Breast Cancer Survivors Aren’t Getting Enough Guidance About Sex and Intimacy

Any woman navigating breast cancer knows that conversations with her medical team often focus on one thing: survival. It’s all about chemotherapy, surgery, medicine, recovery. But when it comes to her sexual health and intimacy after treatment, it’s often radio silence.

This is shocking, given that 70% of survivors will be forced into early menopause as a result of treatment including chemotherapy, ovary removal or certain medications like Lupron or Zoladex. And with more and more women being diagnosed early, that translates to more and more women being affected in their sexual prime. But regardless of age — sex, intimacy and romantic relationships take a hit.

As a result, about 75% of survivors have to contend with the genitourinary syndrome of menopause (GSM) years before they would ever have ever planned to. Pain, dryness and stiffness can make sex hurt. Loss of sensation in the breasts and vagina, scars and implants and constant fatigue can make sex — or just the idea of it — anxiety-inducing. On top of that, the mental load that comes with handling a health crisis like cancer can do a number on a woman’s body image and self-confidence.

“While we have become extremely good at treating the cancer part, we still are remarkably bad at the living life after cancer part,” Dr. Jordan Emont, a board-certified OB-GYN who specializes in menopause care for survivors, tells Flow Space. “Oncologists are really good at treating cancer, but they’re not always as good about having evidence-based discussions about how you can improve quality of life afterwards.”

That’s especially true when it comes to sex. About 80% of breast cancer survivors deal with “significant” sexual health issues post-treatment. Yet only about 5% of oncology patients said their doctors informed them about the sexual side effects they would experience. Another 2025 survey found that three-quarters of survivors say nobody on their healthcare team told them anything about how treatment would impact their sexual health.

Survivors need support to manage physical and emotional changes so they can feel confident to pursue a life that’s as well-rounded and close to normal as possible. “We have to take people where they’re coming from and what their needs are, and then come up with a plan to help them live their life well beyond all of this,” says Jeanne Carter, PhD, clinical psychologist and certified sexual health therapist at Memorial Sloan Kettering Cancer Center (MSKCC).

That looks different for every woman. It might be getting to know your body again — and learning what feels good now — before getting back into the dating world. It could mean learning how to communicate more effectively with a partner in the bedroom. It could even be getting to a place where you come to peace with your new body — scars and all.

It’s not about eliminating the grief and sadness, but rather finding “where can we sense and feel the awe, love and compassion for my body,” Naomi Zellin, a somatic, sex and relationship therapist, tells Flow Space. “The question is how do I come back to my human-ness and the things that lit me up before cancer.”

Here are some tips to build back self-confidence and be comfortable with the idea of intimacy.

Manage Physical Pain First

Sex shouldn’t hurt and there are ways to mitigate that. Vaginal estrogen is a great tool to restore tissue function and moisture — but only about 5% of breast cancer survivors use it. “Nobody can do something that is painful, so you can’t even think about what your social dynamics and what your psychological associations of sex look like if you’re in pain,” explains Emont.

Talk to your doctor about if it’s right for you. If not, there are non-hormonal options to moisturize and lubricate that contain hyaluronic acid and aloe vera. Good quality lubes and moisturizers — Zellin recommends aloe or water-based — make sex smoother. Opt for toys that won’t cause pain.

Zellin recommends working with a pelvic floor therapist to minimize pain. They can teach effective techniques to make everything feel less tight and painful, including using vaginal dilators.

Pelvic and vaginal pain can compound if left untreated. Emont says “you have to address this component, particularly when it pertains to pain, before you can think about anything else.”

Re-Aquaint Yourself with Touch

You’ve survived having your naked body examined by countless doctors, PAs, radiology technicians, nurses — not to mention being operated on — sometimes several times. Throughout that process “often the person behind the body isn’t seen — you feel distant because you feel like a science project,” explains Zellin. “When you overcome it, there can be a lot of dissociation.”

