For some women who have had breast cancer, the impact on their sex life can be just as devastating as other more obvious treatment related symptoms, such as hair loss. Reduced interest in sex among women is a familiar issue for the South London and Maudsley NHS Foundation Trust's (SLaM) Psychosexual and Relationship Service. Professor Myra Hunter is a consultant clinical psychologist in the service and in her work she sees many women struggling with physical, emotional and sexual changes brought on or exacerbated by breast cancer.

"Adjuvant therapy like chemotherapy and tamoxifen can produce menopausal symptoms and women who have oestrogen-dependent cancers are advised not to have hormone treatment for these symptoms," Professor Hunter explains.

"Vaginal dryness is commonly brought on by reduced oestrogen levels following adjuvant treatments and hot flushes and night sweats can add to the discomfort."

Breast cancer is more common among older women and this means many women with breast cancer can have the symptoms of menopause exacerbated by cancer and its treatments. Breast cancer treatments can also trigger early-onset menopause in younger women.

Professor Hunter stresses that women experiencing changes in sexual functioning following breast cancer treatments need to acknowledge the range of physical and emotional changes they have undergone.

"Breast cancer can impact on a woman's self-esteem and body image, especially if she has had surgery or hair loss. Many women also feel as though their body is out of control or unfit. It is understandable that these feelings can result in a reduced lack of sexual interest and many couples adjust to this by recognising that other concerns take priority for a while."

"Sexual desire is closely linked to stress and women experiencing breast cancer can be under considerable stress, juggling their health concerns with ordinary life stresses. When stressed, sexual interest is affected in men and women."

Professor Hunter also says that relationship issues also play a part, with many people worried about their unwell partner's health and uncertain how to respond sexually. The stress of their partner's illness can also affect their own sexual functioning.

"Fortunately, most women find their quality of life, well-being and libido will improve as they enter remission. But for an estimated 20 to 30 per cent, problems can persist. Ongoing problems are more likely among women who have had chemotherapy," Professor Hunter explains.

Professor Hunter is reluctant to reduce changes in sexual feeling in the context of breast cancer to 'female sexual dysfunction disorder' – a term often used flippantly by some doctors and the media to describe a range of female sexual issues.

"When working with women who have experienced breast cancer, it is helpful to normalise their experience in the context of stress. It would be counter-productive to give them an additional diagnosis just when they are trying to get their lives back to normal."

Professor Hunter works with women and their partners to discuss the many factors affecting their well-being and sexual relationships, including cancer. Along with facilitating improved communication, she also provides her patients with information and advice on managing menopausal symptoms, stress and their sexual relationships.

"For example, one woman was concerned that since her breast cancer treatment she and her husband had not had sex. She was feeling low about herself and began to worry that the lack of sex was a sign that there were problems in the relationship. She began to withdraw and blame herself. After a joint session with her and her partner, the couple were able to clarify these assumptions and this resulted in improved communication and more emotional intimacy and understanding between them."

Source: South London and Maudsley NHS Foundation Trust

For more information, visit www.national.slam.nhs.uk