There is no doubt that most cultures see the breast as a symbol of femininity and the loss of a breast is frequently mourned because of this. Surgeons try to be as conservative as possible but where the priority is longterm survival, and hopefully a cure, the cosmetics take a back seat. Losing a breast can cause a massive psychological reaction, so it is now a relatively common practice for the cancer surgeon to work with a plastic surgeon to reconstruct the breast at the time of the mastectomy. Nonetheless, many women notice a change in their sexual behavior after a mastectomy. This seems to be particularly true of women who rely a lot on breast and nipple stimulation for arousal or orgasm. Sensate focus exercises also come in handy here. The different touching techniques used on other areas of your body stimulate the erotic feelings that build towards orgasm. In the case of mastectomy, it takes the emphasis away from the breasts by discovering other parts of the skin that will give you a similar response.

The loss of a breast can also mean a loss of self-confidence and a reluctance to initiate sex. Rita was forty-two when her breast cancer was diagnosed. ‘I was devastated. I thought they must have put the wrong name on the mammogram. The whole ordeal felt like some terrible nightmare. Matthew and I

had always had a great sex life. We married late and I suppose we were making up for lost time or something. He was always a big breast man and he always said how much he loved the fact that I was well-endowed. When I heard I had to have a mastectomy I thought, “Well that’s it then, he won’t have any interest in me sexually any more. This will turn him right off.” The strange thing was that it was me who had the trouble with sex. I couldn’t bear to let him see me without a shirt on, and I would freeze if his hands went anywhere near my chest. He said it really didn’t matter to him, he was just so glad he still had me. He was so patient and so gentle, I don’t know how I would have coped on my own.’

*136/17/9*

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