A breast cancer survivor is speaking out about the profound and often unaddressed impact that life-saving treatments can have on intimate relationships. Sarah Cawood, who was diagnosed with stage one breast cancer in August 2021, detailed her experience with a significant loss of libido and painful sex, issues she believes are a 'last cancer taboo.'
Cawood, 53, underwent a lumpectomy and radiotherapy, and is now on a five-year course of aromatase inhibitors to reduce the risk of recurrence. These drugs suppress estrogen production, inducing a medical menopause. While effective in fighting cancer, the treatment brought unexpected side effects, including hot flushes and joint pain. More intimately, a couple of months into the medication, she experienced vaginal dryness, or atrophy, and vaginismus, an involuntary tightening of pelvic floor muscles that made sex agonizing.
"Simply put, my pelvic floor is so tight that it feels like there’s a wall in the way," Cawood wrote. She noted that when she searched for information, she found few discussions among breast cancer survivors about these specific issues. This lack of shared experience prompted her to speak openly in hopes that other women would know they are not alone.
Impact on Relationships
Cawood described how the physical pain and her diminished libido created a cycle that strained her relationship with her husband, Andy. "Every time Andy and I became intimate, I started tensing up in anticipation of the pain and, because Andy knew he was hurting me, he eventually stopped instigating sex," she explained. With her own desire absent, the couple found themselves having sex only about once every three months, a stark contrast to their earlier intimacy.
While her husband was understanding, Cawood felt guilt and frustration over the change. She emphasized that her lack of desire was a side effect of treatment, not a reflection of her feelings for her husband. To maintain connection, they focused on other forms of physical touch like cuddling and holding hands. The emotional toll of losing her desire was particularly hard, leaving her feeling a profound sadness at the absence of arousal.
Last year, the couple attended 12 weeks of couples therapy, which helped them understand each other's "love languages." Cawood learned that her husband felt loved through quality time, while she felt loved through acts of service. This insight helped them navigate their difficulties, though Cawood acknowledged that finding solutions for their physical intimacy remained an ongoing process.
Medical Perspective and Support
Dr. Liz O’Riordan, a breast cancer surgeon who also underwent treatment, confirmed that sexual dysfunction is a common, yet often undiscussed, problem for women on hormone therapy. She stated that up to 80% of women treated for breast cancer experience some form of sexual dysfunction. O’Riordan explained that aromatase inhibitors thin and dry vaginal tissues, leading to pain and reduced libido, often more acutely than a natural menopause.
To help mitigate these effects, O’Riordan suggested several options: vaginal moisturizers and lubricants, vaginal dilators to stretch and desensitize tissue, and low-dose vaginal estrogen, with a doctor's consultation. She also stressed the importance of communication with partners, clarifying that the issues stem from treatment, not the relationship itself. Seeking help from a pelvic health physiotherapist or a psycho-sexual counselor can also be beneficial. O’Riordan’s key message is that no one should suffer in silence or accept sexual dysfunction as an unavoidable price of survival.
Cawood continues to use vaginal estrogen pellets, which have helped with dryness but not vaginismus. She also mentioned that vaginal dilators could be an option, but privacy and time are currently challenging. She also noted that giving up alcohol, a carcinogen, after her diagnosis led to weight gain, further impacting her self-perception and feelings of sexiness, though she remains grateful to be alive and is working on her health and happiness with her family.