SEX AND HEALTH: SOME THINGS THAT CAN GO WRONG FOR WOMEN- MASTECTOMY

A mastectomy (removal of one or both breasts) is a major blow to most women’s sexuality but the negative psychosexual effects can be greatly reduced by careful psychological preparation before the operation. With modern trends in the treatment of breast cancer fewer women are having their breasts removed so the problems associated with mastectomy are likely to be seen less frequently.

Once the operation and its immediate after-effects are over, worries about sex and sexuality often dominate a woman’s emotions about mastectomy. Many women say that they feel less of a woman and the natural reaction in the early days is to feel unsexy and undesirable. Some women even feel strongly enough to say that they would rather have kept their breast and lived a few years less.

The one key factor to emerge from the large amount of research into this subject is that the role of the woman’s partner is absolutely crucial. This is true of women of all personalities and of all levels of intelligence and education. Ideally, the woman’s husband should be actively involved through the whole process right from the time when the lump is discovered. In this way the woman feels she has the support she needs and so fares much better.

There is no reason why sexual intercourse should not be resumed the day the woman gets home. There is no such thing as too much sex after a mastectomy and as long as the wound area is not hurt there are no problems. It is a matter of trial and error to find a position that is comfortable for the woman and then to use it until healing is complete.

Some women are afraid that their partners will leave them – the underlying fear being that a woman with one breast is not able to attract and keep a man. The facts are that men are no more likely to leave their partner after a mastectomy than otherwise and that most worry a lot about how to be supportive and helpful. Although most women try to hide their chests from their partners (especially in the early days), most men are not as upset by the loss of the breast as their women think they will be.

Some couples approach mastectomy with considerable existing psychosexual and relationship problems and for them the mastectomy may be the last straw. That this is unusual can be seen from one study which found that two-thirds of post-mastectomy women judged their emotional state to be excellent or very good. Women who fared best had been married longer, had found their partners (and doctors) more supportive and were pleased with the response from their children and the hospital staff.

Strange though it may seem, most women say that the worst time emotionally is immediately after the lump is discovered. Only one in seven women in one study found the immediate

post-operative period the most difficult. Although most women have thoughts about mutilation, loss of femininity and death, several studies have found that the good news outweighs the bad. One study, for example, found that 71 per cent of women rated their husband’s reaction to the mastectomy as extremely or very understanding; 76 per cent felt that the loss of the breast made no difference or had a positive effect on their sexual satisfaction or their ability to be orgasmic; and 60 per cent rated their overall post-mastectomy adjustment as ‘very good’.

Many women have married after a mastectomy. If you are still having periods, you may find you will get the same sort of discomfort on your mastectomy side as you previously had at this time of the month.

Remember that talking about it with your husband, family and friends is bound to help. Slowly they will all come to terms with your new condition.

Stages of breast self-examination:

1) Stand in front of a mirror with your breasts bare. Look carefully to see if there is any change from your normal appearance.

2) Raise your arms and see how your breasts move. Are there any dimples or bulges that change their outline? Does each nipple point in the same axis as its breast? Is there any puckering of the skin?

3) Gently squeeze the nipples. If more than a drop of colourless fluid emerges, see your doctor.

4) Lie down on your back with a small pillow or towel under the shoulder of the breast you are feeling and work slowly round the breast, section by section, feeling with the tips of your fingers for lumps.

5) Don’t forget to feel at the very edge of the breast tissue which can extend high up on the chest and