Many women who have had mastectomies struggle to navigate their dating and sex lives. Photo / 123RF
Hi Verity and Nic,
I've had a double mastectomy and have elected to wear prostheses. My partner and I separated two years ago and since then I've resisted getting into another relationship because I'm afraid of what men will think of my lack of breasts. Every time a relationship looks like
becoming serious, I end it so I won't have to be embarrassed having sex. How can I get past this? Diane.
Diane, you are not alone; we have worked with many women who have had mastectomies and struggle to navigate their dating and sex lives. A number of them have talked about avoiding sex to sidestep their feelings of embarrassment about their bodies. Understandably, you feel afraid of men's reactions to your lack of breasts and the presence of scar tissue.
Shame hates company, so make connections with others to help you stand firm against negative self-judgement. Because this is such a common issue, we encourage you to use resources such as books, websites and podcasts by other women who have trod this path ahead of you. You don't have to be alone with this; many regions in NZ also have breast cancer support groups where you could discuss your concerns, see the Breast Cancer Aotearoa Coalition for information about support groups, counselling and other resources.
Before you focus on how potential dates might react, it's wise to look at your own beliefs about sexuality, femininity, attractiveness and worth. We live in a culture that emphasises women's appearance, which has a strong commercial imperative to make women feel insecure about how they look. Before your surgery, how did that culture impact you? Did you make a considerable effort to make yourself attractive according to some received notion of what was "feminine", "attractive" or "sexy"? If so, you will need to find a different path to feeling good about yourself in relationships.
For many women, let alone someone in your situation, finding your way to confidence in dating usually involves recognising and challenging conventional ideas about attractiveness and sexuality. Can you reclaim the concept of yourself as an attractive sexual being when your body no longer fits society's limiting notions about beauty? To believe in your beauty and vibrancy when you have had a double mastectomy in the current social climate requires an act of rebellion and some fire in your belly. If you don't think to some extent that you are an attractive and desirable person, it will be hard to trust that anyone else will.
Independent of cancer scars, we all age and our bodies change and don't look or operate the way they used to. If we want to thrive in terms of positive self-worth and intact sexuality into middle age and beyond, we must learn that attractiveness is about your person, your being, not your body. This is the path to lasting desire and eroticism that everyone needs to find if they want to remain sexually alive.
You may find some helpful thinking on the internet under the banner of "body neutrality" with its focus on embodiment. Instead of asking (as most heterosexual women do), "Do I think I look sexy to the male gaze?", instead turn to ideas about doing and being. Ask yourself, "When do I feel sexually alive and vibrant?" What are you doing when you feel like that, e.g. dancing, bathing, wearing silky fabrics, chairing a meeting, laughing with friends?
Having stressed that your beliefs and feelings about yourself are fundamental, many women say the final step of regaining their sense of themselves as sexy occurs in their first accepting sexual relationship post-mastectomy. There's no question that having a relationship with a new partner who is into you sexually and with whom you have a satisfying sex life can be helpful. So please don't feel unrealistic pressure to be all 100 per cent sorted and sexually positive about yourself before you can date well. Just try and head as far as you can in that direction.
In terms of dating, we have to acknowledge that some people out there are judgmental, shallow, immature, and critical. The threat of unpleasant judgement and critical thoughts in those you date is real. We don't advise being afraid because you have identified a real risk in your dating life; we say, "don't be afraid, take care".
There are a variety of styles used by women about how soon they talk about their mastectomies. Some women are bold and indicate on their dating profiles and table their mastectomy straight away if they are interested in someone. They can handle whatever response this involves and say they prefer to know very early on.
Others suss the person's safety out before revealing this to protect them from thoughtless hurtful comments. If you decide to vet people you might date, look for more mature guys who are open, seem non-judgemental and are not overly conformist to narrow societal norms. Someone you can have a deeper conversation with and who can be honest and hold an emotional connection with you. Remember, many people have family members who have had severe cancers, breast cancer, mastectomies or other radical surgeries. Your date may have more personal understanding than you think.
Even if they are non-judgmental people, your dates may find you having no breasts causes them anxiety or is too much for them. They may not know how they will respond. That is OK as long as they express it with sensitivity and care. They are not bad and wrong for being honest that they do have a concern or barrier in this area. It may be hard for you, but it's OK for them to choose not to have a relationship with you.
You will need to make a call for yourself based on who you are about whether you raise it early or a bit later. Just be aware that if you have not fully sussed someone out, you may get an unkind response, and you need to be able to handle this verbal "knock".
The reality is that over our lifetime, we are all, to a greater or lesser extent, going to face multiple physical or psychological challenges that will risk derailing our sexuality, dating and sex lives. In particular, as we age, all our bodies will stop meeting societal norms. Getting good at handling this now will put you well ahead of the game and likely make you sexually far more resilient than most moving forward. This challenge offers the opportunity to turbocharge your sexual maturity and establish your sexuality on a firmer foundation than simply what your body looks like.
• Verity & Nic are psychologists and family therapists who have specialised in relationship and sex therapy for more than 25 years. They have been working on their own relationship for more than 40 years and have two adult children.
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