is a perfectly normal response to being diagnosed with cancer and thinking about various types of treatment. It usually subsides, at least somewhat, after treatment is begun. Anxiety can intensify if you fear that symptoms such as pelvic pain or vaginal bleeding mean the cancer has recurred. Anxiety can be substantial and chronic, upsetting behavior, disposition, and the overall feeling of wellbeing.
Affecting every aspect of daily living, anxiety is well known to interfere with the normal cycle of sexual activity. It is likely to delay and lower the level of sexual response, regardless if medication is used. A woman’s worry regarding how she will handle her partner’s expectations once they resume having sex can inhibit her from being an active partner or even attempting to engage in sex.
Marilyn, a young single woman who had a mastectomy, was fearful about going out on dates because her companion might want sex. “If he asks me, and I say no, he will probably not ask me out again. If I say yes and he sees a half-woman, he’ll walk out. I can’t win.”
In committed relationships, the partner’s anxiety can reinforce the patient’s concerns. In this situation, each partner’s distress can further increase the other partner’s discomfort.
The stress of both partners can be lessened if they take an approach of “Let’s try different things and see what happens.” Tension will be lessened if both partners can accept that they will jointly decide on things such as the woman remaining clothed during sex. In fact, her being dressed in clothing that both partners find exciting can be part of the sexual event.
Anxiety is also linked to the anticipation of being rejected. After therapy, women may project the way they feel about themselves onto their partner and take unwarranted actions. Anxiety after diagnosis is to be expected. But if it cannot be brought under control, psychologial treatment should be considered.
Fear of Rejection
Since the day I told him I had breast cancer, he hasn’t touched me.
Deborah
The “R” word. Many women do not want to even think it. But it exists. One woman who was single was worried about how her boyfriend would behave after her mastectomy. She did not think she could handle the rejection she expected, and was preparing to end the relationship so she would not run the risk of being rejected.
Janice told the sex counselor that when she came home from the hospital and began to get undressed in the bedroom, her husband was there. All of a sudden she felt rather warm and nausea attacked her. Her mind was in a jumble. Would he walk out? (He didn’t.)
Debra came home from the hospital and went to lie down. Her husband told her he had to leave town on a business trip. Although she said okay, she thought, “Why did he have to go today? He owns his business and controls the schedule.” Her next thought was that he didn’t want to be with her.
Some women may feel rejection even when it does not exist. It’s easy to over-interpret hesitation in your partner’s voice, a look to the side when you are undressed, or to sense that he wants to pull away when he sees your unclothed body.
The anticipation of rejection can loom large when it comes to sexual activity. Fearing the partner’s reaction to the scars can cause the woman to isolate herself, mentally as well as physically, to avoid getting into a sexual situation. An extended length of time since a couple was physically intimate compounds the problem. Resuming sex after a hiatus can be stressful. Unless the partners discuss the issues before resuming sex, sex is less likely to be satisfactory.
Identity Disorder
Without my breasts, what am I? I see myself in the mirror every day. I’m only part of who I was. Nobody will want me.
Naomi
Amy is pretty, a size 8, and full of energy. A routine mammogram led her doctor to call her in. He told her, “It doesn’t look good.” The analysis showed a possible cancer in one breast. The biopsy proved it.
Then she had to make a decision. Consultation with her new doctor led to her decision to have a mastectomy. She had surgery for breast cancer in her left breast. Then she decided to have a second, prophylactic mastectomy.
After surgery, Amy began to regret her decision. Her husband loved her breasts. What would he say now? He had always been supportive of everything she did. Also, this was her second marriage. The first one was abusive. She was lucky to have met Frank. And he was younger than she was. What if he went elsewhere because she had no breasts? “Am I still a woman?” she wondered. “Women are supposed to have breasts. Is a woman still desirable without breasts? I’m not having any more children. But in our society, a woman’s desirability is biased by how men view her breasts. I have none.”
Suddenly, attractive Amy no longer existed in her own mind. She had lost her identity. At the very least, it was severely disabled. “I’m a woman with no breasts,” she said. “I’m still a woman, perhaps, but certainly not a normal woman. How will people look at me? What will Frank think? What will Frank do?”
No matter what their size and shape, a woman’s breasts are connected to both her body image and her total identity as a woman. Her identity encompasses everything she presents to society. A change in her female anatomy often causes a change in a woman’s self-perception. Although it is not a universal or inevitable reaction, a woman’s identity is often shattered with the loss of a breast or female organ.
Some women with cancer begin to define themselves through the disease or the consequences of treatment. These women create a barrier between themselves and others. They may see themselves several times a day and say, “So this is me. I don’t think of myself as a woman. I am not the total person I was when I entered into this relationship.”
Women with gynecological cancers can have as much identity difficulty as those with breast cancer, even though their exterior figures may remain intact. For them, the scars of one or more surgeries are evidence that the body is no longer the same. The resulting change in hormonal activity keeps reminding women of the changes to their bodies. Women who were planning to have children are deeply affected by infertility.
With this sense of a change and “defective” identity, the woman distances herself from her partner and from the mutual enjoyment possible during sexual activity. She defines herself as different and unlovable due to the effects of therapy. A woman who feels unattractive or ugly for an extended period of time following cancer treatment will withdraw from situations where she must interrelate with other people. They, in turn, perceive her as unfriendly or as preferring to be alone, and no longer try to interact with her, leading to further social isolation.
Depression
Early in the relationship, I was satisfied probably 85% of the time. Now I’m not satisfied. I’ve been on depression medicine. I keep hoping it’s that. My doctor changed my medicine. He says, “Maybe this one will work.”
Brenda
Depression occurs in about one in four women with cancer, twice the rate of the general population. Depression and anxiety are closely related, since they can be promoted by similar conditions such as the diagnosis of a severe and possibly life-threatening illness and the presence of unpleasant symptoms, such as pain, nausea, and fatigue. In addition, there are the worries about changes in life plans, quality of life, and disease recurrence.
Depression or anxiety
