When Sarah was diagnosed with Stage 3 breast cancer in 2020, the last things on her mind were menopause and her marital relationship.
The new mother had given birth eight months ago and now had to brace herself for chemotherapy, lumpectomy and radiation. But by September 2021, the cancer had progressed to Stage 4.
A few months later, blood tests showed that she had gone into early menopause. She was only 37 years old.
“Being young, it was not something I expected. I had very bad hot flushes and my vagina was so dry that I could feel the abrasion even when I was walking or sitting down, not to mention having sex. I thought, ‘Why am I so abnormal?’ she recalled.
This affected her marriage. “My husband’s needs were not getting met. But it was difficult for him to talk about it. So his frustration showed in other areas. We kept arguing,” she told CNA Women.
“At my lowest point, I felt, ‘Why do I even want to fight cancer? What is the purpose of going through such tough treatment if I’m going to fight with my husband every day,” she said.
Sexuality is an underrated and under-treated problem in cancer survivors, in Singapore and around the world, said a clinical psychologist. (Photo: iStock/Tirachard)
Like Sarah, the struggles of many cancer warriors go beyond having to face tough medical treatments.
“It is quite common, especially in the beginning, for patients to have their self-confidence, self-esteem and trust in their bodies affected because of all these physical and functional changes that are not within their control, and that can happen quite abruptly,” said Assistant Professor Irene Teo, principal clinical psychologist at the Department of Psychosocial Oncology, National Cancer Centre Singapore (NCCS).
“Sexuality remains one of the under-rated and under-treated problems in cancer survivorship, not only in Singapore, but worldwide,” Asst Prof Teo added.
One in six women with a history of breast or gynaecological cancer who have a partner reported sexual dissatisfaction, she said, citing a study by NCCS and KK Women’s and Children’s Hospital (KKH).
PHYSICAL AND FUNCTIONAL CHANGES DURING CANCER
“Cancer is a life-changing event that affects a patient physically, psychologically and socially. Some of the side effects may be long-term,” said oncologist Dr Joline Lim, a consultant at the Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS).
Beyond temporary hair loss – which can be devastating to patients – some may experience peripheral neuropathy (numbness of the limbs), one of the side effects of chemotherapy. While this usually improves after chemotherapy, a small number of patients may live with some nerve damage for life, Dr Lim noted.
Women undergoing hormonal therapy for cancer may put on weight or experience early menopause. (Photo: iStock/Nuttawan Jayawan)
For certain cancers, treatment also requires the surgical removal of breasts, ovaries, uterus, cervix, or other anatomical changes.
Colorectal tumours may sometimes require a colostomy, added Dr Lim. The operation creates an opening in the colon or large intestine through the abdomen where body waste is rerouted to a collection bag. This affects patients’ daily living and self-image.
June, who was diagnosed with breast cancer in 2010, had a mastectomy at the age of 28, nine months after her wedding.
“I was in denial. For weeks leading to the surgery, I often woke up in the middle of the night hoping the news was nothing but a nightmare. When reality hit, I broke down crying. The thought of waking up from the hospital bed with a flat chest and a scar across it was too much for me,” she said.
She opted for breast reconstruction and doctors were able to retain her nipple although there was now a permanent loss of sensation.
“That, together with my scars, had me worried about its impact on my relationship with my husband. But he never despised me because of that. He didn’t pressure me for physical intimacy and always placed my health and recovery as a priority,” said June.
Weight gain is also a common side effect, especially for women who undergo hormonal therapy that causes changes in their hormonal function, and early menopause, said Dr Lim.
Long-term steroid consumption as part of cancer treatment can also lead to weight gain and water retention, she added.
Lisa was diagnosed with Stage 3 thyroid cancer in 2016 and underwent surgery to remove her thyroid, which controls the metabolism, as well as her lymph nodes, vital for immune defence.
Previously an ultra-marathoner who ran 160km weekly, the 52-year-old quickly gained 8kg. “I feel frumpy and lethargic,” she said.
