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Sex After Cancer

After breast or prostate surgery, many wonder about intimacy. New surgical techniques are helpful, but an understanding partner and a reevaluation of what's really important go a long way to dispel fears.

August 14, 1996|KATHLEEN O. RYAN | SPECIAL TO THE TIMES

Prostate cancer. Breast cancer.

Two gender-specific diseases with distinctive similarities.

Deadly when left untreated, both claim similar numbers of lives--at least 40,000 people in the United States will die from each disease this year--and both strike a very intimate side of self-image.

The outcome of most breast and prostate cancer surgeries is good. Yet, in the process, sexual self-esteem is often jeopardized. A man cannot comprehend losing the external badge of femininity. A woman will never know how erectile dysfunction shatters manhood.

The journey from discovery to beyond recovery can be soul stripping.

"I wondered how our sex life would change after the surgery," says Sandy Chaplain Bailey, 52, a Seattle poet. "In our lovemaking, my breasts were a large part of foreplay and comfort afterward. For us it complicated things for a while, but my husband was very reassuring in letting me know I was still desirable to him. I knew that my breasts didn't define me," she says.

FOR THE RECORD - Update
Los Angeles Times Friday August 16, 1996 Home Edition Life & Style Part E Page 2 View Desk 2 inches; 47 words Type of Material: Correction
Cancer tests--A Life & Style story on cancer Wednesday stated that African American men should receive a digital rectal exam (DRE) and a prostate specific antigen (PSA) test yearly, starting at age 50. According to new guidelines just issued by the American Cancer Society, the recommended age to begin testing has been lowered to 40.

Bailey says intimacy was emotionally and physically painful after surgery in May 1995.

"You are left with muscle and bone. I didn't realize how much I would miss my breasts, especially during an embrace," she says. "Foot rubs became very important."

Linda Dackman, a San Francisco author who wrote about her experiences in the book "Upfront: Sex and the Post Mastectomy Woman" (Viking Penguin, 1991), says being undressed is definitely the moment of truth.

"It's a metaphor for exposure," she says. "For the woman without a mastectomy, her body may be the first layer to her inner self."

Dackman, who had her surgery at 36, says that even 10 years later she still wears a camisole when in bed with a lover for the first time. The reconstructed breast still reminds her of a blind eye with a vacant unmoving stare. She says it will never feel like a natural breast.

"In the beginning, it was hard to understand why a man would want to go out with a woman with one breast, when he could go out with a woman with two breasts," she says. "I was reducing myself to my body parts, not my personality. The men could see that more clearly than me."

After her mastectomy, Melissa Jeffries thought she would never date again. "I thought I'dnever find someone who would be comfortable," says Jeffries, 38, who works at the Long Beach Memorial Breast Center.

The man she eventually married didn't mind at all.

"The first time we were intimate I remember feeling very self-conscious, but he made a real big effort to pay attention to both sides, even though there isn't feeling on the reconstructed side. He made me feel sexy and wanted. I finally let my guard down."

Jeffries says the fears of sexual encounters become trivial when compared with the emotional risk of becoming involved when you have a history of cancer. At 29, Jeffries had a lumpectomy; at 34, a mastectomy; and at 36 her ovaries were removed to stop estrogen production.

"The issue becomes: Is this someone who will want to stick through it with you if there are recurrences?" she says.

Indeed, the support of "a good relationship can be very important," says Dr. Patricia Ganz, oncologist and professor at the Jonsson Comprehensive Cancer Center at UCLA and director of cancer control and research.

"Most studies show the mood of the partner is very much affected by the mood of the patient," Ganz says.

Adds Carolyn Livingston, a Seattle registered nurse and certified sex therapist, "In therapy [men] talk about how much they may miss this part of her. Some find it difficult to look at the scars that remind them something is missing."

Dackman says it is her scars that frighten men the most, sometimes bringing up life and death issues of their own. Dackman recalls her first post-mastectomy sexual encounter as tearful.

"Most times the first post-mastectomy experience is tearful and very emotional," says Livingston, who advises couples to sit down and map out that first sexual experience.

Tom, 60, of Century City (who asked that his last name not be used) remembers a girlfriend who was concerned about their first sexual encounter.

"She'd had a radical mastectomy and was worried about what I would think," he says. "I had to be honest. I told her it would have been nice if she still had her breast, but this is her now and I accepted that. I told her it was fine."

Now, Tom can better understand how she felt since he had prostate cancer surgery five years ago. He doesn't wish things were different. He simply accepts that his sexuality is defined differently now.

Like a growing number of radical prostatectomy patients, Tom had surgery that not only saved his life, but also allows him to have erections. Although the sexual desire is still there, sex is undeniably different. Erections are infrequent, and because there is no seminal fluid, orgasms are dry and can occur whether flaccid or hard. Tom says much depends on how he is manipulated physically. He is upfront and honest with his partners.

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