Not Just Another Body Part

Where breast cancer is concerned, every woman’s viewpoint is unique.

And in each individual patient, we’ll never know what that viewpoint is until we ask.

Last week’s blog highlighted the importance of discussing sexual function within the context of breast cancer treatment, not only when a patient expresses concern. A brief recap: 60% of women hope you’ll introduce the topic of sexuality, but the talk takes place just 23% of the time.

Today, we’ll explore sexuality and breast cancer beyond the clinically sterile word, function. Because, as you well know, if you live in the Western world in the 21st century, breasts are not just functional body parts that happen to be a cancer site. Complex doesn’t even begin to describe the role they play in terms of a woman’s sexuality, sexual self-image, and sexual relationships.

Sexuality potentially suffers from many aspects of breast cancer treatment, and that may arise from pain, hormonal changes, relationship upheaval, and a realigning of life priorities following an unexpected and frightening major life event.

When discussing sexuality is taboo, as it all-too-often is, none of these issues come to the fore.

And neither do breasts. Specifically, what they mean to a woman facing tough decisions about treatment alternatives, reconstruction options, and behind-closed-doors scenes that will play out when she’s standing alone before the mirror or sharing an intimate moment with a sexual partner.

In speaking with several survivors, dabbling in the sparse literature on the topic, and eavesdropping on virtual conversations online, I am reminded that today’s women of all ages face complex pressures (cancer-imposed, self-imposed, partner-imposed, and society-imposed) when making cancer-related decisions about their breasts.

Can a woman be a card-carrying feminist and still yearn for a restoration of the beauty as well as the sexual function of her breasts, or the "fetishized sexual objects that men have turned them into" – as one blog poster put it?

Listen to one survivor posting on a British online bulletin board for women, as she asks that very question:

I am and have always been a feminist, raised in a feminist household, raising my [daughter] in a feminist household. Part of my feminist beliefs have always included a firm stance that we as women are more than our biology, are more than our physicality and are more than the way we look. Ergo I have always thought I would shun breast augmentation – presenting oneself as "well-groomed" to the patriarchal world being one thing, cosmetic surgery designed to hyper-sexualise my being another entirely. (note, I judge not those who chose these things, just have always believed they aren’t for me). I now find myself having to think about what I to do in the event of double mastectomy. It seems I am somewhat more attached to my breasts than I thought I was! It seems that my feminine persona is more wrapped up with them than I realized – and I somehow can’t help feeling like I would be less of a woman, or maybe just less of me without them, and its making me really sad trying to imagine dressing differently, having sex differently, etc. And think that I want the reconstruction. But then the "head" part of me thinks that I’m falling into the trap of defining myself by the way I look, all of the things that I’ve spent my life arguing against. Which quite frankly is making my head explode with confusion. Not sure if its even relevant but I have medium-large breasts, I don’t dress to emphasise them, but neither will I apologise for them or dress to hide them – they are there and they are part of me, and if a man thinks that I should hide them away in case he’s tempted to stare at them then that’s his issue not mine. So, what would you do, then? Is this a feminist issue? Am I betraying my principles? It’s not really any better than a boob-job, is it? Or am I just getting myself twisted up over nothing at all?

Answers poured in to the confused poster on the Mumsnet site, with most respondents warmly reassuring "TheBossofMe" that reconstruction was not incompatible with feminist ideology, and that she should do whatever she could to help herself heal.

One poster, for example, responded:

My mother had a single and no reconstruction – I don’t think it was that available then and she always had issues with it – it’s much harder to cope with one in terms of dressing etc. She used to cry when she saw her special bras hanging on the line. Please don’t worry about the decision from a feminist/non-feminist pov – it’s all about how you feel and what will make you feel whole and come to terms with the whole thing.

Others admitted their bias leaning in the other direction, noting complications and mixed results of reconstruction surgery, or mentioning fashion alternatives – "flowing tops or layered tops on top of one another ... interesting scarves and fashionable shawls" that de-emphasize the shape of breasts for women who require mastectomy but choose not to have reconstruction or to use prostheses.

Wanting to further explore the issue of breasts, sexuality, and breast cancer, I spoke with a beautiful young cancer survivor who expressed her tremendous gratitude to an ob.gyn. who openly and in a matter-of-fact way discussed her breasts, sexual relationship, and yes, sexual function in a way her oncologists never had, since she had felt caught unprepared for the catastrophic hit that her sexual relationship, as well as her body, had taken during her cancer battle.