Even though her old clothes don’t fit her anymore, she still has them. “I refuse to buy a bigger size. I just believe that some day, I will get there. Otherwise, you will be stuck in T-shirt and shorts and pyjamas.”
DEALING WITH SEXUALITY, INTIMACY AND SEX
Many loved ones and friends do not understand the long-term impact of the disease and treatment on cancer warriors.
“I hear from patients that they typically receive the strongest support from loved ones during treatment and that it can wane over time as they complete treatment and return to their pre-cancer lives,” said NCCS’ Asst Prof Teo.
“This is natural as patients look and feel stronger. But I also hear patients say that just because they now look ‘normal’, doesn’t mean they are. Their hair may have grown back, but symptoms like fatigue and neuropathy can have lasting effects… and are not visible to others,” she added.
Sometimes, this inadvertently breaks down relationships.
One aftermath of her cancer treatment and the surgical removal of her lymph nodes is Lisa suffers from constant allergies despite taking antihistamines daily. “My eyes are always puffy, watery and itchy. I have a constant ear itch and an itch on my upper palate [in the mouth].”
This affected her sexuality, she said. “When you always have allergies, the last thing on your mind is to get intimate. And because of my allergies, I was always irritable. I also had mood swings.
“For the first six months, I got some sympathy from my partner. But after that, he was like, ‘Deal with it. It has been six months.’”
One patient who had thyroid cancer said the removal of her lymph nodes resulted in allergies which caused her to be irritable all the time. (Photo: iStock/Doucefleur)
For young women in their reproductive years, cancer treatment can be particularly devastating because chemotherapy can cause sub-fertility issues, NCIS’ Dr Lim said.
Patients receive counselling on these effects and are given the option of egg freezing for conception in future, she added. But for late-stage cancer patients like Sarah, this does not help.
“Our dream was to have three kids. We only have one. I have my frozen eggs, but going for chemotherapy means I cannot carry them myself. And surrogacy is not allowed in Singapore so there’s no legal way to have more kids,” said Sarah.
Asst Prof Teo added that women in their thirties and early forties tend to have a harder time because such changes can affect their decisions in typical life milestones such as dating, committing to a life partner or starting a family.
“Sometimes, these milestones are delayed due to the treatment. Sometimes, they are put off as the patient is worried about cancer recurrence, how their condition will affect their partner, or that the situation is unfair for their future partner or family,” she said.
COPING WITH CHANGES
It helps when family members are supportive and aware of the patient’s residual challenges and treatment side effects, said Asst Prof Teo. In many cases, a hug or word of affirmation by loved ones can be a lifeline for patients.
“It is normal for the dynamic in a romantic or marital relationship to change during the cancer journey,” she said. “Sexual intimacy often takes a backseat, although many couples report continued or increased emotional closeness.”
Patients concerned about sexual intimacy may also seek professional help or speak to their oncologist for a referral. NCCS, for instance, started a multi-disciplinary Women’s Wellness and Intimacy Clinic last year, run by physician- and psycho-sexologists to address sexual challenges that come up during cancer treatment.
Sexual intimacy may take a backseat during a patient’s cancer journey and couples may benefit from seeking professional help. (Photo: iStock/trumzz)
Sarah shared that her marriage improved after consulting a sex therapist – her husband better understood her struggles, she felt more supported, and the couple began working on intimacy issues.
For some patients, these struggles can ultimately lead to powerful personal growth.
Although June admitted that she still feels conscious of her mastectomy scars, these thoughts are now fleeting.
Her advice to other cancer warriors: “Be confident about your body. These are our battle scars. We have been through, conquered and survived the tough ordeal. What can be more difficult than that? Our bodies and looks will change as we age anyway, so don’t fret over it.”
Likewise, despite Stage 4 cancer, Sarah took up a coding course last year and has since left her administrative role to work as an engineer.
“The majority of patients and cancer survivors require adjustment time, and then go on to live meaningful lives. Many describe their cancer experience as having an important impact in their chosen life priorities moving forward,” said Asst Prof Teo.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...
