Sexuality and intimacy for LGBTIQ+ people with breast cancer

Physical and emotional changes associated with breast cancer may affect your body, sexuality, intimacy, desire and feelings of pleasure. You may find that sexual practices you used to enjoy are now difficult or painful. You may no longer enjoy certain parts of your body being touched, or new areas of your body may be sensitive and easily stimulated. Your body image and identity as a LGBTIQ+ person may change due to the impact of cancer treatment. These changes can affect your intimate relationships. There are things you can do to deal with these changes.

Changes to sexuality and intimacy during your cancer experience

What is sexuality and intimacy?

Sexuality is how you express yourself sexually, with your partner/s, and your sexual feelings for others. Intimacy means being close to someone else, emotionally and physically. Sexuality and intimacy are different for each person. Sexuality and intimacy can change during and after breast cancer.

How does my body change?

Cancer treatment can directly affect your ability to enjoy sex. You may experience loss of breast sensitivity, vaginal dryness, pain, reduced desire for sex, or difficulty getting or keeping an erection. You may experience early menopause. Weight gain, hair loss, mastectomy scars, hot flushes, tiredness, and emotional changes can also affect how you feel about your body, and your sexual desire or pleasure.

You may experience enhanced stimulation, at unexpected times and in unexpected parts of your body. Changes to sexuality may affect your ability to conceive and birth a child. See Fertility for LGBTIQ+ people with breast cancer

These changes can be short term, or may last for a long time. See 'Sexuality, Intimacy and Cancer: A guide for people with cancer and their partners' in the resources section below for further information.

If you use hormonal therapy (such as for gender affirmation or related to intersex variations), and you are diagnosed with a hormone receptor positive breast cancer, you may need to stop taking your hormonal therapy during your cancer treatment. This may affect your mental wellbeing and may also affect how you see yourself. For some people, it creates feelings of discomfort.

Some trans people feel more comfortable in their bodies after mastectomy, with positive effects on their sexual relationships. See Trans and gender diverse people with breast cancer

How can my intimate relationships change?

The demands of treatment and recovery may affect your relationships with intimate partners. Your partner/s may be helping you with medications or providing other forms of care such as bathing. They may be taking on more responsibilities in the home. This can alter your pattern of relating and make it difficult to be intimate.

You may be too tired to do the things you usually do with your partner/s and chosen family. As a result, you may feel isolated from LGBTIQ+ communities and other support networks. For more information about supports, see Social support for LGBTIQ+ people with breast cancer

You might miss the life you had before cancer, or wish that cancer had not interfered with your relationships. You may want to talk with each other about your feelings, but are afraid of upsetting each other.

Are these changes to sexuality and intimacy important?

You may not be concerned about changes to your sexuality during your cancer journey. Sex may not be important in your life or your intimate relationships. You may accept changes to your sexuality as part of aging, or be focusing on recovery from breast cancer right now. Some people report that they are closer to their intimate partners after cancer, even though they are not having sex in the ways they used to.

If sex is part of who you are as a LGBTIQ+ person, or is important in your life, sexual changes can be very distressing. You may be concerned about the impact of changes to sexuality and intimacy on your partner/s, worrying that they will leave you. You may worry about starting new relationships. Changes to sexuality may affect how you see yourself, or how you relate to others romantically or sexually. See LGBTIQ+ Body image and gender.

The next section is about things you can do to help deal with these changes.

How to adapt to changes to sexuality and intimacy

Talking about changes to sexuality and intimacy

There are many ways to adapt to changes to sexuality and intimacy during your breast cancer journey. Talking to your partner/s is important. Communicate about what pleasure means to you and share your concerns about having sex or being intimate. Tell them when you are ready to have sex and if they should do anything differently to help you to feel pleasure. Talk about which parts of your body feel numb, sore, excited or stimulated. Explain how your body may have changed during or post treatment. Ask your partner how they are feeling. They may be worried about hurting you or upsetting you by wanting to be intimate when you do not want to.

