Q. I'm 43 years old, married and going to have a mastectomy. I'm insecure about how my body is going to look and being intimate with my husband. How can I maintain my femininity and a positive body image?

A.

When it comes to changes in our bodies, no matter what a woman’s age, those changes will challenge how we see ourselves and our perception of how others see us. This can be especially true for women who have had a mastectomy or bilateral surgery since images in the media so often place a heavy emphasis on how women look. Breast reconstruction has helped many women redefine their feelings about the loss of a breast. You might want to consult with a plastic surgeon about what options are available to you. For women who do not choose reconstruction, the use of a breast prosthesis can be a good alternative. A prosthesis can give a look of symmetry; many of the newer prostheses are made of a lighter weight material and come in special forms that can be used in swimwear and night gowns. It’s important to recognize that this is a loss, and with loss comes grief. Remember that it will take time to adjust and it’s a good idea to reach out for support and guidance during this time.

Treatment for breast cancer such as chemotherapy or hormonal blockers may also have side effects that can produce early menopause, vaginal dryness and a diminished desire for intimacy. Talking with your doctor about products that can reduce symptoms of dryness or discomfort can help. Opening a conversation about your concerns with your partner is an important first step. Many people don’t understand the actual physical basis for diminished desire and feel they are being rejected.

How to Help Your Wife (and Yourself) Through Diagnosis, Treatment and Beyond (Rodale Inc.) by Mark Silver, is one book you and your partner might find helpful. In addition, you may try contacting Living Beyond Breast Cancer.

You can also find additional information and advice in a previous Ask CancerCare that addressed body image and intimacy issues.