The new mother had given birth eight months ago and now had to brace herself for chemotherapy, lumpectomy and radiation. But by September 2021, the cancer had progressed to Stage 4.
A few months later, blood tests showed that she had gone into early menopause. She was only 37 years old.
“Being young, it was not something I expected. I had very bad hot flushes and my vagina was so dry that I could feel the abrasion even when I was walking or sitting down, not to mention having sex. I thought, ‘Why am I so abnormal?’ she recalled.
This affected her marriage. “My husband’s needs were not getting met. But it was difficult for him to talk about it. So his frustration showed in other areas. We kept arguing,” she told CNA Women.
“At my lowest point, I felt, ‘Why do I even want to fight cancer? What is the purpose of going through such tough treatment if I’m going to fight with my husband every day,” she said.
Sexuality is an underrated and under-treated problem in cancer survivors, in Singapore and around the world, said a clinical psychologist. (Photo: iStock/Tirachard)
Like Sarah, the struggles of many cancer warriors go beyond having to face tough medical treatments.
“It is quite common, especially in the beginning, for patients to have their self-confidence, self-esteem and trust in their bodies affected because of all these physical and functional changes that are not within their control, and that can happen quite abruptly,” said Assistant Professor Irene Teo, principal clinical psychologist at the Department of Psychosocial Oncology, National Cancer Centre Singapore (NCCS).
“Sexuality remains one of the under-rated and under-treated problems in cancer survivorship, not only in Singapore, but worldwide,” Asst Prof Teo added.
One in six women with a history of breast or gynaecological cancer who have a partner reported sexual dissatisfaction, she said, citing a study by NCCS and KK Women’s and Children’s Hospital (KKH).
PHYSICAL AND FUNCTIONAL CHANGES DURING CANCER
“Cancer is a life-changing event that affects a patient physically, psychologically and socially. Some of the side effects may be long-term,” said oncologist Dr Joline Lim, a consultant at the Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS).
Beyond temporary hair loss – which can be devastating to patients – some may experience peripheral neuropathy (numbness of the limbs), one of the side effects of chemotherapy. While this usually improves after chemotherapy, a small number of patients may live with some nerve damage for life, Dr Lim noted.
Women undergoing hormonal therapy for cancer may put on weight or experience early menopause. (Photo: iStock/Nuttawan Jayawan)
For certain cancers, treatment also requires the surgical removal of breasts, ovaries, uterus, cervix, or other anatomical changes.
Colorectal tumours may sometimes require a colostomy, added Dr Lim. The operation creates an opening in the colon or large intestine through the abdomen where body waste is rerouted to a collection bag. This affects patients’ daily living and self-image.
June, who was diagnosed with breast cancer in 2010, had a mastectomy at the age of 28, nine months after her wedding.
“I was in denial. For weeks leading to the surgery, I often woke up in the middle of the night hoping the news was nothing but a nightmare. When reality hit, I broke down crying. The thought of waking up from the hospital bed with a flat chest and a scar across it was too much for me,” she said.
She opted for breast reconstruction and doctors were able to retain her nipple although there was now a permanent loss of sensation.
“That, together with my scars, had me worried about its impact on my relationship with my husband. But he never despised me because of that. He didn’t pressure me for physical intimacy and always placed my health and recovery as a priority,” said June.
Weight gain is also a common side effect, especially for women who undergo hormonal therapy that causes changes in their hormonal function, and early menopause, said Dr Lim.
Long-term steroid consumption as part of cancer treatment can also lead to weight gain and water retention, she added.
Lisa was diagnosed with Stage 3 thyroid cancer in 2016 and underwent surgery to remove her thyroid, which controls the metabolism, as well as her lymph nodes, vital for immune defence.
Previously an ultra-marathoner who ran 160km weekly, the 52-year-old quickly gained 8kg. “I feel frumpy and lethargic,” she said.
