Medsarticles. Medical Weblog

There is no doubt that most cultures see the breast as a symbol of femininity and the loss of a breast is frequently mourned because of this. Surgeons try to be as conservative as possible but where the priority is longterm survival, and hopefully a cure, the cosmetics take a back seat. Losing a breast can cause a massive psychological reaction, so it is now a relatively common practice for the cancer surgeon to work with a plastic surgeon to reconstruct the breast at the time of the mastectomy. Nonetheless, many women notice a change in their sexual behavior after a mastectomy. This seems to be particularly true of women who rely a lot on breast and nipple stimulation for arousal or orgasm. Sensate focus exercises also come in handy here. The different touching techniques used on other areas of your body stimulate the erotic feelings that build towards orgasm. In the case of mastectomy, it takes the emphasis away from the breasts by discovering other parts of the skin that will give you a similar response.

The loss of a breast can also mean a loss of self-confidence and a reluctance to initiate sex. Rita was forty-two when her breast cancer was diagnosed. ‘I was devastated. I thought they must have put the wrong name on the mammogram. The whole ordeal felt like some terrible nightmare. Matthew and I

had always had a great sex life. We married late and I suppose we were making up for lost time or something. He was always a big breast man and he always said how much he loved the fact that I was well-endowed. When I heard I had to have a mastectomy I thought, “Well that’s it then, he won’t have any interest in me sexually any more. This will turn him right off.” The strange thing was that it was me who had the trouble with sex. I couldn’t bear to let him see me without a shirt on, and I would freeze if his hands went anywhere near my chest. He said it really didn’t matter to him, he was just so glad he still had me. He was so patient and so gentle, I don’t know how I would have coped on my own.’

*136\17\9*

Being able to express our sexuality is one of those things we take for granted, provided everything is going well. If you have a current partner and your relationship is happy, if you both manage to orgasm most of the time and don’t worry when you don’t, if erections are never a problem, and you have matching libidos, then sexuality is probably not an issue.

As a matter of fact, when you consider the intricate blend of factors that need to combine to make it all happen … personalities, emotions, moods, blood vessels, nerves, hormones and muscles … it’s amazing that it works as often as it does.

But things can go wrong and when they do it can come as a huge surprise. For many people, developing a problem with their sexual function will force them to confront their attitudes and beliefs about sex in a totally new way. It can make you question the way you see yourself, your partner, and your relationship(s). On an even deeper level, a sexual difficulty can suddenly bring up all sorts of memories of the sexual anxieties and insecurities of childhood and adolescence.

It is not possible to talk about sexual problems without also dealing with relationship problems. Difficulties with sex always need to be seen in the context of the whole living situation. It’s a chicken and egg situation. Sexual problems can have an influence on the relationship and, if the relationship is in trouble, one way or another it will show up sexually. All sorts of factors can have an impact. Do you have time alone together? Do you have privacy or are you sharing a house with the in-laws? Are you frightened of getting pregnant? Is sex being used as part of a punishment and reward system? Do you resent your partner controlling the pursestrings and holding back money unless they get their way sexually?

*116\17\9*

Letting go of a dream can be punishing. ‘It got to the point where I would avoid seeing any of my friends who were pregnant or who had children. It was too painful; they were just a reminder of my deepest insecurity. When my sister told me she was pregnant, I actually found myself feeling angry with her for having it so easy. Even now I still get a little pang when a friend gets pregnant, but I try to hide it. One good thing though … Tom and I came out of it stronger than ever. We learned to talk to each other about what we really wanted out of life, and we have started to readjust our plans for the future.’

Whatever the results of infertility management, it represents a crisis. Both partners are forced to face emotional and sexual issues that may never have arisen otherwise. .The outcome for the relationship depends on the state of the relationship before the infertility is discovered. If things are shaky and the potential pregnancy is seen as the way to patch up their problems, the added stress of IVF/GIFT might be the straw that breaks the camel’s back. As yet, IVF is generally offered only to married heterosexual couples in a stable longterm relationship. This is partly moralizing but it is largely a recognition of the difficulties a couple will face when the going gets tough.

*95\17\9*

For many years it’s been held to be true that men peak sexually in their late teens and women in their thirties. Are they really so different? Interestingly, these dictums relate more to quantity than quality. Now, at the risk of generalizing, if you count the number of orgasms a man has from wet dreams, masturbation and sex with a partner, combined with the ability to quickly reload and do it again, then the ‘peak’ is around eighteen … but does that make him a better lover? Ask any man in his thirties if he would still like to be making love with the technique he used when he was eighteen and you would surely get a pile of ‘no’ votes. Similarly, women develop a greater ability to orgasm as they get older. It takes time to get it right, and to break down some of the inhibitions that can stand in the way.

In terms of your sexual relationship, there are advantages to a longterm relationship. Getting to really know your partner intimately takes time. The awkwardness and guesswork of the early stages of any sexual relationship develop into a comfortable familiarity that has a passion all its own. The nuances of your partner’s breathing and body movements as they respond to your touch become the unspoken sensual clues in your lovemaking. It is a learning process, and one that evolves. In fact, many people find they can only fully relax sexually when they feel secure in a relationship.

However, longterm relationships have their disadvantages too. While many relationships remain exciting and passionate and fun forever, limited only by the imagination, many people run into problems with sexual boredom.

*75\17\9*

The issue of permanent contraception is a difficult one. Once a person has decided that they have had all the children they ever want to. have, and their partner agrees that they also don’t want any more children, then it is up to one of them to decide to have the operation of tubal ligation for her, or vasectomy for him. One couple put it quite well when Paula said, ‘Of course I would consider sterilization … for him! I have had to take the Pill for years, I have fiddled around with diaphragms, I had the baby … now it’s his turn.’ Noel agreed. ‘Yes, I’d consider Paula having it done!’ An impasse. Let’s just say they are still locked in negotiations. In Australia you don’t need your partner’s permission for either operation, although most people in a relationship would feel an obligation to include their partner in the decision. If one partner wants more babies or has religious or other objections to sterilization, it can set up a real battleground.

There are benefits in no longer having to worry about contraception. Most people are satisfied with the decision and are relieved that they can have sex without the fear of pregnancy. This may need to be balanced against the sometimes negative feeling that you are no longer fertile. Even though it has no effect on your sex drive, some men equate fertility with masculinity and it would be a particularly difficult decision under those circumstances. As hard as it is to face, marriages aren’t necessarily as lasting as the cut in your tubes, and even though you may not be able to foresee it, things can change. So before you take the plunge, it’s a good idea to go through all the ‘what ifs’: ‘What if my partner dies and I want to have babies with someone else?’; ‘I’m still young; what if I change my mind when our youngest has gone to school?’; ‘What if, God forbid, something happened to one of the kids? Would I still feel the same way?’ What I am saying here is that circumstances can and do change, and if you have any doubts at all, then don’t do it. Not yet anyway.

Tubal ligation needs a general anesthetic. The woman’s Fallopian tubes are located, usually by a laparoscope, and they are clipped, or cut and tied. An Australian study showed that up to six percent of women strongly regretted their decision to be sterilized and that one to two percent actually seek reversal — not an easy operation. Others try for invitro fertilization when they change their minds.

*55\17\9*