Sexuality and Intimacy After Breast Cancer

painful sex after breast cancerMany women undergoing breast cancer treatment or those who have gone through breast cancer treatment may get painful sexual intercourse. Lets lay it on the table and talk about another common hurdle breast cancer heroes encounter. breast cancer treatment approaches like surgery, radiation therapy, chemo-therapy and estrogen modulation therapies can greatly alter sexual experience.

While most breast cancer survivors are grateful and excited enough to be cancer free, and most of breast cancer survivors could care less about sex immediately after conquering the disease, sex is an important part of human life. Women should not be without sex especially after coping with breast cancer treatment as this could add on to body disfigurement related stress. Women should be supported and encouraged to engage in sex. It’s time the world accepted breastless and scarred breasted women as normal. Sex is a good communication tool for lovers and it should be addressed without shame or reservation. Let’s talk about the commonest causes of painful sex after cancer treatment.
  1. Vaginal dryness
  2. Muscle Spasm

Vaginal Dryness

Sex feels great and painful sex can be heartbreaking. Sex is pure friction but vagina is adapted to withstand this friction. In fact, sexual friction is what causes pleasure in sexual intercourse, not lack thereof. Vaginal walls are made up of several layers of cells naturally adapted to protect deeper layers from getting damaged by sexual friction. These protective cells also produce lubricants that reduce the amount of friction.
Over 50% of breast cancer cases are estrogen receptor positive. One of the treatment combination therapy is to block estrogen production or action on receptor cells. Vaginal wall cells are maintained by estrogen. Lubricant production is another function of estrogen hormone. When attempt to save breast cancer heroes lives involves estrogen therapy, vaginal wall dryness occurs causing painful sexual intercourse.
Most chemotherapeutic agents target fast growing/generating cells (like cancer cells) in the body. Cells naturally adapted to withstand friction and produce lubricants belong to this group, among other cells like hair follicle cells and nail germinal cells. This explains why hair and nails falls off. Vaginal walls cells and other cavity cells like oral cavity are easily damaged by chemotherapeutic agents. Most women who have undergone chemotherapy have had oral sores.
Oxytocin, also called “Love Hormone” is a very important hormone in sexual pleasure experience. While oxytocin is produced by pituitary gland, stimulation of breast nipples have shown to increase its production. This oxytocin spurt has shown to have effect on orgasmic experience and relaxation of vaginal walls.
Mastectomy and other breast surgeries usually damage areola (nipple dark part), the most sensitive breast tissue decreasing sexual pleasure. This explains why breast fondling before intercourse is not only pleasurable but also causes arousal and lubrication. With mastectomy or surgeries that may severe breast nipples, sexual intercourse may be painful due to poor lubrication (in addition to chemo damaged lubricant producing cells) and tension of vaginal floor.

Vaginal Muscle Spasm

Oxytocin production causes uterine walls to contract and vaginal walls to relax, making delivery of the baby easier. When vaginal walls/floor is deficient of lubrication (estrogen) and oxytocin, sexual experience can be very painful. Initial pain causes even more pelvic wall contraction causing even more pain.
Stress related to dealing with breast cancer treatment worsens these vagina wall spasms. Pleasurable sexual experience in women is a combination of many factors, not just one. Emotional or physical stress can completely alter sexual pleasure or even inhibit arousal.


Oil based lubricants may prove helpful in situations where dryness is the primary cause of painful sexual intercourse.
For women with estrogen receptor positive breast cancer, talk to your doctor about estrogen related options like estrogen ring (estring). No not use such options without asking your oncologist.
Foreplay and use of toys may help in decreasing vaginal muscle spasms before penetration. The couple should use toys that are comfortable for both of them to enhance the overall sexual experience.