BREAST CANCER WILL inevitably put a strain on your relationship with your partner and this may last for months or even years – but it may also bring you closer as you learn how to support each other through a very difficult time.
Cancer is very one-sided – it is all about you! You get the cards and the flowers and the presents and the sympathy and the attention, while your partner is often a silent witness in the background, picking up the pieces of the things you aren’t able to do, such as housework, school runs or worrying about finances if you have to take time off from work. This can lead to resentment and guilt on both sides. Your partner may be unable to take time off work to come with you to every treatment and appointment, and this can leave them feeling sad and inadequate.
Alternatively, your partner may not seem to care that you have cancer and expect you to carry on with life as normal. They may not want to talk about cancer at all, maybe because they are scared about the future, or just cannot cope. The end result is that you push your partner away at the time you need them the most. Some women that Liz talked to said they had asked their husbands to divorce them because they felt so guilty about getting breast cancer and the effect it was having on their relationship. The husbands said ‘no’, thankfully, but it goes to show the irrationality of dealing with a cancer diagnosis.
We were very lucky. Our husbands Fraser and Dermot were incredibly supportive. They shared our devastation over the cancer diagnosis, cried with us and reassured us that they still loved us even if we only had one breast. They were able to come with us to most of our appointments and treatments, and we don’t think we could have got through treatment without them. However, there were still lots of times when we were tired and irritable and got on each other’s nerves.
There is no magic formula for getting through cancer with your relationship intact. You know far better than we do what does and doesn’t work for you, but here are a few things that helped us.
There’s no ‘right’ time or place to have a conversation about cancer, and you may just blurt something out at the worst possible moment, but this is much better than keeping your feelings bottled up. Be explicit and tell your partner exactly how you are feeling, and then listen so you can hear their side of the story. You may both be feeling unsupported and fed up. Try not to do this late at night when you are both exhausted. You could both try keeping a diary about your feelings that you then share with each other, a bit like a private blog.
Do something together. It could be silly, like pretending you’re on your first date. It could be simple like going for a walk or trying a yoga class together. It could be mundane like doing the food shopping. It’s important to reconnect and forget about cancer for a while.
Trish and Fraser went on a 10-kilometre walk most days – sometimes at a snail’s pace and sometimes broken part-way round at a nice tea shop. They often didn’t say anything but just being together out of doors gave them some shared headspace.
Liz and Dermot borrowed a tandem bicycle, and did lots of dog walks by the sea side.
It’s really important that you both keep seeing your own friends. It helps to get some breathing space away from each other, and you may find it easier to talk and work things through with friends instead of your partner.
Liz would often go for coffee with friends, but she made sure that Dermot’s friends invited him out for a drink too so he had some ‘not-cancer’ time.
There may be a cancer centre (see here) near you and this can be a great source of help and support for you and your partner. They provide free coffee and magazines, and there is always someone to talk to. It may be nicer for your partner to escape there while you are having treatment.
If your relationship seems to be full of tensions that you can’t resolve, you could try counselling. Your doctor or GP may be able to arrange this on the NHS for free. Support groups – either face-to-face or online – may also help (see Chapter 14). If either of you think that the other is becoming anxious or depressed, you may need to encourage them to see their GP for some extra help.
Breast cancer treatment means putting your life on hold, and this can mean cancelling parties and holidays. If you have primary cancer, you could put something in the diary to look forward to when you’ve finished treatment. Plan a short break or a week away between surgery/chemotherapy and radiotherapy, and plan a longer holiday once all your hospital treatment has finished. Liz had a quick week in the sun between chemotherapy and surgery which was great to recharge. If you have secondary cancer it is more difficult because treatment never finishes, but you could still try to plan days or trips away between each treatment. Having something to look forward to is a huge psychological boost, and gives you a little dose of normality.
If you are single when you are diagnosed, it can be incredibly daunting to think about dating again. How will you meet someone? When do you tell them that you have cancer? When do you tell them your breasts aren’t real? The Breast Cancer Care website has a great article about dating after cancer, featuring the stories of seven women in their thirties, forties and fifties. And for a brilliant, funny account of how a single woman managed the ups and downs of breast cancer without an ongoing relationship, read Anne Gildea’s I’ve Got Cancer, What’s Your Excuse? (Hachette Books, 2013).
TRAVEL INSURANCE
Once you have had a cancer diagnosis, travel insurance is more expensive. If you don’t tell the insurance company that you have breast cancer, they will not cover you for any claim related to your cancer.
If you are planning a trip soon after you have finished surgery, chemotherapy or radiotherapy, the premiums may be even higher because the chance of you having a complication is higher at that time. Some companies will pay for your medical costs abroad, but may not automatically pay to fly you home if you need to. This option can be added as an additional cost, and you might want to consider it if you are flying in the first few weeks after finishing chemotherapy, because of the risk of a serious infection while your immune system is still low. If you have secondary cancer and are having ongoing treatment, it may be even more expensive to get insurance, but travelling abroad without adequate insurance could prove even more expensive.
