Guest Post: Not Just Another Body Part

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Today, I am really excited to share a guest post by my colleague and friend, Dr. Betsy Bates Freed. In addition to being a clinical psychologist, she is also a medical journalist who writes a weekly blog for Oncology Report.

Where breast cancer is concerned, every woman’s viewpoint is unique.

And in each individual patient, we’ll never know what that viewpoint is until we ask.

Patients want oncologists to discuss sexual function within the context of breast cancer treatment. In fact, 60% of women hope their oncologist will introduce the topic of sexuality, but the talk takes place just 23% of the time.

This post explores sexuality and breast cancer. Because, as you well know, if you live in the Western world in the 21st century, breasts are not just functional body parts that happen to be a cancer site. Complex doesn’t even begin to describe the role they play in terms of a woman’s sexuality, sexual self-image, and sexual relationships.

Sexuality potentially suffers from many aspects of breast cancer treatment, and that may arise from pain, hormonal changes, relationship upheaval, and a realigning of life priorities following an unexpected and frightening major life event.

When discussing sexuality is taboo, as it all-too-often is, none of these issues come to the fore. And neither do breasts. Specifically, what they mean to a woman facing tough decisions about treatment alternatives, reconstruction options, and behind-closed-doors scenes that will play out when she’s standing alone before the mirror or sharing an intimate moment with a sexual partner.

In speaking with several survivors, dabbling in the sparse literature on the topic, and eavesdropping on virtual conversations online, I am reminded that today’s women of all ages face complex pressures (cancer-imposed, self-imposed, partner-imposed, and society-imposed) when making cancer-related decisions about their breasts.

Can a woman be a card-carrying feminist and still yearn for a restoration of the beauty as well as the sexual function of her breasts, or the “fetishized sexual objects that men have turned them into” – as one blog poster put it?

Another woman confided, “It seems that my feminine persona is more wrapped up with [my breasts] than I realized – and I somehow can’t help feeling like I would be less of a woman, or maybe just less of me without them. … Am I betraying my principles?”

Wanting to further explore the issue of breasts, sexuality, and breast cancer, I spoke with a beautiful young cancer survivor who expressed her tremendous gratitude to an ob.gyn. who openly and in a matter-of-fact way discussed her breasts, sexual relationship, and yes, sexual function in a way her oncologists never had, since she had felt caught unprepared for the catastrophic hit that her sexual relationship, as well as her body, had taken during her cancer battle.

I spoke to another survivor – this one middle-aged – who was stunned into silence when a physician casually noted that she needn’t worry about ever replacing the breast implants she would receive during reconstruction, as is periodically necessary. When that day came she would be in her 70s, he mused, and the implants would simply be removed, since she “wouldn’t be needing” her breasts anymore.

It was against this backdrop that I read the study “Pink Ribbon Pin-Ups: photographing femininity after breast cancer” in the journal Culture, Health & Sexuality (2012;14:753-66).

Author Kaitlyn Regehr described her controversial project, which raised money for the Canadian Breast Cancer Foundation, as a reaction to gallery portraits and coffee table books depicting “haunting” visages of women’s scarred, postmastectomy chests, bald heads, and gauntly disfigured bodies.

I’ve encountered women whose empowerment came from saying “no” to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.

I’ve encountered women whose empowerment came from saying “no” to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.

In other words, it’s complicated.

And we’ll never understand how it is for a particular woman until we frankly discuss breasts in the context of breast cancer – not just how they appear, clothed or unclothed, but what meaning they hold for her sexuality and sense of self.

To read more of Dr. Freed’s articles, please visit: http://www.oncologypractice.com/oncologyreport/views/vitality-signs/

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Comments

  1. Catherine says

    This post really spoke to me. I had a bilateral mastectomy 18 months ago after a FBC diagnosis. I made the decision without hesitation, and I would still make the same decision because of my type of cancer, genetics, etc. That being said, no one in the process ever discussed with me how much removing my breasts would change my life. How much I would miss them. How I would feel differently about myself. I wish someone had taken the time to explain that to me. I have mourned the loss of my breasts more than I ever dreamed. I keep thinking that I should tell my breast surgeon, my plastic surgeon and/or my oncologist (all people I love and respect) that they should talk to women more about how it feels physically and emotionally, but they never ask and I never bring it up. Looking back, I'm not sure that I would have been able to listen to anyone while I was in the crisis, but maybe I would have been better prepared for the feelings that came afterwards.

  2. Monique Doutre says

    At a recent conference, there was a booth called Sexy After Cancer…her name is Barbara (something!) and she has a GREAT book which can also be used as a launching point/talking point. Thank you Hollye! Thank you so much for what you do & what you say & who you are. FBC definitely did NOT take that from you!!!

  3. says

    I have been desperate to have this conversation since my bilateral mastectomy in January of 2011. This column is a starting place but really how do we get the conversation started. Saying we need it is obvious. The "how to", "where to" , "to whom" and "with whom" are the hard parts.

    • says

      You're so right, Jill. The Silver Lining is that we have the starting place and I'm hoping to provide the "how/where/whom" elements soon. Thanks for writing!

    • says

      Of course you can, Monique. Please share it wherever you like. Thank you for asking. I hope that it is helpful for you and others. Take good care! Hollye