It’s important to re-define touch as something pleasurable and comforting. Zellin says it’s key to build trust with the body again by touching yourself and noting what feels good. “It’s reintroducing not only ‘How do I trust myself?’ but then ‘How do I let something pleasurable in which is really hard and scary after cancer,” she adds. “It’s ‘How do I come back to my body, wake it up and find sensation?’”

There are easy ways to introduce soothing, pleasurable touch out of the bedroom. Doing so will help you reconnect with your body. Massages are a perfect example and when targeted to specific treatments like craniosacral therapy, scar tissue mobilization and myofascial release (MFR) they can be both emotionally and physically therapeutic. A restorative yoga class and even a weighted blanket can help bring you back to your body.

Zellin says you can start even smaller.

“Just try to notice which things and sensations give you pleasure and happiness,” she explains. “Let’s say there’s a soft blanket and it feels good when I put my feet in it. What feels so good about it? Can we expand on why that feels good and can we take time to let ourselves let it feel good? Learning that stuff is really helpful for getting turned on individually or with a partner.” Even gently running your fingers up and down your arms and hugging yourself can re-write these interactions.

Explore New Ways to Find Pleasure

Sex after cancer is different. The body may not look or operate as it once did. That’s okay. There is going to be a moment of readjustment to figure things out. This may require trying or doing things you have never done before. Exploration with an open mind is key to getting back your groove — regardless of your dating situation. Zellin notes, “The more you know about yourself and understand your own pleasure, the more we can get to more pleasure.”

If you’re feeling physically weaker, then try stimulating your mind — download some audio erotica, watch some porn or read some smutty fan fiction. If you have a partner, involve them. For example, take turns reading some sexy pages.

“It could be saying, ‘Hey I just read this really sexy scene — would you mind recreating it with me?” Zellin explains. “It’s not that we don’t and can’t have sex, but rather ‘What do we need to do differently to find pleasure in our experience together?”

For many survivors dealing with severe dry and thinning vaginal tissue that can cause serious discomfort during sex, there is another option to consider. “There’s also anal,” reminds Zellin. “If vaginal sex is painful and isn’t going to work for a while but you want penetration, we’ve got a lot of other body parts.”

Take Your Time

Intimacy isn’t something to rush. Reconnecting with pleasure takes time. Whether exploring alone or with a partner, give yourself the time and space to find what feels good, without pressure or expectation. Anatomy alone requires it. Explains Zellin, “It takes 30-45 minutes for female genitalia to get fully engorged and lubricated.”

In terms of dating, there’s no timeline for getting back out there, either. “I mentally could not focus on building something new when I didn’t know what the road ahead would look like,” says Melissa Bunning, a 35-year old survivor who ended a new relationship shortly after her diagnosis four years ago. “To get a diagnosis like that when you feel like you’re at your peak performance, it just creates this disconnection between your physical body and how you mentally perceive [it], so in terms of intimacy, I really took that off the table throughout treatment.” Only toward the end of treatment did she update her dating apps.

Adorn Yourself

Building back confidence and self-esteem, especially around body image and sexuality, is a lifelong project for many women. Many survivors, including Bunning, used fashion and makeup to feel beautiful again and boost their confidence.

“There’s a funny line I heard that I always repeated — when people would be like, ‘You’re in cancer treatment? You look great!’ The punchline is, ‘I’m in cancer treatment, I’m not ugly,” she adds with a laugh. “I worked in fashion and beauty [at the time], so I felt very equipped to do my makeup in ways that gave me confidence — I wore a wig for a short period of time and I always looked fabulous.”

Don’t think about keeping up with the trends or what others find attractive. What matters is what makes you look and feel good.

“In my dream world, every single cancer center would have a menopause specialist, a sexual medicine specialist and a sex therapist,” Emont says. That’s not the reality yet, but he sees the growing conversation as real progress. “As this becomes something more women are advocating for, hopefully we will get there and it will become the standard of care.”