therapy. Studies have shown that heightened anxiety and depression may last months or even years following successful treatment. Jed Diamond (Male Menopause) notes one of the differences between female and male depression is that the woman constantly wonders, “Am I loveable enough?” whereas the man wonders, “Am I being loved enough?” With love so closely associated with a woman’s figure and sex in their minds, most women treated for breast and female cancers ask themselves questions similar in nature.
It is neither unusual nor shameful to become depressed when you have cancer. If you think you might be suffering from depression, seek professional help. It can markedly improve your quality of life.
Anti-depressants have helped millions of people. But like all medications, each one will work better on some people than on others, because our bodies and metabolisms are different. According to Dr. Robert Hedaya, a leading psychopharmacologist and clinical psychiatrist, “[Only] 60 to70 percent of patients respond to even the most effective medications…Thus, antidepressant medications actually can be said to relieve only 50 percent of the symptoms in 60 to 70 percent of patients.” Therefore, it benefits patients to try and find one that works well for them.
Assessing whether an anti-depressant has the desired effect must be done in the context of the patient’s behavior and habits. Dr. Hedaya notes that “Caffeine, sugar, and alcohol are the three biggest saboteurs of antidepressants. They wreak havoc on your moods, energy levels, and weight…” Therefore, the first step is to assess whether you are doing anything that could prevent the drug from helping you.
Complicating the intimacy picture for post-cancer therapy patients is that a major side effect of most antidepressants is sexual dysfunction. Women may experience reduced libido. They may sense some numbness or reduced sensitivity in the genital area when they are touched, and thus take a longer time to reach orgasm. Some will fail to reach orgasm at all. Since these patients may have emerged from therapy with sexual problems in the first place, antidepressant treatments only compound these problems. So what can the patient do?
The first step is a discussion with your doctor about alternative anti-depressants with fewer sexual side effects. A possible option to discuss is the Bupoprion class of antidepressants, which has been found to have the lowest incidence of negative sexual side effects, and sometimes even to have positive sexual effects. Chapter 12 has more detail on this class of antidepressants. Often, women have to try several different antidepressants before they find one that works against depression and does not cause sexual problems. As always, any decision on medication changes must be made with your doctor.
Complementing your medication, perhaps even as an alternative to medication with your health care provider’s counsel, are techniques such as visualization and meditation, addressed briefly in Chapter 11, that can help you improve your mind-body balance.
Living With Breast Reconstruction
Many women who have had a double mastectomy expect or are given the impression that reconstruction will give them perfectly matched, equal size breasts. In the case of a single reconstruction, they usually believe that the reconstructed breast will closely match the existing breast. Unfortunately, depending upon the quality of the reconstructive surgery and the skill of the surgeon, this is often not the case.
Many women have found that a reconstructed breast, even one well matched at the beginning, may no longer match in situations of weight change and as they get older. Mismatch can also occur with changes in the implant itself.
Other possible complications following breast reconstruction include capsular contraction (tightening of the scar tissue that forms around the implant), infection, hematoma (where blood collects around the implant), delayed wound healing, shifting of the implant, and even rejection of the implant(s) by the body. Women should also be aware that implants are not permanent, and will need to be replaced at some point in the future, requiring further surgery.
One woman had to have nine surgeries related to the reconstructive surgery, some planned and some due to unexpected complications. Nevertheless, she is glad she had the reconstruction.
Some women who have reconstruction want their body’s appearance to be as close as possible to the figure they had before surgery, and some may hope for breasts that are superior in appearance to what they had before. Sometimes this is possible and sometimes it is not. Some women have reconstructive surgery because they want to continue pleasing their partners. Unfortunately, that does not always work. “I can’t get him to put his hand on that breast,” said one woman. “If I put it there, he’ll leave it on for a minute and then take it off.” Her husband comments that her reconstructed breast does not feel as soft and natural as her other breast. Some types of reconstruction feel more natural than others.
The biggest complaint about reconstruction is that women miss feeling aroused by the touch on the breast. The reason: Reconstruction is a cosmetic solution. It does not restore the nerves; therefore the sensitivity in the breast is lost. The good news is that a couple engaging in “whole-body sex” will find plenty of other areas to touch that will arouse both partners.
The greatest benefit expressed by women who have had reconstruction is that it makes them feel that their body looks normal and attractive. Some women who had “matching work” done on the other breast even feel they got an extra bonus because their breasts are now larger or smaller than before, making them look the way they always wanted.
In this chapter, we only discussed the effects of reconstruction on sexuality and body image. The appendix titled “Reconstruction Options” addresses more questions women ask when they are faced with the decision whether they should opt for reconstruction, such as:
•Who should I consult with?
•Is it a good idea to talk with a plastic surgeon before I have a mastectomy?
•When can reconstructive surgery be performed? Does it have to be done at the same time as the mastectomy?
•What are the various reconstruction options?
•How much do these procedures cost? Will they be covered by my insurance?
•How long will it take for me to recover?
A Cauldron of Emotions—and Hope
Emotions often range widely from the time of diagnosis through treatment and thereafter. Depressed, positive, or somewhere in between, feelings are often volatile and driven by reaction to events or to the side effects of therapy.
The bedroom is a potential domestic war zone. Anxiety over what the future holds co-exists with worries whether the partner will still desire the woman after a mastectomy, or whether the woman with a gynecological cancer will still be able to be a good loving partner, even if she cannot handle intercourse. Post-surgery, nervousness accompanies the woman and her partner into the bedroom.
The emotional stage may be set in the hospital corridors, the treatment facilities, and other places, but it is at home where the drama plays out. Bombarded by the physical and emotional effects of the cancer treatment, it is easy for a couple to feel overwhelmed, lose their connection to each other, and start to drift apart. They may stop talking, stop touching each other, and become more and more isolated from each other, which will make them feel even worse. This is utterly unnecessary and entirely preventable.
The remaining chapters of this book provide you with the tools to overcome the considerable difficulty that cancer treatment can create for your love life. Rebuilding your self-esteem and taking steps to energize yourself are the basis for
