncology consultant gynecology UZ Gent

If you feel a strong connection with each other during "normal" times, you can also handle "challenging" times more easily as a couple. "Yet it's really not surprising, or rather but normal, that your relationship can come under high stress due to something as drastic as breast cancer," says Birgit Van hoorde, psychologist-sexologist in the Center for Sexology and Gender at Ghent University Hospital. "Fortunately, most couples manage to find a new balance again and their relationship can even become closer because of it." The latter is also evident from a study in which 282 (Canadian) couples participated, and in which both partners were interviewed separately at different times up to 1 year after the breast cancer diagnosis: 42% of the couples felt that the breast cancer had brought them closer together. In 6% of the couples, 1 partner indicated that the distance between them had grown, and in less than 1% of the couples, both partners indicated this (*).

"It is also our experience that breast cancer fortunately drives very few couples apart," agrees oncological consultant gynecologist Katrien Devalez, who co-founded the breast clinic at UZ Gent some 20 years ago. "If it does come to a breakup, people often say afterwards that the reasons for it were already present before the breast cancer diagnosis. Which is not to say that it all goes smoothly for the other couples. Many have to go through a difficult period after the diagnosis. Not only because both partners experience and process everything somewhat differently, or at a different pace. But also - and not least - because breast cancer treatment can have concrete, disruptive effects on something important within a relationship: intimacy and sexuality."

Jammers

"Here we consider not only the drastic impact of breast surgery, but also the often much less visible consequences of post-treatments," Katrien Devalez continues. Some examples: "Radiotherapy can sometimes leave you with a sore nipple for years, so you prefer to avoid touching that area. Chemotherapy can not only temporarily reduce the sensation when making love, but can also - like the antihormone pills, which often have to be taken for 10 years - reduce the desire for sex and vaginal fluid production. As a result, not only can lovemaking be less pleasurable, but the risk of vaginal infections is also somewhat greater." "So just because of side effects or complications, you may feel inhibited from having sex," Birgit Van Hoorde concurs with her colleague. "That your body image may have changed because of breast loss, scarring or hair loss can also play tricks on you. And all your feelings of pain, fatigue, insecurity, shame or frustration also affect your partner. Perhaps he is afraid to make advances, because he assumes that you do not need sex. Or because he finds it confusing that your body, which causes you so much trouble, stimulates him at the same time. It is quite possible that he therefore focuses even more on his "nurturing" role and keeps his own feelings or concerns to himself as much as possible. But because of the distance he keeps, you may begin to assume that he no longer finds you attractive. Where, of course, 'he' in all these examples can also be 'she,' because on the one hand, men can also get breast cancer, and on the other hand, women can have lesbian relationships."

Overcoming diffidence

Talking helps to break the negative spiral of mixed feelings that are troubling you. But often talking is difficult, because breast cancer has already turned both your lives upside down. Perhaps you don't like talking about it with friends either, because you didn't share such things about intimacy and sexuality with them anyway. That leaves the doctor and the oncology nurse, but even with them you may feel too timid. The relief can be great when one of them brings up the subject themselves. "Fortunately, this already happens much more often than, say, a few decades ago," says Katrien Devalez. "But even caregivers sometimes still find it a tricky issue and take a wait-and-see attitude, while they would like to help you and they can - each from their own expertise. So as a patient or partner, don't hesitate to bring it up. Many people drop something on us for the first time, as nurses. For example, they raise a very practical problem, such as vaginal dryness. We gratefully take advantage of that to give them practical tips in advance. But we also see it as an opportunity to support their problem more broadly. Such as with the expertise of a psychologist-sexologist, to whom people often do not spontaneously turn, but after an informal chat with us they might."

Step by step

"When people indicate that, unfortunately, lovemaking no longer works well, we check what exactly they mean by that," says Birgit Van hoorde. "Making love has an extended meaning for many people: sexual intercourse and reaching orgasm. But sexuality is also about fulfilling feelings of intimacy and lust in other ways, by hugging, massaging, kissing or caressing, for example. Focus on what does already feel comfortable, is our advice. Take your time, get reacquainted with your body, and try to go further step by step. Making love differently does not mean less enjoyment. Besides enjoyment, making love can also bring you more emotional connection, peace and comfort. And that in every stage of the disease, including - and not least - when the cancer has spread. If your desire for sex is at a low ebb, find out what can help fuel your desire. Maybe for you that means: relaxing self-consciously beforehand, making it cozy and taking plenty of time. Breast cancer certainly doesn't have to mean the end of your sex life."

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"Toys can also help," Katrien Devalez adds. "Even when you try them on your own for the time being. One patient confided to me, 'That saved my sex life, because it made me experience again how nice those feelings can be, which made me feel like having sex with my partner again.' Such toys are also a nice tool for singles to get used to all the body changes and to relax."
"We indeed want to be there for singles as well," Birgit Van hoorde joins her colleague. "Because they often still have very different questions. How do I handle it if I want to date again? When do I tell people I have or had breast cancer? When do I literally and figuratively expose myself? What if I am rejected because of the effects of my illness? How do I deal with this? And so on. All valid questions, but without ready-made answers, because everyone is unique. Talk about it with a psychologist-sexologist, to find out what is best for you, where you feel most comfortable."

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