I spoke to another survivor – this one middle-aged – who was stunned into silence when a physician casually noted that she needn’t worry about ever replacing the breast implants she would receive during reconstruction, as is periodically necessary. When that day came she would be in her 70s, he mused, and the implants would simply be removed, since she "wouldn’t be needing" her breasts anymore.

It was against this backdrop that I read the study "Pink Ribbon Pin-Ups: photographing femininity after breast cancer" in the journal Culture, Health & Sexuality (2012;14:753-66).

Author Kaitlyn Regehr described her controversial project, which raised money for the Canadian Breast Cancer Foundation, as a reaction to gallery portraits and coffee table books depicting "haunting" visages of women’s scarred, postmastectomy chests, bald heads, and gauntly disfigured bodies.

A self-described "burlesque expert and television personality," Ms. Regehr recalls her encounter with a breast cancer survivor who had been asked to participate in a "rather provocative photo shoot in which she would be photographed without her wig."

The woman, she said, mentioned feeling like a "victim on display," leading Ms. Regehr to contemplate that "voyeurs of ... cancer" objectify women in a manner no less objectionable than the male-centered cheesecake photography and pin-up photography popularized from 1915 through World War II.

Today’s version of pin-up art is created according to the healthy whims and fantasies of women themselves "for the purposes of personal empowerment and sexual exploration," according to Ms. Regehr.

She invited survivors to apply to be calendar models and set about creating the first in a series of "Pink Ribbon Pin-Ups" in which women would choose how they would be seen, sexually, post-cancer.

Among the first 14 participants, none chose to highlight the scars of their cancer by posing without a wig or prosthetic breasts. Some said frankly that that they had decided to participate as a gift to a significant other, or as a means of reclaiming sexual self-confidence. One young woman described her marriage post-cancer as "predominantly nonsexual" and said she wanted to give her husband the pin-up photo for Christmas. Another survivor, dying of her cancer, was thrilled by the idea that she would be "Miss March" – her husband’s birthday month.

Were the images self-objectifying, or "subscribing to the feminine ideal as defined by the male gaze"? Ms. Regehr asks.

Later in the article she provides her own answer, drawn from the definition of individualized sexual empowerment: "Each woman has the right, and should have the opportunities, to explore and express her post-cancer body."

I’ve encountered women whose empowerment came from saying "no" to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.

In other words, it’s complicated.

And we’ll never understand how it is for a particular woman until we frankly discuss breasts in the context of breast cancer – not just how they appear, clothed or unclothed, but what meaning they hold for her sexuality and sense of self.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist. Visit the Views section at www.oncologyreport.com to see what is new in Vitality Signs.

Where breast cancer is concerned, every woman’s viewpoint is unique.

And in each individual patient, we’ll never know what that viewpoint is until we ask.

Last week’s blog highlighted the importance of discussing sexual function within the context of breast cancer treatment, not only when a patient expresses concern. A brief recap: 60% of women hope you’ll introduce the topic of sexuality, but the talk takes place just 23% of the time.

Today, we’ll explore sexuality and breast cancer beyond the clinically sterile word, function. Because, as you well know, if you live in the Western world in the 21st century, breasts are not just functional body parts that happen to be a cancer site. Complex doesn’t even begin to describe the role they play in terms of a woman’s sexuality, sexual self-image, and sexual relationships.

Sexuality potentially suffers from many aspects of breast cancer treatment, and that may arise from pain, hormonal changes, relationship upheaval, and a realigning of life priorities following an unexpected and frightening major life event.

When discussing sexuality is taboo, as it all-too-often is, none of these issues come to the fore.

And neither do breasts. Specifically, what they mean to a woman facing tough decisions about treatment alternatives, reconstruction options, and behind-closed-doors scenes that will play out when she’s standing alone before the mirror or sharing an intimate moment with a sexual partner.

In speaking with several survivors, dabbling in the sparse literature on the topic, and eavesdropping on virtual conversations online, I am reminded that today’s women of all ages face complex pressures (cancer-imposed, self-imposed, partner-imposed, and society-imposed) when making cancer-related decisions about their breasts.

