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My breast surgery has killed our love life

Resuming sexual relations after a mastectomy can be very difficult, says Dr. Gail Saltz. The key is candid communication.

Q: After breast cancer, I had a mastectomy and reconstruction. Thankfully, I’m now cancer-free, but I dislike my body. My feelings are eliminating my sexual desire and driving my husband away. How can I change my attitude?

A: Women who have had a mastectomy — or a hysterectomy — often feel bad about their bodies afterward.

Face it, many women don't like their bodies under normal circumstances. But if you've had surgery -- especially on a female body part -- such feelings of dislike are apt to either appear or intensify.

In addition, there can be some physiological consequences of such surgeries that can lessen your desire. For instance, after premature menopause caused by a hysterectomy, you might experience a decline in lubrication.

But, for most people, the issues are psychological.

Even when this kind of surgery is not disfiguring, you might feel you've lost what made you feminine and youthful. It's a feeling that threatens you to the very core.

Because you see yourself as lacking in these feminine physical qualities, you think your husband won't desire you. Even though intellectually you know there is more to womanhood than body parts, you may not feel that way.

And, as you identify in your question, that feeling can spread to your partner. If you sense your husband is aloof or distant, he is probably reacting to your lack of confidence rather than being put off by you your changed state. In addition, he might be worrying about physically hurting you.

The awkwardness can also come from him. He might have no idea what to say, and feel uncomfortable broaching the subject.

As always, communication is key. Bring the subject up with him. Talking about your feelings candidly will help.

Also, give yourself time to adjust to your new body. Your dislike of it may lessen over time as your life returns to normal. However, if the problems you describe last more than three months after surgery, you could really benefit from discussing your feelings with a therapist.

Dr. Gail’s Bottom Line: Your negative body image is understandable because these female body parts are strong symbols of femininity — but really, there is much, much more to being a woman.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to “Today.” For more information, you can visit her Web site, Her new book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” is to be published in May 2004.

PLEASE NOTE: The information in this column should not be construed as providing specific medical or psychological advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician, psychiatrist or psychotherapist. Copyright ©2004 Dr. Gail Saltz. All rights reserved.