South Texas Oncology and Hematology

Worrying about your body image as you go through cancer treatment is a real concern for patients and it can take time to adjust to the new you. Not only can the physical changes such as scars from surgery or hair loss from chemotherapy be very distressing, but the emotional scars can too. These changes can have a great impact on your self-esteem.

People who are already self-conscious about their bodies may have a harder time adjusting to the changes than those who are confident and comfortable with their bodies. The added pressure may be felt from today’s society focusing so much on the “perfect body”. The reality is, no one has the perfect body, and trying to achieve this will only set you up for disappointment.

Since self-esteem is so closely tied to body image, changes from cancer treatment can wreak havoc on your intimate relationships and affect your sex life. How breast cancer affects intimacy in a relationship will vary from person to person based on the comfort level with their body. It is important to know that your partner will still find you attractive and remaining intimate throughout your treatment will be an important part of your physical, emotional, and intellectual recovery.

Sharing a closeness or bond with each other can be done through many different methods:

Physical Intimacy
- Kissing
- Massages
- Holding hands
- Hugs
- Intimate touch
- Intercourse

Emotional and Intellectual Intimacy
- Communicating your feelings and thoughts at the deepest levels
- Being able to express yourself without fears of being judged or the consequences of your expressions

The physical and emotional side-effects of breast cancer treatment may be uncomfortable or difficult to tolerate. Some of these side-effects are temporary, but others are permanent, and they will vary greatly depending on the type of treatment you receive.

Temporary side-effects that may occur:
- Physucal changes:
  - Exhaustion or fatigue
  - Nausea or GI upset
  - Painful or uncomfortable intercourse (vaginal dryness or atrophy)
  - Pain or discomfort (surgical scars, bone achiness)
  - Menstrual cycles stop or are irregular
  - Hot flashes
  - Hair loss
  - Body changes (puffiness, weight gain/weight loss, skin changes)
- Emotional changes:
  - Depression or sadness
  - Low libido leading to decline in intimacy with your partner
  - Post-Traumatic Stress Disorder (PTSD)
  - Anxious, avoidance, numbness
- Permanent side-effects that may occur:
  - Physical/Biological changes
  - Surgery scars can vary greatly depending on the type of procedures you have
  - Premature menopause
  - Sexual dysfunction or difficulty (vaginal dryness or atrophy)
  - Infertility
- Permanent side-effects that may occur:
  - Physical/Biological changes
    - Surgery scars can vary greatly depending on the type of procedures you have
    - Premature menopause
    - Sexual dysfunction or difficulty (vaginal dryness or atrophy)
    - Infertility

Some people feel the physical scars left behind from surgery are a sign of strength and courage and they are very comfortable with them, with many expressing feelings of pride having survived breast cancer.

Other people may see the physical scars as a reminder of the cancer and feel very uncomfortable with them, often avoiding looking at or even touching them. The way you feel about the scars left behind will depend on your comfort level with your body.

There are some steps you can take to help soften the blow to your self-image and the new you:

Prepare yourself
- Talk to your doctors about what to expect based on the type of surgery you are getting. It may take time to adjust to this new physical reality so the sooner you prepare yourself, the more prepared you will become.
- Look at before and after pictures of surgeries. Include your partner to prepare them on what to expect.
- For women getting mastectomies, visit a mastectomy boutique to become informed about special garments and prosthetics available to you.
- Communicate with your partner and healthcare team about your feelings. Be open and honest about your feelings.
- Remaining intimate with your partner is a very important part of your healing and recovery.
- Seek counseling – a professional can help you understand the feelings you are going through and deal with the physical changes.
- Join a support group - talking to others that have experienced similar situations can help you understand and cope with your situation better.
Dealing with Scars after Treatment
- Allow yourself time to adjust to the new you - your body may have gone through dramatic changes and it can take months to adjust to the changes.
- Look at yourself in the mirror - be connected to your body so you become comfortable with the changes you are experiencing.
- Clothing and lingerie– buy clothes that make you feel good about yourself and help cover areas you don’t want to expose.
- Makeup – camouflage the areas of concerns with makeup.
- Stay in shape - good nutrition and exercise will help you look and feel better and will only benefit you.
  - A healthy Body Mass Index (BMI) is always recommended for improved outcomes.
- Scar lotions or bleaches (ask your surgeon for recommendations) – many products are available to help reduce the appearance of scars and skin changes.
- Tattoos – a growing number of patients are choosing tattoos as a cosmetic choice to conceal scars after surgery.
- Laser therapy or chemical peels – once the scar has fully healed, these treatments can help improve the appearance of the scars.
- Do something nice for yourself - if you treat yourself well, you will feel better physically and mentally.

It is not unusual if you lose interest in sex during this life changing event. Stress and concerns about your body image are deeply entwined with sexual activities and can lead to a loss of desire. Also, a range of different factors, such as a loss of hormones or medication side-effects, can lead to uncomfortable or painful intercourse (dyspareunia).

Keep in mind, you do not have to suffer alone. The more you avoid the problem, the more difficult it can be to deal with. Be open and honest with your partner about what you are experiencing and see a medical professional if you have any questions or concerns about your emotional or physical intimacy. You want to make sure you don’t have anything physically wrong that is causing this discomfort.

Below are suggestions that can help alleviate uncomfortable intercourse:

Products to use:
- Lubricants
  - Talk to your physician for recommendations on products to use
- Lidocaine
  - Local anesthesia that numbs the area it is applied to
  - Talk to your physician for recommendations on using this product
- Natural Remedies
  - Natural oils (olive, baby, petroleum jelly)
- Prescription Remedies
  - Talk to your physician for recommendations. Hormone-based products may not be recommended for you if your breast cancer is estrogen driven.
Other Tips
- Yoga
- Switch positions
- Vaginal relaxation exercises
- Cognitive therapy to change negative thought behaviors
- Your doctor may recommend a physical therapist who specializes in pelvic floor therapy to improve vaginal relaxation and lubrication.
- Laser therapies are available to improve vaginal dryness and elasticity.

A relationship with physical, emotional, and intellectual intimacy, is very important throughout your treatment and beyond. As time passes and as your body heals, self-image concerns about your body will subside. You may even find positive changes as you move forward with life:

Change in priorities
Stronger relationship(s)
Appreciation for life
Clarity of life goals
Appreciation for your body

Remember, you are going through this journey with your partner and you are important to one another. By being open and honest with each another, you will be able to make decisions to help you both cope and find solutions that work. If you choose to work at staying intimate with your partner and connected to your body, you can experience an even tighter bond after going through this life changing event together