Even though her old clothes don’t fit her anymore, she still has them. “I refuse to buy a bigger size. I just believe that some day, I will get there. Otherwise, you will be stuck in T-shirt and shorts and pyjamas.”
DEALING WITH SEXUALITY, INTIMACY AND SEX
Many loved ones and friends do not understand the long-term impact of the disease and treatment on cancer warriors.
“I hear from patients that they typically receive the strongest support from loved ones during treatment and that it can wane over time as they complete treatment and return to their pre-cancer lives,” said NCCS’ Asst Prof Teo.
“This is natural as patients look and feel stronger. But I also hear patients say that just because they now look ‘normal’, doesn’t mean they are. Their hair may have grown back, but symptoms like fatigue and neuropathy can have lasting effects… and are not visible to others,” she added.
Sometimes, this inadvertently breaks down relationships.
One aftermath of her cancer treatment and the surgical removal of her lymph nodes is Lisa suffers from constant allergies despite taking antihistamines daily. “My eyes are always puffy, watery and itchy. I have a constant ear itch and an itch on my upper palate [in the mouth].”
This affected her sexuality, she said. “When you always have allergies, the last thing on your mind is to get intimate. And because of my allergies, I was always irritable. I also had mood swings.
“For the first six months, I got some sympathy from my partner. But after that, he was like, ‘Deal with it. It has been six months.’”
One patient who had thyroid cancer said the removal of her lymph nodes resulted in allergies which caused her to be irritable all the time. (Photo: iStock/Doucefleur)
For young women in their reproductive years, cancer treatment can be particularly devastating because chemotherapy can cause sub-fertility issues, NCIS’ Dr Lim said.
Patients receive counselling on these effects and are given the option of egg freezing for conception in future, she added. But for late-stage cancer patients like Sarah, this does not help.
“Our dream was to have three kids. We only have one. I have my frozen eggs, but going for chemotherapy means I cannot carry them myself. And surrogacy is not allowed in Singapore so there’s no legal way to have more kids,” said Sarah.
Asst Prof Teo added that women in their thirties and early forties tend to have a harder time because such changes can affect their decisions in typical life milestones such as dating, committing to a life partner or starting a family.
“Sometimes, these milestones are delayed due to the treatment. Sometimes, they are put off as the patient is worried about cancer recurrence, how their condition will affect their partner, or that the situation is unfair for their future partner or family,” she said.
COPING WITH CHANGES
It helps when family members are supportive and aware of the patient’s residual challenges and treatment side effects, said Asst Prof Teo. In many cases, a hug or word of affirmation by loved ones can be a lifeline for patients.
“It is normal for the dynamic in a romantic or marital relationship to change during the cancer journey,” she said. “Sexual intimacy often takes a backseat, although many couples report continued or increased emotional closeness.”
Patients concerned about sexual intimacy may also seek professional help or speak to their oncologist for a referral. NCCS, for instance, started a multi-disciplinary Women’s Wellness and Intimacy Clinic last year, run by physician- and psycho-sexologists to address sexual challenges that come up during cancer treatment.
Sexual intimacy may take a backseat during a patient’s cancer journey and couples may benefit from seeking professional help. (Photo: iStock/trumzz)
Sarah shared that her marriage improved after consulting a sex therapist – her husband better understood her struggles, she felt more supported, and the couple began working on intimacy issues.
For some patients, these struggles can ultimately lead to powerful personal growth.
Although June admitted that she still feels conscious of her mastectomy scars, these thoughts are now fleeting.
Her advice to other cancer warriors: “Be confident about your body. These are our battle scars. We have been through, conquered and survived the tough ordeal. What can be more difficult than that? Our bodies and looks will change as we age anyway, so don’t fret over it.”
Likewise, despite Stage 4 cancer, Sarah took up a coding course last year and has since left her administrative role to work as an engineer.
“The majority of patients and cancer survivors require adjustment time, and then go on to live meaningful lives. Many describe their cancer experience as having an important impact in their chosen life priorities moving forward,” said Asst Prof Teo.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...