October 13th marks Metastatic Breast Cancer Awareness Day, a day dedicated to amplifying the voices, stories, and challenges of people living with metastatic breast cancer. Sexual health and body image are often left out of the dialogue, but they are essential parts of quality of life. We asked Fox Chase Cancer Center’s Dr. Jennifer Reese and Dr. Eleonora Teplinsky of Valley-Mount Sinai Comprehensive Cancer Care to share tips on how you can navigate changes, start conversations with your care team, and find strategies that support intimacy and well-being. 

Navigating sexual health with metastatic breast cancer

If you’re noticing changes in your sexual health, you’re not alone. Having a conversation with your care team is the first step in understanding why you may be experiencing some of the side effects.

Sexual health specialist Dr. Reese says, “Your sexual health is an important part of your overall health. It’s okay to ask about this as part of your healthcare. Keep in mind you’re not burdening your provider. Of course, providers can often refer to someone who can help if they are not able to.”

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Breast medical oncologist Dr. Teplinsky agrees that creating open dialogue with your provider is essential. “Working with a sexual therapist can be helpful for some people, or seeing your gynecologist and making sure you’re getting an exam. There are things that we can do. I hope people are talking to their doctors, and they’re not being dismissed because it’s a really important topic.” 

How can breast cancer treatments influence sexual health?

Breast cancer treatments can have a significant impact on sexual health, both physically and emotionally. Dr. Teplinsky states, “Vaginal dryness is very common. It’s common in people who’ve gone through menopause, through premature menopause as a result of treatment, and people who are in a lower estrogen state from the endocrine therapies. When that happens, it can cause painful sex.” 

Dr. Reese adds, “We know that vaginal dryness and discomfort, loss of sensation in the genitals, loss of breasts, of course, through surgery, as well as nipples, and orgasmic problems are some examples of biologic or physical types of sexual problems.”

There’s also the emotional component that can be challenging to manage. Dr. Teplinsky says, “All of these things play a role. The impact of body image, anxiety, and depression. Some people, it’s the changes that have happened as a result of a diagnosis. Then there’s the social part. Sometimes patients will say, ‘My partner is afraid to touch me,’ or ‘They don’t want to hurt me.’ It creates a lot of uncertainty.”

If you have a partner, Dr. Reese recommends having a conversation and sharing these side effects of treatments. “ One thing we’ve heard a lot from patients and survivors is that having their partner know this was not all in their head is really helpful and really important.”  

What are some ways to help manage vaginal dryness?

According to Dr. Teplinsky, vaginal dryness not only causes painful sex, but it can also increase the risk of urinary tract infections. The good news is there are a lot of options that can help. She shares, “There are non-hormonal options that are hyaluronic-acid-based vaginal moisturizers that you can use several times per week. Vaginal estrogen is a great option, especially for people who’ve not had a good response to the non-hormonal vaginal moisturizers. It doesn’t get absorbed into the circulation, so when they’ve monitored estrogen levels in the blood, they haven’t seen a bump for people using vaginal estrogen. There are creams, rings, and tablets. A lot of that is just preference.”

What do the next steps look like? 

Sexual health after a breast cancer diagnosis looks different for everyone. Recognizing and acknowledging that your intimate relationship may change is the first step. Dr. Reese emphasizes that “there are paths to satisfaction and intimacy.” 

She suggests lightening the mood by taking a perspective that’s rooted in exploration. “I think that emphasizing a playful, curious stance as opposed to thinking about it in a panicked way of addressing all the problems can often be helpful. It takes some experimentation and that’s okay. That can be fun.”

Your sexual health is a part of your overall well-being. Starting an open conversation with your care team can help you find the support and solutions you need.

As always, if you would like to connect with an Outcomes4Me oncology nurse practitioner at no charge through the Outcomes4Me app, just use the “Ask Outcomes4Me” button.