Can a woman be a card-carrying feminist and still yearn for a restoration of the beauty as well as the sexual function of her breasts, or the "fetishized sexual objects that men have turned them into" – as one blog poster put it?

Listen to one survivor posting on a British online bulletin board for women, as she asks that very question:

I am and have always been a feminist, raised in a feminist household, raising my [daughter] in a feminist household. Part of my feminist beliefs have always included a firm stance that we as women are more than our biology, are more than our physicality and are more than the way we look. Ergo I have always thought I would shun breast augmentation – presenting oneself as "well-groomed" to the patriarchal world being one thing, cosmetic surgery designed to hyper-sexualise my being another entirely. (note, I judge not those who chose these things, just have always believed they aren’t for me). I now find myself having to think about what I to do in the event of double mastectomy. It seems I am somewhat more attached to my breasts than I thought I was! It seems that my feminine persona is more wrapped up with them than I realized – and I somehow can’t help feeling like I would be less of a woman, or maybe just less of me without them, and its making me really sad trying to imagine dressing differently, having sex differently, etc. And think that I want the reconstruction. But then the "head" part of me thinks that I’m falling into the trap of defining myself by the way I look, all of the things that I’ve spent my life arguing against. Which quite frankly is making my head explode with confusion. Not sure if its even relevant but I have medium-large breasts, I don’t dress to emphasise them, but neither will I apologise for them or dress to hide them – they are there and they are part of me, and if a man thinks that I should hide them away in case he’s tempted to stare at them then that’s his issue not mine. So, what would you do, then? Is this a feminist issue? Am I betraying my principles? It’s not really any better than a boob-job, is it? Or am I just getting myself twisted up over nothing at all?

Answers poured in to the confused poster on the Mumsnet site, with most respondents warmly reassuring "TheBossofMe" that reconstruction was not incompatible with feminist ideology, and that she should do whatever she could to help herself heal.

One poster, for example, responded:

My mother had a single and no reconstruction – I don’t think it was that available then and she always had issues with it – it’s much harder to cope with one in terms of dressing etc. She used to cry when she saw her special bras hanging on the line. Please don’t worry about the decision from a feminist/non-feminist pov – it’s all about how you feel and what will make you feel whole and come to terms with the whole thing.

Others admitted their bias leaning in the other direction, noting complications and mixed results of reconstruction surgery, or mentioning fashion alternatives – "flowing tops or layered tops on top of one another ... interesting scarves and fashionable shawls" that de-emphasize the shape of breasts for women who require mastectomy but choose not to have reconstruction or to use prostheses.

Wanting to further explore the issue of breasts, sexuality, and breast cancer, I spoke with a beautiful young cancer survivor who expressed her tremendous gratitude to an ob.gyn. who openly and in a matter-of-fact way discussed her breasts, sexual relationship, and yes, sexual function in a way her oncologists never had, since she had felt caught unprepared for the catastrophic hit that her sexual relationship, as well as her body, had taken during her cancer battle.

I spoke to another survivor – this one middle-aged – who was stunned into silence when a physician casually noted that she needn’t worry about ever replacing the breast implants she would receive during reconstruction, as is periodically necessary. When that day came she would be in her 70s, he mused, and the implants would simply be removed, since she "wouldn’t be needing" her breasts anymore.

It was against this backdrop that I read the study "Pink Ribbon Pin-Ups: photographing femininity after breast cancer" in the journal Culture, Health & Sexuality (2012;14:753-66).

Author Kaitlyn Regehr described her controversial project, which raised money for the Canadian Breast Cancer Foundation, as a reaction to gallery portraits and coffee table books depicting "haunting" visages of women’s scarred, postmastectomy chests, bald heads, and gauntly disfigured bodies.

A self-described "burlesque expert and television personality," Ms. Regehr recalls her encounter with a breast cancer survivor who had been asked to participate in a "rather provocative photo shoot in which she would be photographed without her wig."

The woman, she said, mentioned feeling like a "victim on display," leading Ms. Regehr to contemplate that "voyeurs of ... cancer" objectify women in a manner no less objectionable than the male-centered cheesecake photography and pin-up photography popularized from 1915 through World War II.

Today’s version of pin-up art is created according to the healthy whims and fantasies of women themselves "for the purposes of personal empowerment and sexual exploration," according to Ms. Regehr.

