Normal, Interrupted

Sexual Difficulties
Vaginal dryness and lack of libido are two symptoms that crop up often among breast cancer survivors, but it’s not always something that is discussed candidly in clinical follow-ups. There are many reasons for the lack of libido, but the vaginal dryness is mostly related to decreased estrogen. Richard Zera, MD, Ph.D., chief of Surgical Oncology at Hennepin County Medical Center has learned a lot from his patients about how to help them manage this lesser-discussed aftereffect. “I had one patient come to me and say, ‘You can help me, but you may not know how,” he recalls. “It made me look into sexual side effects and take more proactive steps to help the women who were dealing with these challenges.”

Zera recommends various treatments according to women’s specific health status and symptoms; he talks to his patients about what is happening in their lives. Some common approaches include use of testosterone (discuss the risks with your doctor), a loss of which is thought to lead to lack of sexual desire, and vaginal estrogen and lubricants.

Depression and Anxiety
At one point during her treatment, breast cancer survivor Freda Carlson, a health promotions manager for the American Cancer Society’s Minnesota Region in Duluth, discovered that she wasn’t experiencing the normal “highs and lows.” “I felt flat, and I knew that this wasn’t right emotionally, but I also knew that I was protecting myself in terms of whether I would come through,” she says. “I talked to my doctor about it, and in the fall of 2002, I did see a therapist for a little while.”

Although psychotherapy and medications are available for treating depression symptoms, patients can also take proactive, non-medical steps that can make a difference. A regular exercise program has been shown to decrease rates of depression and fatigue, improve symptoms of lymphedema (swelling of the arm related to chemotherapy and surgery), and increase a sense of well-being in breast cancer patients specifically. Support groups have also been shown to be beneficial.

Inevitably, women who have faced breast cancer also face a fear of recurrence. “The unfortunate thing about breast cancer is that it’s sneaky, and it can come back years later,” Carlson says. “You end up going back and forth between ‘I want to know the reality of my disease’ to ‘I am alive and feel good, and that’s what matters.’”

Being “cut loose,” as Kathy Flynn refers to it being off treatments, can be a profound rite of passage for women with breast cancer. Since being diagnosed in 2002, Flynn has had one recurrence in 2006 and additional surgeries but is now in remission. Today, she is rediscovering the “normal” so cherished on the day of her first diagnosis. “I do think about it every day, but what feels good is I have also found a way just to put on my jammies and get cozy,” she says. “I am participating in the pleasures of life again, and it’s wonderful.”