Breast Cancer Surgery May Also Affect Sexuality The removal of all or part of the breast may be linked to sexual problems. Losing a breast can be very distressing. Some women even have both breasts removed. When it comes to sexuality, the most common side effect of breast surgery may be that the female patient feels less feminine. In modern culture, full breasts are a fundamental part of a woman’s beauty and femininity. If a female patient has her breasts removed due to a medical condition, she may feel insecure about whether or not her lover accepts her sexually or whether or not she is sexually desirable. For many couples, the breasts and nipples are one of their sources of sexual pleasure. Breast fondling is the most common part of sexual foreplay. Some women can reach orgasm simply by touching their breasts. For many women, touching the breasts can also enhance sexual arousal. Breast cancer surgery may affect sexual pleasure from breast fondling. Some women after mastectomy like to be touched around the healed scars, while others do not like to be touched in these areas, or even on the opposite side of the breast that remains. Some women who undergo total mastectomy feel uncomfortable with the male supreme position during sex. This is because the missing breasts can be very visible in this position. Some post-total mastectomy women have been known to wear short nightgowns, tank tops, or bras with breast implants during sex. However, some women feel that these implants are awkward or do not work well. Some women experience prolonged chest and shoulder pain after radical breast cancer surgery, which removes the breast and the pectoralis major muscle beneath it. It is helpful to place an appropriately high pillow on the back of the affected shoulder during sex. Additionally, adopting a sexual position that reduces the amount of force exerted on the chest and shoulder may also relieve pain. Surgery to remove a breast lump (partial mastectomy or lumpectomy) followed by radiation therapy may result in scarring of the breast. Such patients will experience deformity, abnormal sensation and changes in size of the breast on the operated side. During radiotherapy, the skin in the irradiated area becomes red and swollen, and the breast becomes sensitive and painful. Later, numbness and decreased sensation in the scarred area may occur. There is no physiologic reason why breast surgery or radiation therapy would decrease a woman’s sexual desire. These treatments do not change their ability to achieve sexual pleasure. They do not reduce the ability of the vagina to produce discharge during sexual arousal and their ability to feel and enjoy sexual sensitivity and achieve orgasm. If a patient has reached menopause and is on hormone replacement therapy when her breast cancer is discovered. Her doctor asks her to discontinue the hormone medication, which may cause a thinning of the vaginal lining, a decrease in vaginal secretions, and a tightening and drying of the vagina due to the decrease in estrogen levels in the body. Application of water-based lubricants or vaginal moisturizers can help reduce these symptoms. In addition to this, her doctor may also advise her to use some hormone-containing creams to improve these phenomena. Breast Reconstruction After Breast Cancer Surgery Breasts can be reconstructed after breast cancer surgery to make them look similar to the opposite breast. Breast reconstruction preserves the shape and size of the breast, but does not preserve the normal sensory function of the breast. The reconstructed breast produces reduced or absent sexual pleasure from stroking the nipple of the nucleus pulposus. The sensory nerves innervating the nipple run deep into the breast tissue and may be severed during surgery. The result is decreased sensory function of the reconstructed nipple. The skin around the reconstructed nipple also has little sensory function, although certain sensory functions may gradually appear later. Over time, sensation of the reconstructed breast gradually emerges, but it does not produce the same sexual pleasure that the breast and nipple produced under stimulation before surgery. Breast reconstruction leads to better sexual sensations more because the reconstructed breast makes the patient feel physically intact and attractive to remain. It is not the case that the reconstructed breast can have the same sensory function to produce pleasure with sexual stimulation that it had before the surgery.