Exploring new ways of being intimate

The ways you usually enjoy having sex or being intimate may be difficult or not possible during and after breast cancer treatment. Keep an open mind about ways to experience sexual pleasure and closeness. Explore different erogenous zones through touch or kissing; try mutual masturbation or oral sex; use lubricants, vibrators and other sex toys; look at erotic images and stories; discuss sexual fantasies. There are a range of ways to explore sexual pleasure, in addition to sexual intercourse. This can help with adaption to sexual changes after cancer.

If you have had surgery to your breast, it may be useful to spend time alone touching these areas to find out whether there are changes in how you feel. Is there any, soreness or numbness, and what provides pleasurable feelings? When you are ready to be intimate with your partner, this preparation and exploration can help you to tell your partner what feels good.

You may want to explore non-sexual ways of being intimate, such as cuddling, expressing love for each other, going on a date, having a bath or shower together, or massage.

Communicating with a new partner

You may be worried about starting a new sexual relationship in the future. When do you discuss changes to your body, or that you’ve had breast cancer?

It is natural to be worried about feeling vulnerable when you are naked for the first time in an intimate relationship. This can be more difficult in casual relationships, where you have not had time to build up trust. It may be helpful to rehearse a few phrases you could use when talking about cancer. Before starting any sexual activity, talk to your partner about any changes to your body. Getting support from other LGBTIQ+ people with cancer can help you with this process. See Social support for LGBTIQ+ people with breast cancer

Seek professional assistance

It can be helpful to talk to your treating team about changes to sexuality and intimacy, so that they can help you. Recognition and validation of your sexual orientation or gender is a crucial part of receiving support. Try to find a doctor or sexologist with whom you feel comfortable talking about your sexuality and relationships. If you have a partner, take them along to doctor’s visits. This will show your doctor who is important to you and will enable your partner/s to be included in discussions and treatment plans.

Your treatment team may not have experience or confidence in discussing LGBTIQ+ patients’ sexual concerns. They may make inaccurate assumptions about your sexual activities. If you are comfortable coming out to your treating team, you can tell them about your intimate relationships and explain your specific sexual concerns. You can also ask for a referral to a LGBTIQ+ friendly sexual health physician or sex therapist, to help you find solutions See LGBTIQ+ friendly breast cancer services.

Acknowledgements

These materials were developed from the Out with Cancer Study, conducted at Western Sydney University, and funded by the Australian Research Council. Thanks are offered to the Out with Cancer study committee members with lived experience of cancer, BCNA LGBTIQ+ consumer representatives, ACON and LGBTIQ+ Health Australia who contributed their time and expertise.

BCNA's LGBTIQ+ project was undertaken with support from Cancer Australia through the Supporting Women in Rural Areas Diagnosed with Breast Cancer program.

Resources

• Cancer Council - LGBTIQ+ People and Cancer. The Cancer Council NSW has detailed  information on its website including a downloadable book that will help you understand how cancer and its treatment may affect LGBTQI+ people – lesbian, gay, bisexual, transgender, queer, and other diverse sexualities and genders, as well as people with intersex variations.
• Sexuality, Intimacy and Cancer: A guide for people with cancer and their partners. This booklet is for people with cancer and their partners. It aims to help you understand and deal with the ways cancer and its treatment may affect your sexuality. It does not need to be read from cover to cover – just read the parts that are useful to you.
• Ask the Expert: Menopause - It's more than a hot flush!
  Many people experience changes to their sexual wellbeing associated with breast cancer treatment, that can be caused by menopause or menopause-like symptoms. These can include vaginal dryness or discomfort, loss of libido (sex drive) and fatigue. You will hear from Dr. Tonia Mezzini, a Sexual Health Physician and Naveena Nekkalapudi, a BCNA Consumer Representative, who will provide you with strategies to help manage menopausal symptoms and discuss the supports available to assist you with your sexual and emotional wellbeing. This video was recorded on 6th December 2023.