Three of the most popular insurance companies that specialise in covering cancer patients are Insurancewith, Free Spirit, and World First, but others are available. You can get advice from other patients on the Macmillan and Breast Cancer Care forums. Ring several companies to get quotes for comparison and make sure you have all the details of your treatments to hand: exactly what surgery you had, which chemotherapy drugs you were given, which drugs you were taking, and the dates when everything happened. You may also need a letter from your doctor confirming that you are not travelling against medical advice.
Whether you are young or old, gay or straight, in a long-term partnership or a more casual relationship, getting breast cancer will almost certainly affect your sex life. The menopausal side effects of treatment can make sex uncomfortable or even painful, and you may lose your sex drive completely. Your altered body image after surgery can make it difficult to get naked and feel sexy in front of your partner. The mixed-up feelings of fear, guilt, anger, frustration and resentment (why me? why her? why us?) as well as the pressure of your other commitments (to children, parents, work, etc.) also have a knock-on effect. It’s hardly surprising that sex can go to the very bottom of your to-do list and becomes a source of trouble (and even conflict) between you.
A lot of people find it difficult to talk about sex with their partner, let alone their doctor, and many patients give up on sex altogether, but it doesn’t have to be that way. Here are our tips:
If sex has become the ‘elephant in the room’, talk to your partner and tell them exactly what the problem is (although ideally not before you’re about to have sex). It could be that you are worried it will be painful, or that they won’t find you sexy, or that you simply have no desire. Listen to your partner’s concerns as well – they may be scared of hurting you, or they don’t know whether they should touch your scars or avoid them altogether. You might want to try counselling to help you work through these problems.
Masturbation can help you get used to feeling aroused again, especially during chemotherapy, which can dull down the sensitive zones in your clitoris or penis. You can do this by yourself or with your partner, and it may help to relax you and get you in the mood. Despite what some women were taught many years ago at school or church, there is absolutely nothing wrong or dirty about using masturbation as a means of exploring what works for you and becoming more confident about sex.
Sex is likely to be less spontaneous after breast cancer treatment, especially if you have vaginal dryness. Longer foreplay is part of the answer. Another solution could be a bag of tricks by the bedside. This is what we recommend:
● Lubricant. It can take a long time to get aroused enough to have sex, and even then, you may need additional lubricant because you are too dry. We recommend the ‘YES’ range of lubricants and internal moisturisers, that are also recommended by cancer nurses. They are water-based, additive-free and available on prescription and to buy online. You could also try a silicone-based lubricant, but try to use one without added chemicals.
● Dilators. These are good to help relax and stretch your vagina before you have sex. You can buy them online from websites such as Stress No More (see here for details). Use them with lubricants during foreplay.
● Vibrators. You can buy small vibrators that you can use internally or externally to help you have an orgasm. You may want to try masturbating with a vibrator and dilators first, before going on to make love with your partner.
These exercises strengthen the muscles of your pelvic floor and can help improve your sexual enjoyment. Ideally, a specialist physiotherapist will tell you how to do them, and you may have been shown them if you have had children. Here is one that Trish used successfully after childbirth:
● Stand with your legs slightly apart. Now imagine there are some tiny people standing in an elevator at the opening of your vagina. Tighten your pelvic muscles to bring those tiny people vertically up several floors – and then relax slowly to bring them down to the ‘ground floor’ again. Repeat half a dozen times.
If you are still struggling with vaginal dryness despite using lubricants, your doctor can prescribe you a topical oestrogen cream (see here). If your partner is having trouble maintaining an erection, your doctor could prescribe a tablet like Viagra to help him.
Remember that sex isn’t compulsory and there are many ways of making love without penetration, orgasm or even genital contact. Simple hugs and kisses, or even a massage, can comfort you both and help you feel close during the physical and mental challenges of cancer. Go with the flow. And keep in mind that for most couples, things get a lot better once active cancer treatment is behind them.
You doctor will advise you to use contraception if you are having chemotherapy, HER2 treatment or tamoxifen because all of these drugs can harm an unborn baby. You may feel menopausal (e.g. if your periods stop) but could still be ovulating, so use contraception until your doctor has confirmed that you are menopausal with a blood test (see Chapter 16).
You usually can’t use the oral contraceptive pill or implant injection because they contain oestrogen and/or progesterone which could stimulate any remaining breast cancer cells. Condoms are safe, although some partners are reluctant to use them. A cap is a good alternative, since neither you nor your partner can feel it, and you can insert it a bit before sex so your partner doesn’t even need to know you’re using it.
Another alternative is to have a coil (intrauterine device) fitted. This works by releasing a synthetic version of progesterone. However, because the hormone is released locally into your womb, very little of it enters your bloodstream, and there is no evidence to prove that a coil can cause breast cancer or increase the risk of recurrence. Once inside you, this will protect you from getting pregnant for three to five years (and you can have it removed before that if you’re ready to try for a baby). The morning-after pill can be used in emergencies (for example, after a split or ‘forgotten’ condom) because it is only a single dose of hormones. Your GP or an NHS family planning clinic can give you more advice.
At the one time in your life when you need the support of your partner more than ever before, your breast cancer treatment may mean that you end up pushing them away. This is one of the really tough bits to deal with – trust us, we’ve been there too. We hope with the advice we’ve given you that you can show your partner how to support you, both in and out of the bedroom, and learn to have fun again.