Sex After Breast Cancer

I'm a 50-year-old man and my wife is 48. We just celebrated our 27th anniversary. About six years ago, my wife was diagnosed with breast cancer. Thankfully, she has made a miraculous recovery. However, because of the treatments and drugs she had to take after her lumpectomy, her desire for sex has all but diminished. I, on the other hand, still have a very strong sex drive and crave the intimacy that intercourse brings to a couple. It's not like we're not having sex at all. My wife will, on occasion, perform oral sex on me or help me masturbate. She does still seem to enjoy me going down on her, but I can't help thinking: If she has no sex drive, is she really enjoying our "special time" or just going through the motions? I know communication is key for working these kinds of things out, but sometimes I feel like I'm putting pressure on her to "perform." I would never intentionally do that. I just want her to be able to enjoy sex again. I guess I would like to know if you've met or heard from couples with a similar story and what advice you could give on where my wife and I go from here.

For an answer to this question, I turned to my colleague Dorian Solot, who is not only a fabulous sex educator and the author of the book I Love Female Orgasm: An Extraordinary Orgasm Guide, but is also a nine-year breast cancer survivor (find out more about Dorian and her book at www.sexualityeducation.com).

Dorian mentioned six common issues for breast cancer survivors that can have an impact on sexuality: scars and body changes; menopause; vaginal lubrication; the need for additional "warm-up" time; sexual activities outside of intercourse; and what she calls the "Platinum Rule." Here's what Dorian has to say about these issues:

"Many women who have gone through treatment for breast cancer are self-conscious about how their bodies look after surgery and radiation. Some experience pain and numbness at the surgical sites. Have you seen your wife's breast and scars? Have you kissed them, caressed them, talked about them? If not, ask your wife if you could find time for a gentle, unhurried show-and-tell. Let her talk to you about her scars. Explore together the sensations of touch, the borders of the numb area, any new sensitivities. Your wife may need your reassurance that you still find her beautiful, that you're not turned off by her scars or the new shape of her body. She might need your help making peace with the way her own body has changed.

"Chemotherapy frequently plunges women into menopause overnight, especially for women who were nearing menopause at the time they got chemo. Chemo-induced menopause can be more sudden and harsher than the gradual changes of a natural menopause. As you probably know, menopause changes many women's experience of sexuality. If your wife finds that her body doesn't lubricate as much or as easily as it used to-she doesn't get as 'wet'-adding lubricant will be essential for vaginal penetration (and there are lots of fantastic, fun lubes available now, way more than the K-Y jelly on the pharmacy shelf).

"Because of both physical and emotional changes, it may take longer than it used to for your wife to get turned on, so you might need to factor in extra time for 'warm-up.' If it appeals to her, incorporating extras that can spark a sexual flame could help, things like erotica, porn that she likes, sex toys, role-playing, or other 'edgy' sexual adventures that may not have previously been part of your sexual relationship pre-cancer.

"You say that your wife seems to enjoy oral sex-it's entirely possible that she does enjoy receiving sexual pleasure, just not penetration. You might talk with her about this and consider other ways you can help her experience pleasure if intercourse isn't doing it for her. Would she like to masturbate while you kiss her neck and lick her shoulders, or tell her sexy stories? Long, slow, sensual massage-complete with candlelight, massage oil, maybe even chocolate syrup-can be incredibly intimate without any penetration or orgasm. Unless the goal is to make babies, there's no rule that says that marital intimacy should be limited to-or even include-vaginal intercourse.

"Finally, accept that she may be happy to give without receiving. It sounds like you already understand the importance of communication. If you've talked about all of this at length and she is emphatic that this is the case, accept the possibility that it may truly bring her pleasure to pleasure you. It's possible she enjoys giving handjobs and blowjobs, or taking part in your masturbation, because the acts themselves are fun for her-or because it's fun to turn you on. While you might not choose this kind of 'giving without receiving' yourself, my relatives call this concept the Platinum Rule. It's a step beyond the old Golden Rule that emphasizes doing for others what you would want yourself-the Platinum Rule means understanding what others want and allowing them to have that, even if it's not what you would want for yourself."

Want Laura to answer your questions in SEXpress? Send them to laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master's degree in public health and has worked as a sexuality educator for more than a decade. She owns the Tool Shed, an erotic boutique on Milwaukee's East Side.