Psychological Effects
Table 4 is an overview of the emotional landscape of women and their partners, showing the range of psychological effects that each may experience. Dealing with these feelings plus the physiological changes can put a couple under considerable pressure and disrupt their daily balance. In effect, the couple must adjust to a new status quo.
In looking at the table, you may notice that quite often, the partner expresses emotions similar to those of the patient. Yet the two may have widely different perceptions and mismatched expectations. For instance, both partners may feel frustrated in their attempts to get on with life. One example may be intimacy. One partner may want to do what he or she believes the partner wants, except that “feeling sexual” cannot come at will. Unrealized expectations can kill the romance. Unfortunately, adjustments must come in the heat of battling the side effects. It is analogous to trying to rebuild a town while the shelling is still going on.
The situation is more difficult for those couples that had problems with intimacy prior to cancer. Incompatibility that has not been worked through is still there. Couples must deal with the related issues to have a good foundation for an intimacy that works.
The effects of cancer and its treatment can impact the whole person. Prominent psychological side effects may include mood swings, anxiety, and depression. The change in appearance due to the loss of one or both breasts as the result of a mastectomy often has a profound effect on the woman. The loss of reproductive organs may have a similar effect on a woman with gynecological cancer. Her perception of herself as a woman and as a sexual partner may be drastically altered, resulting in a negative body image and in withdrawal from contact with other people, especially her partner. Breast reconstruction surgery may alleviate some of the negative feelings about her appearance for the mastectomy patient, but since reconstruction does not restore normal sensation, she may still feel that intimacy is different than before.
Four psychological side effects of cancer therapy may undermine the confidence and self-esteem of women during and after treatment for cancer. These conditions effectively create barriers to restarting the couple’s physical intimacy. Together, these conditions can be represented by the acronym ARID. The ARID Complex consists of anxiety disorder, feelings of rejection, identity disorder, and depression. Individually, these are psychological ailments; if they come in combination, patients may experience trauma-related symptoms of stress akin to post-traumatic stress disorder (PTSD). According to the National Cancer Institute, cancer patients may be at risk for PTSD because “the physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one's body and life are traumatic experiences for many cancer patients.” Whether a person suffers some form of PTSD related to cancer treatment depends on many factors and is being studied at research facilities throughout the country.
Anxiety Disorder
Will the treatment work?
Will the disease recur?
Will I die from this cancer?
How will my partner or future partner react?
Anxiety is a perfectly normal response to being diagnosed with cancer and thinking about various types of treatment. It usually subsides, at least somewhat, after treatment is begun. Anxiety can intensify if you fear that symptoms such as pelvic pain or vaginal bleeding mean the cancer has recurred. Anxiety can be substantial and chronic, upsetting behavior, disposition, and the overall feeling of wellbeing.
Affecting every aspect of daily living, anxiety is well known to interfere with the normal cycle of sexual activity. It is likely to delay and lower the level of sexual response, regardless if medication is used. A woman’s worry regarding how she will handle her partner’s expectations once they resume having sex can inhibit her from being an active partner or even attempting to engage in sex.
Marilyn, a young single woman who had a mastectomy, was fearful about going out on dates because her companion might want sex. “If he asks me, and I say no, he will probably not ask me out again. If I say yes and he sees a half-woman, he’ll walk out. I can’t win.”
In committed relationships, the partner’s anxiety can reinforce the patient’s concerns. In this situation, each partner’s distress can further increase the other partner’s discomfort.
The stress of both partners can be lessened if they take an approach of “Let’s try different things and see what happens.” Tension will be lessened if both partners can accept that they will jointly decide on things such as the woman remaining clothed during sex. In fact, her being dressed in clothing that both partners find exciting can be part of the sexual event.
Anxiety is also linked to the anticipation of being rejected. After therapy, women may project the way they feel about themselves onto their partner and take unwarranted actions. Anxiety after diagnosis is to be expected. But if it cannot be brought under control, psychologial treatment should be considered.
Fear of Rejection
Since the day I told him I had breast cancer, he hasn’t touched me.
Deborah
The “R” word. Many women do not want to even think it. But it exists. One woman who was single was worried about how her boyfriend would behave after her mastectomy. She did not think she could handle the rejection she expected, and was preparing to end the relationship so she would not run the risk of being rejected.
Janice told the sex counselor that when she came home from the hospital and began to get undressed in the bedroom, her husband was there. All of a sudden she felt rather warm and nausea attacked her. Her mind was in a jumble. Would he walk out? (He didn’t.)
Debra came home from the hospital and went to lie down. Her husband told her he had to leave town on a business trip. Although she said okay, she thought, “Why did he have to go today? He owns his business and controls the schedule.” Her next thought was that he didn’t want to be with her.
Some women may feel rejection even when it does not exist. It’s easy to over-interpret hesitation in your partner’s voice, a look to the side when you are undressed, or to sense that he wants to pull away when he sees your unclothed body.
The anticipation of rejection can loom large when it comes to sexual activity. Fearing the partner’s reaction to the scars can cause the woman to isolate herself, mentally as well as physically, to avoid getting into a sexual situation. An extended length of time since a couple was physically intimate compounds the problem. Resuming sex after a hiatus can be stressful. Unless the partners discuss the issues before resuming sex, sex is less likely to be satisfactory.
Identity Disorder
Without my breasts, what am I? I see myself in the mirror every day. I’m only part of who I was. Nobody will want me.
Naomi
Amy is pretty, a size 8, and full of energy. A routine mammogram led her doctor to call her in. He told her, “It doesn’t look good.” The analysis showed a possible cancer in one breast. The biopsy proved it.
Then she had to make a decision. Consultation with her new doctor led to her decision to have a mastectomy. She had surgery for breast cancer in her left breast. Then she decided to have a second, prophylactic mastectomy.
After surgery, Amy began to regret her decision. Her husband loved her breasts. What would he say now? He had always been supportive of everything she did. Also, this was her second marriage. The first one was abusive. She was lucky to have met Frank. And he was younger than she was. What if he went elsewhere because she had no breasts? “Am I still a woman?” she wondered. “Women are supposed to have breasts. Is a woman still desirable without breasts? I’m not having any more children. But in our society, a woman’s desirability is biased by how men view her breasts. I have none.”
Suddenly, attractive