Intimacy after Breast Cancer: Cultivating Connection with Care

Sexual intimacy after breast cancer can be hard. I guess that sounds obvious as I write it, but in reality people experience sex differently based on a number of factors. There are some common challenges like nerve damage, hormonal changes, numbness, body image issues, etc., but honestly, one of the biggest factors is what your relationship was like before cancer. How well did you do with communication? Sharing your feelings? Being vulnerable? How has your sexual relationship been? Was it satisfying? What made it that way or what seemed to be missing? You see, it's kind of like a sponge…you don't know what is in it until you squeeze it. Cancer squeezes couples, and it reveals what was really true in the relationship. What was hidden is now seen.
 
If you read an earlier post in this series, you heard that Rachel and I entered therapy early in our marriage. That work was so helpful, but it wasn't the permanent solution. We had to continue to talk about our relationship, and especially our sexual relationship. We went through different stages of life including four children, starting a business, financial struggles, and many more stressors that impacted us. It was our willingness to keep talking, keep sharing our thoughts and feelings, and…though maybe obvious, keep having sex, that has helped us to navigate this side of breast cancer.
 
If you are reading this and thinking that your sexual experience wasn't great before cancer and you are discouraged and fearful, I want you to know there is still much hope. Cancer has a way of pushing us to face things that we don't want to face, and to actually talk about them and feel the emotions we tend to push away. I imagine you have already experienced this with all the information you have received and the decisions you have had to make because of your diagnosis. It is the same with sex. It is a chance to keep pushing into the vulnerable places and take the risk to start talking about sex, but be gentle. It is a delicate season.
 
Some of you may be problem-solvers and fixers, so you are thinking, “what do we need to solve?” Let me first encourage you to think about how you are both doing. How are your hearts? Check in with each other. Are you ready to be sexual? What is important to you as you start? What are your concerns? If you are ready, talk about what you are ready for sexually. How would you like to start being sexual? What feels safe for you? Without addressing these types of questions, you can easily create pressure that you didn't mean to create, and set yourself and your spouse up for a more difficult path back to sexual intimacy with a lack of emotional connection.
 
Many individuals struggle with the misconception that being sexual or engaging in sex is limited solely to penetration. Let's change that. I want to encourage you to think of sex on a spectrum where penetration is only one aspect of being sexual. After many years of talking with couples about their sexual relationships and the various struggles they are facing, I can assure you that people are sexual in a lot of different ways. Intercourse sometimes isn't even possible for different reasons and unfortunately, that is the place that some people stop being sexual. They start to believe there is no reason to engage sexually at all if they can't have penetration. But there really are so many ways to enjoy sexual feelings and sexual connection.
 
Go with me back to when you were dating. Do you remember how exciting a kiss was back then? Do you remember when you danced and the closeness of your bodies sparked those tingly, sexual feelings? Are you going to tell me that didn't feel sexual? Some of us have lost these and other aspects of being sexual and have over-simplified sex to a brief experience of intercourse that lacks emotional connection and sometimes even lacks much pleasure. Sex can become more of a functional item on a to-do list instead of an opportunity to connect and soak in kisses and caresses. It can become more like "drive-through" sex instead of a "sit-down" meal at a table. Or, maybe you have never cultivated much sexual intimacy in your marriage. I get it. That is where Rachel and I were early on. We just had struggles we couldn't navigate. If that is you, let's change that. I think sexual intimacy following breast cancer is a great platform to grow sexually together and I want to introduce six key ingredients that can help. And, if you need some professional help, I want to encourage you to reach out for help. It truly was one of the great investments we made into our marriage.

Being known is something lovers must do if they are going to have a rich connection emotionally and sexually. Each person must be willing to honestly and vulnerably share about their sexual experience as well as listen to one another without reacting defensively. It requires a careful pursuit of the heart, while tolerating some of your own difficult emotions like frustration or rejection. If your spouse shares a sexual preference and you feel a sense of inadequacy or failure, take a breath and reflect back what you think she meant and not your interpretation such as, "You're saying I'm a bad lover." Instead, paraphrase with something  like, "You prefer a firmer touch because when I touch you lightly, it tickles." Our defensiveness often disrupts our attempts at connection.
 
Ladies, it will be important that you share with your husband how cancer and treatment has impacted you physically. There may be areas that you are not ready to have touched or maybe be seen yet and that is ok. You need to start where you are comfortable starting. If you need to, wear something you are comfortable being in so you can focus on the good feelings and not be worried about how you look. Following Rachel's mastectomy, she had to coach me on ways she was ready for her reconstructed breast to be touched. This offered us both freedom as we incorporated this new part of her body. Another common impact from cancer is having less sexual desire. This occurs due to different factors, but one can be the way necessary treatments impact hormone production. You may need to move toward being sexual without sexual desire, because if you wait for sexual desire, you probably won’t have sex. There are reasons to be sexual besides sexual desire, so instead, notice when there is an openness for a sexual experience to meet other goals of being together such as closeness, skin to skin contact, and some sexual caresses that remind you that cancer did not take your sexuality. This takes the pressure off of you needing to feel a certain way and instead, to simply enter into the experience allowing it to be what it is…no expectations. There are many ways for you to be known by your husband, and it will require you to take risks. Cultivating safety will help you to take those risks.

