The area under discussion is very personal and sensitive. Key themes found were:
These themes will now be considered in depth.
Relationships and Sexuality
Relationships have been shown to experience substantial stress during breast cancer, with reports that 25% of breast cancer patients suffered relational strain, 35% felt their partners to be emotionally unavailable, and 12% reported a separation (13). Although Walsh et al. (13) indicated that separations were mostly initiated by men who were unable to cope with issues relating to their partner’s cancer, the first participant commented to the contrary that the psychological pain experienced by women is a major contributing factor to relationship dissolution.
The partner, the second participant, reflected on her experience and agreed that although it is commonly perceived that male partners are responsible for separations, it may well be that women wrongly perceive their partners to be uninterested and repulsed, and so remove themselves emotionally and sexually.
It appears that breast cancer diagnosis has a way of bringing pre-existing marital problems into the limelight (8). However, for a proportion of patients and their partners, breast cancer has been shown to create a greater sense of closeness in the relationship (13). This was certainly the case for participants 1 and 2, who both believe their relationship is greater, overall, as a result of the experience. Nonetheless, this did not occur without an initial and lasting blow to their sexual relationship. The sexual relationship ceased entirely for at least 12 months, and even 5 years after surgery, sexual activity was not quite the same. The participants commented that a lack of sexual satisfaction may be one reason why men initiate separation.
Some men may withdraw from making sexual requests as a consequence of feeling disturbed by physical appearance after surgery or in response to their partner’s anxiety, depression, and altered body image (10). For participant 1, it was simply about giving his partner time to heal and come to terms with the surgery. He considers that his respect for his partner’s desire for time and space contributed to a strengthening of their relationship. In spite of a decrease in sexual activity, he believes that their sexual relationship actually went through “a healing process,” in relation to breast cancer.
In regards to his ability to cope with changes in the relationship and support his partner, participant 1 acknowledges that not all men may be as understanding and proactive. Indeed, participant 1 may be substantially different from the majority of population of interest, i.e., spouses of breast cancer patients. Researchers have hypothesized that that those who experience greater relational strain and difficulties relating to body image and sexuality, are those spouses who find communication more difficult and therefore those who are unwilling to participate in the present study.
The current research has argued that sexuality is a deep, pervasive, and integral aspect of the total human personality (1), and is in fact central to a person’s sense of wellness and self-concept. Despite its importance, Henson (10) found that healthcare providers simply do not discuss sexuality and related issues. Participant 1 confirmed that:
we weren’t getting told anything that was happening…Like what was going to be the effects of chemotherapy, what was going to happen, how we could help our wives…sexuality, sexuality how that was going to interrupt their sexuality, how it was going to interrupt and stuff up the whole life of our lives too, because it was a rude turn around for us as well.
Participant 3, from a sexual health support service expressed a similar concern and sadness that women who are suffering from breast cancer are simply not counseled in regard to issues relating to sexuality, let alone their partners. During a recent sexual health nurses network night organized by participant 1, a breast cancer patient presented her experience in regard to sexuality stating that no one had talked her through how she was feeling and strategies to move on from how she was feeling, particularly about the mastectomy. It appears that even now, in a time of increasing focus on holistic and primary health care, sexuality issues are often not addressed by health care professionals.
Sexuality encompasses one’s most intimate feelings of individuality (2) and relates directly to our well-being and experience of ourselves as sexual beings (3). For breast cancer patients, the current research has found that the amputation of a breast affects a woman and her sexuality in a profound and lasting way. Participant 2 feels that she has never fully come to terms with the dramatic assault on her body caused by the mastectomy, and this undoubtedly affects her conception of her self as a sexual being. Research has indicated that many patients of breast cancer feel more self conscious (13), less attractive (10) and have poorer body images than their healthy counterparts (11). The results of the current study support these findings.
Summarizing the importance of sexuality, participant 4 said:
Sexuality for people who’ve had cancer, can be a very healing thing. That relationship that you have with your partner, the intimacy, the sensuality …that’s often what people crave…Yes, sexuality is a part of us from life to death.
Sexuality and body image are clearly central to one’s identity, self-concept and relationships, and, all of these aspects are severely compromised during breast cancer. Our society needs to improve our understanding of the experience of breast cancer and the effective ways of providing support; the impact of cancer can be lessened, for the patient and her partner.