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Mastectomy, oophorectomy, and hysterectomy commonly lead to significant physical and emotional transitions for women and their husbands. Though medical professionals tend to focus more on the physical procedures, the emotional transitions merit just as much attention.
Both physical and emotional recovery from these surgeries can be challenging. In addition to the usual difficulties of post-op recovery, women who are also confronting cancer may be confronting a grueling regime of treatments as well. Many women struggle emotionally with these surgeries, which can seem to cut to the core of female identity.
Couples should know that there are sources of support for navigating these transitions, for example, the resources listed here. Read on to learn more about challenges related to body image and intimacy following surgery, and some initial ideas for addressing them.
Body Image
Even prior to surgery, many women have complex relationships with their bodies. These surgeries may add to that complexity.
Women may feel that they have lost body parts that play a key role in making them feminine, and that their womanhood and their sexuality have been irrevocably changed. Even as they feel gratitude for potentially life-saving surgery, women may need to mourn the losses of these body parts and learn to accept the changes to their bodies.
After a mastectomy, a woman’s chest looks different, and she loses some, if not all, sensation at the site of the surgery. This is true whether the woman has flat closure or breast reconstruction. A woman may have a harder time accepting her chest when it not only looks different but has lost sensation. Hair loss can also have a negative effect on a woman’s self-image. The process of accepting her new body can be very emotionally fraught and typically takes time.
A wife who turns to her husband to help her feel beautiful may unwittingly make him feel pressured to be attracted to her new body more quickly than he can adjust. This may play into her fears that she is no longer attractive to him.
It’s important for a husband to reassure his wife that he loves her and that, in his eyes, she will always be beautiful. She needs to know that nothing will change his commitment to and love for her. At the same time, a wife needs to understand that just as she may have difficulty embracing her new body immediately, so may her husband. It’s important for them to trust that acceptance and love will come in time.
It can be helpful for a woman to take steps to build up her body image, focusing on the positive. A woman can take time to think about what she does or does not want to expose and how. She might consider, or reconsider, reconstruction. She may find it helpful to invest in clothing and lingerie that make her feel good about her new body. Therapy may also help a woman work through these issues.
Physical Aspects of Intimacy
After surgery, it is common for women to experience a range of physical changes that can affect all aspects of a couple’s intimate relationship.
Vaginal Pain
Vaginal pain is especially common following surgery. After an oophorectomy or hysterectomy, hormonal changes often lead women to experience vaginal dryness and shifts in libido. A woman who had cancer may also have vaginal scarring from radiation. When surgery triggers menopause, it can lead to a thickening and shortening of the vaginal walls and muscle tightening, which may also lead to vaginal pain.
These symptoms may be temporary or long-lasting. Lubricants and moisturizers may reduce discomfort during sexual relations. Treatments such as hormonal replacement or topical estrogen creams may alleviate some symptoms. Laser therapies can sometimes restore vaginal lining, and dilators can help to address pain from scarring.
Other Symptoms
A woman may feel stress, fatigue or low energy, and some degree of discomfort or nausea (especially on pain medications). Some women find it more difficult to reach orgasm. In some cases, scarring, swelling with lymphedema, side effects of treatment, or direct effects of cancer can cause long-term physical pain. A husband may also be especially concerned about causing his wife pain.
More broadly, a couple may find that their old routines are no longer pleasurable and require rethinking. For example, following mastectomy, if a woman has lost sensation, touch to her breasts might feel less meaningful to her. Alternatively, a woman who has retained some sensation might find it especially meaningful for her husband to touch her chest, while her husband may not be immediately ready for this.
This is a time for a couple to think outside the box and try new ways to connect physically. The couple can take this transitional period as an opportunity to rediscover each other physically and to experiment with different types of touch or positions that may be better suited to them now.
During the transitions of post-op intimacy, it’s important to remember that sensual touch can be just as important as sexual touch, if not more important. For example, holding hands, massage, and hugs are just a few ways that couples can express their love for each other that don’t necessarily need to lead to intercourse. The full range of intimacy between husband and wife is holy and a blessing.
Emotional Aspects of Intimacy
While some couples may navigate the emotional transitions after surgery smoothly, many others find them difficult. Some couples may have to take a break from intimacy due to treatments or surgeries and will need to give themselves time to ease back into it. It may also be difficult for the couple to make the transition from the roles of caregiver and patient back to the role of lovers. They both need to process their feelings about the physical changes from surgery.
Following surgery, many women experience a sense of grief and isolation that can affect interest in sexual relations, and some women may even experience depression. Some women develop an aversion to sex, a fear of it, or simply lowered libido. Others see a drop in sexual self-esteem and may find that the separation of niddah triggers feelings of rejection. Emotions and energy levels may fluctuate as a woman finds her way to a new normal.
All of these changes can have a negative influence on sexual desire or interest and lead to discrepancies in desire for the couple. Often, just being aware of potential challenges can be a first step toward addressing them.
Some changes can be treated, whether with therapy, support groups, hormones, medications to enhance desire, or antidepressants.
Empathetic and responsive communication that makes room for each spouse’s perspective is essential to working through changes. A couple may discuss readjusting the frequency of sexual relations and what kind of lead-up they devote to them. They can express their love, discuss expectations, and even set times and conditions for physical contact to enhance their feeling of connectedness. For example, a couple might decide that intercourse will not happen at a certain time while agreeing on other kinds of pleasurable touch to engage in. Sometimes, communication works best with third-party support from a professional, such as an individual, couple, or sex therapist.
Couples also benefit from spending quality time together on date nights, weekend getaways, or shared projects or interests. They can expect ups and downs, but with love, commitment, patience, humor, prayer, and a shared sense of the journey, the challenges of post-op intimacy are surmountable. They can even enable the couple to grow closer together.