She invited survivors to apply to be calendar models and set about creating the first in a series of "Pink Ribbon Pin-Ups" in which women would choose how they would be seen, sexually, post-cancer.

Among the first 14 participants, none chose to highlight the scars of their cancer by posing without a wig or prosthetic breasts. Some said frankly that that they had decided to participate as a gift to a significant other, or as a means of reclaiming sexual self-confidence. One young woman described her marriage post-cancer as "predominantly nonsexual" and said she wanted to give her husband the pin-up photo for Christmas. Another survivor, dying of her cancer, was thrilled by the idea that she would be "Miss March" – her husband’s birthday month.

Were the images self-objectifying, or "subscribing to the feminine ideal as defined by the male gaze"? Ms. Regehr asks.

Later in the article she provides her own answer, drawn from the definition of individualized sexual empowerment: "Each woman has the right, and should have the opportunities, to explore and express her post-cancer body."

I’ve encountered women whose empowerment came from saying "no" to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.

In other words, it’s complicated.

And we’ll never understand how it is for a particular woman until we frankly discuss breasts in the context of breast cancer – not just how they appear, clothed or unclothed, but what meaning they hold for her sexuality and sense of self.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist. Visit the Views section at www.oncologyreport.com to see what is new in Vitality Signs.

Where breast cancer is concerned, every woman’s viewpoint is unique.

And in each individual patient, we’ll never know what that viewpoint is until we ask.

Last week’s blog highlighted the importance of discussing sexual function within the context of breast cancer treatment, not only when a patient expresses concern. A brief recap: 60% of women hope you’ll introduce the topic of sexuality, but the talk takes place just 23% of the time.

Today, we’ll explore sexuality and breast cancer beyond the clinically sterile word, function. Because, as you well know, if you live in the Western world in the 21st century, breasts are not just functional body parts that happen to be a cancer site. Complex doesn’t even begin to describe the role they play in terms of a woman’s sexuality, sexual self-image, and sexual relationships.

Sexuality potentially suffers from many aspects of breast cancer treatment, and that may arise from pain, hormonal changes, relationship upheaval, and a realigning of life priorities following an unexpected and frightening major life event.

When discussing sexuality is taboo, as it all-too-often is, none of these issues come to the fore.

And neither do breasts. Specifically, what they mean to a woman facing tough decisions about treatment alternatives, reconstruction options, and behind-closed-doors scenes that will play out when she’s standing alone before the mirror or sharing an intimate moment with a sexual partner.

In speaking with several survivors, dabbling in the sparse literature on the topic, and eavesdropping on virtual conversations online, I am reminded that today’s women of all ages face complex pressures (cancer-imposed, self-imposed, partner-imposed, and society-imposed) when making cancer-related decisions about their breasts.

Can a woman be a card-carrying feminist and still yearn for a restoration of the beauty as well as the sexual function of her breasts, or the "fetishized sexual objects that men have turned them into" – as one blog poster put it?

Listen to one survivor posting on a British online bulletin board for women, as she asks that very question:

I am and have always been a feminist, raised in a feminist household, raising my [daughter] in a feminist household. Part of my feminist beliefs have always included a firm stance that we as women are more than our biology, are more than our physicality and are more than the way we look. Ergo I have always thought I would shun breast augmentation – presenting oneself as "well-groomed" to the patriarchal world being one thing, cosmetic surgery designed to hyper-sexualise my being another entirely. (note, I judge not those who chose these things, just have always believed they aren’t for me). I now find myself having to think about what I to do in the event of double mastectomy. It seems I am somewhat more attached to my breasts than I thought I was! It seems that my feminine persona is more wrapped up with them than I realized – and I somehow can’t help feeling like I would be less of a woman, or maybe just less of me without them, and its making me really sad trying to imagine dressing differently, having sex differently, etc. And think that I want the reconstruction. But then the "head" part of me thinks that I’m falling into the trap of defining myself by the way I look, all of the things that I’ve spent my life arguing against. Which quite frankly is making my head explode with confusion. Not sure if its even relevant but I have medium-large breasts, I don’t dress to emphasise them, but neither will I apologise for them or dress to hide them – they are there and they are part of me, and if a man thinks that I should hide them away in case he’s tempted to stare at them then that’s his issue not mine. So, what would you do, then? Is this a feminist issue? Am I betraying my principles? It’s not really any better than a boob-job, is it? Or am I just getting myself twisted up over nothing at all?