Feeling safe while being sexual gives us an opportunity to freely engage our whole selves in what is happening. Anxiety is one of the foundational barriers to the sexual process. God made our bodies and our brains to work together when it comes to sex. If we are feeling anxious, it can disrupt the arousal process and limit our sexual experience including reaching an orgasm. Given this fact, you can see how important it is to talk together and discuss concerns, worries, insecurities and the ways you are ready to be sexual and ways that you are not. Rachel had to help me understand this with her new breast. Some of the ways we had been sexual in the past were less physically comfortable for her, so we needed to adjust. These conversations are so important so our wives are not distracted by a worry that has not been voiced. Guys, we need to encourage our wives to help us know how to work with them so they are relaxed and focused on the good feelings…that is the place that arousal can start to build.

Perhaps one of the easiest ways to increase overall satisfaction in sex is to be present with an awareness of what your senses are telling you. Your body was created to be sexual. There are some erogenous areas that are going to have the nerve endings really firing and heating things up, but our whole body can be sexual. Sometimes cancer limits some of the ways that you used to experience sexual pleasure, but that is ok. Use what you have! Give attention to all your senses…touch, taste, smell, sound, and sight. Again, this is where safety has to be in place so that you are free to be present in the moment instead of checking out and waiting for sex to be over. From the safety of the love you share, be vulnerable and allow your senses to bring pleasure. Enjoy what is present…soak in the good feelings and go after them! Tell him, "that feels really good" with words or with your breathing or your movements. Be known. Don't worry about orgasms, just enjoy the pleasure that is present. If an orgasm happens, that's great, but focus on the pleasure and let its current move you. Sometimes it is our striving that actually pushes orgasms away. Rediscover past sexual feelings as well as new discoveries, and claim that sex and sexuality is something that has great value.

In some ways, this section could have been included with the one on safety, but I wanted it to have its own space. It is so important. This is a time for reassurance. It is a time where parts of breasts, the whole breast, or both breasts have changed. Where once was a nipple now there is a tattoo. They don't feel the same or look the same. It is a time for acceptance and reassurance. Something I wrote in one of Rachel's cards that meant so much to her was the following:
 
"Curves and curves and more curves. I love to admire and caress and kiss and hold. And that includes this new breast that will always be lacking to what was there before, but it stands as a reminder that your life is the most valuable thing we have. We invite it and welcome it into our story of love and offer it acceptance as we have so many things in our story. It will not define your beauty or limit your beauty, but it is part of your beauty."
 
That feels so personal to share, but I want to emphasize the importance of sharing words of acceptance and reassurance. Guys, our words won't be the same, but your words, your admiration, your gentleness, and especially your patience will be a healing salve on your wife's sexuality. Give her space to heal sexually and gather the richness this season offers you.

One of the barriers many women face is that somewhere they got the idea that sex was something that was to happen to them instead of something they would be equally involved in. Don't be passive, ladies. Enter into sex in a way that reflects the whole of who you are…adaptive, creative, fun, sensual, physical, assertive, etc. If some of these don't seem to fit you, maybe these are areas of growth. If they don't fit, reflect on who you are and how those parts can offer life to your sexual experience. Sexuality is not something cancer gets to take! Be active…give and receive pleasure. Learn how to work with the changes that have occurred, instead of focusing on what has been lost. Don't let cancer take more than it has to take. You may need more lubrication than you did previously, so find some great lube. You may not have as much energy as before, so find out when you have the most energy and try to have sex then. You may not look the way you want to in the tops and bras and lingerie you used to wear, so buy more that flatter your body the way it is now. The point is to be empowered sexually and let your pursuit of your sexuality and its expression in sex be part of this healing journey.

What do you think I mean when I say to be curious? Think about the word and how you experience it. When we are curious, we don't rush to conclusions or meanings. We lean in. We approach. We experiment. We question. We focus. Consider how being curious will be important as you start being sexual again. Curiosity removes pressure and invites activity without quick judgments. It seems to create a needed space for couples to invite the inevitable changes. Changes are not the enemies. They just reflect the loss of what used to be, but it's ok. We can work with them once we have been able to accept them. Otherwise, they will become our focus and rob us of joy.
 
Over this past year, Rachel and I have talked about how cancer seems to usher in some of the challenges that aging does. Some include hormone deficiencies, lower sex drive, body changes, less intense arousal, and less reliable orgasms. We are now in our mid to late 50s, so we were already facing some of these changes, but with cancer, some came much sooner than we thought they would. Much like aging, we had to accept these if we wanted to continue to be sexual. I think both aging and the impact of cancer offers us a more fulfilling experience because it requires more relational involvement. Often when we are younger, our bodies work so well, it is easy to rush past aspects of sex that give us a rich experience. Now, we are pushed to be more vulnerably intimate and more sacrificially giving with each other.
 
 
I know these six ingredients are not the full answer and may not fit your individual situation, but they are a good starting point for reflection and conversations between you and your spouse. In our sexually saturated society, it is easy to form false ideas about sex that become beliefs. Then, we can naturally gather evidence to support these beliefs, making them feel like truths to live by. Truths about yourself as well as your spouse…but they are actually lies. And, when they are not discussed, they become hardened and work against sexual intimacy. They become barriers and walls of protection. Without being intentional, cancer can easily fortify these, but I hope to encourage you that it does not have to be this way. Take these ingredients and discuss them with your spouse. Which ones are strengths? Which ones are growth areas? We all have some of both. Regardless of where you start, decide this area of your marriage is worth the effort. Pray together about your sexual relationship and agree to take steps toward today's healing just as you have each day of your journey with cancer.

Kerry is the founder and director of Abundant Life Counseling Services. He works with individuals on a wide range of issues, but specializes in marriage counseling, sex therapy, counseling for sexual addiction, affair recovery counseling, and counseling for same-sex attraction and gender dysphoria. Kerry counsels clients from our North Austin location. For more information about Kerry's practice, or to schedule an appointment with Kerry, call us today!