Answers poured in to the confused poster on the Mumsnet site, with most respondents warmly reassuring "TheBossofMe" that reconstruction was not incompatible with feminist ideology, and that she should do whatever she could to help herself heal.

One poster, for example, responded:

My mother had a single and no reconstruction – I don’t think it was that available then and she always had issues with it – it’s much harder to cope with one in terms of dressing etc. She used to cry when she saw her special bras hanging on the line. Please don’t worry about the decision from a feminist/non-feminist pov – it’s all about how you feel and what will make you feel whole and come to terms with the whole thing.

Others admitted their bias leaning in the other direction, noting complications and mixed results of reconstruction surgery, or mentioning fashion alternatives – "flowing tops or layered tops on top of one another ... interesting scarves and fashionable shawls" that de-emphasize the shape of breasts for women who require mastectomy but choose not to have reconstruction or to use prostheses.

Wanting to further explore the issue of breasts, sexuality, and breast cancer, I spoke with a beautiful young cancer survivor who expressed her tremendous gratitude to an ob.gyn. who openly and in a matter-of-fact way discussed her breasts, sexual relationship, and yes, sexual function in a way her oncologists never had, since she had felt caught unprepared for the catastrophic hit that her sexual relationship, as well as her body, had taken during her cancer battle.

I spoke to another survivor – this one middle-aged – who was stunned into silence when a physician casually noted that she needn’t worry about ever replacing the breast implants she would receive during reconstruction, as is periodically necessary. When that day came she would be in her 70s, he mused, and the implants would simply be removed, since she "wouldn’t be needing" her breasts anymore.

It was against this backdrop that I read the study "Pink Ribbon Pin-Ups: photographing femininity after breast cancer" in the journal Culture, Health & Sexuality (2012;14:753-66).

Author Kaitlyn Regehr described her controversial project, which raised money for the Canadian Breast Cancer Foundation, as a reaction to gallery portraits and coffee table books depicting "haunting" visages of women’s scarred, postmastectomy chests, bald heads, and gauntly disfigured bodies.

A self-described "burlesque expert and television personality," Ms. Regehr recalls her encounter with a breast cancer survivor who had been asked to participate in a "rather provocative photo shoot in which she would be photographed without her wig."

The woman, she said, mentioned feeling like a "victim on display," leading Ms. Regehr to contemplate that "voyeurs of ... cancer" objectify women in a manner no less objectionable than the male-centered cheesecake photography and pin-up photography popularized from 1915 through World War II.

Today’s version of pin-up art is created according to the healthy whims and fantasies of women themselves "for the purposes of personal empowerment and sexual exploration," according to Ms. Regehr.

She invited survivors to apply to be calendar models and set about creating the first in a series of "Pink Ribbon Pin-Ups" in which women would choose how they would be seen, sexually, post-cancer.

Among the first 14 participants, none chose to highlight the scars of their cancer by posing without a wig or prosthetic breasts. Some said frankly that that they had decided to participate as a gift to a significant other, or as a means of reclaiming sexual self-confidence. One young woman described her marriage post-cancer as "predominantly nonsexual" and said she wanted to give her husband the pin-up photo for Christmas. Another survivor, dying of her cancer, was thrilled by the idea that she would be "Miss March" – her husband’s birthday month.

Were the images self-objectifying, or "subscribing to the feminine ideal as defined by the male gaze"? Ms. Regehr asks.

Later in the article she provides her own answer, drawn from the definition of individualized sexual empowerment: "Each woman has the right, and should have the opportunities, to explore and express her post-cancer body."

I’ve encountered women whose empowerment came from saying "no" to any further medical or surgical treatment than was necessary to control their breast cancer. Women whose feminine sense of self never centered on their breasts and who were happy to leave the world of bras behind. Women who were delighted or disappointed by their breast reconstruction or by the appearance of their breast conservation surgery.

In other words, it’s complicated.

And we’ll never understand how it is for a particular woman until we frankly discuss breasts in the context of breast cancer – not just how they appear, clothed or unclothed, but what meaning they hold for her sexuality and sense of self.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist. Visit the Views section at www.oncologyreport.com to see what is new in Vitality Signs.