Sexuality and cancer surgeries: what's mine is yours, apparently

DePaul-ReplacingHere’s an interesting article in Salon by Ann Bauer, “Sex Without Nipples,” about the differential between counseling and treatment offered to cancer patients about sexual issues in men’s versus women’s cancer surgeries.  Sadly, I’m not surprised–as we’ve seen before, somehow it’s all about teh menz and their feelings and their sexual satisfaction, no matter whose body has the cancer.  Whereas prostate cancer patients are counseled heavily about the sexual side-effects of their cancer treatments, women who opt for mastectomies are never advised about the possible consequences to their sex lives.  Bauer writes:

This is particularly true, it seems, when the topic is nipples. Virtually none of the literature or education around the topic of breast cancer covers the sudden disappearance of erotic sensation in the breast. There is no attempt, as there is in a prostatectomy, to preserve the nerves. Modern mastectomy simply hacks off the offending tissue and creates a blank area where there once was tingling current.

There are also body-image issues after breast cancer surgery and reconstruction, for patients and their partners.  But, one young woman who tested positive for BRCA1 and chose to have a preventive double mastectomy makes it sound like her partner’s discomfort and even disgust with her surgery, recuperation, and new body were another problem for her to solve, a problem she didn’t handle well enough.  “Jessie”‘s own mother had died at age 30, and she had five other maternal relatives die from the disease–so she figured, why take the chance? 

But her boyfriend disagreed.  He was angry and felt she hadn’t taken his feelings into account. He grew increasingly uncomfortable and remote throughout the procedure: double mastectomy, reconstruction of the breasts using cadaver tissue, and a messy, gory aftermath involving lymphatic drains.

At the time, Jessie was entirely focused on her own body and its recovery. [ed. note:  selfish, selfish woman!  How dare she?]  She didn’t want to die. And how, exactly, was she supposed to negotiate this decision with her lover when no expert she consulted ever mentioned sex?

Looking back, she says she wishes she had handled it differently. [Emphasis Historiann’s.]  Her boyfriend really tried. He stayed. He helped her to the bathroom and brought her Vicodin at 4 a.m.  [ed. note:  big deal!  Isn’t that what you would do for anyone recovering from major surgery?]

“If I could talk to women, I’d tell them do not let your man drain you,” Jessie says, referring to the process of emptying and measuring the bloody lymphatic fluid siphoned off by her surgical drains. “That whole area is just a mess. I think my partner couldn’t deal with the act of being a caregiver. And a lot is written about the women’s side of it, but I don’t think men get due credit for what it does to him.”

This is clearly a failure of 1) this man, who was incapable of assuming the responsibilities of a committed relationship, and 2) standard breast cancer therapies and counseling, which are focused on the restoration of the cosmetic rather than the sexual sensations of reconstructed breasts.  Although even if breast cancer therapies addressed the woman’s sexual sensations and sexual functioning after mastectomy, I’m pretty sure all of the sex therapy in the world would be wasted on trying to get me excited about a man who thought my mastectomy was all about him and his feelings.)  Fortunately, this couple broke up, and I suppose it was better that “Jessie” find out what a creep her boyfriend was as an otherwise healthy young woman.  Lord help her had she follwed his wishes to keep her breasts, and she got cancer and then had to count on him to get her through it all. 

I just don’t understand the fetishization of a body part that this kind of attitude implies–a fetishization that puts a body part above the health and well-being of his girlfriend.  This fetishization also renders a body part no longer part of a human body–not flesh, blood, and lymphatic fluid, somehow.  (What did this guy imagine is inside a breast?  Confetti?  Butterscotch pudding?  Or, as The Forty Year Old Virgin put it, “sand?”)  Yet “Jessie” blames herself for her genetically imperfect breasts and her lymphatic drains, which apparently really spoiled the show for her boyfriend.

Of course our illnesses and amputations affect not just patients but our friends and loved ones, but I always assumed it was because they love us and don’t want us to be sick or to die, not because they can’t imagine being our friends or lovers unless our bodies are whole and perfectly healthy.  I can completely understand that breast cancer patients and their partners would mourn the loss of what they had thought was a perfect and healthy body.  But–what a turd this guy is.  Apparently in retrospect, he acknowledges this.  When Bauer introduced “Jessie” in the article, she explained that “Jessie” is “a pseudonym — while she wouldn’t mind using her real name, her ex would be mortified, she says.”  You don’t say!  I wonder what he tells the other women he dates when explaining why he and “Jessie” broke up?

0 thoughts on “Sexuality and cancer surgeries: what's mine is yours, apparently

  1. I think a lot of this has to do with the patriarchal (or misogynistic) socialization of the medical community, as well as the larger one. While neither my husband nor I have had to deal with cancer, not long after we married, he had to have a testicle removed, and several years ago, I had to have a hysterectomy and an ovary removed. With my husband, he had four(!) surgeries before the urologists would actually take out the damaged testicle, not because it would affect his hormone levels or anything like that, but because it might affect his masculine self-image! They even cut a nerve in his abdomen to block pain signals from the testicle before they would consider taking it out, while taking out my uterus and ovary was treated as routine and normal. My doctor told me that one ovary would produce a normal hormone level, and “after all, it isn’t like you planned to have more children.” WTF? That’s the only reason I might not want my uterus and ovary taken out? By the way, my doctor was a woman.


  2. I have several, completely incoherent thoughts here. First, yes, the assumptions about sexual impact were all developed initially by male doctors. But when I was in grad school, I had a roommate who was a med student, and she hit the roof when a prof suggested that all women have prophylactic mastectomies as soon as they had finished having children! (OK, this is back in the dark ages of the late 70s…) He was like, yes, breasts are just secondary sexual characteristics, so they are expendable. So I wonder if there might be a more complicated history of all this? (surprise!)

    Another piece is that when my husband had surgery for colon cancer, the docs underestimated the effect on sexual functioning. Now, this may have been unique, but I think they like to think everything will be all right, for men and women.

    The final piece is a little compassion for Jessie’s bf. On the one hand, yes, he was a jerk, and he wasn’t ready for the responsibilities of a committed relationship (which may be why he was a bf and not a partner). But if he was doing the drains, he was doing a lot. Even after more than 20 years as a partner, the kind of caregiving he was doing is HARD. It generates all sorts of emotions which are hard to sort out precisely because we love someone. Caregivers routinely are angry and then feel guilty over the anger. I can imagine that dealing with this in a relationship where you haven’t yet made a full commitment to someone would be an issue. And just because the surgery was the trigger, it doesn’t mean it wouldn’t have been something else otherwise…


  3. I just want to second Susan’s comments re: the bf’s reaction. I think dealing with friends of loved ones who are ill is an area where there is often a disconnect between how we would ideally behave and how we often do behave and react to the messy reality. (As a side note, I think this is partly because of the ridiculous false expectations set up by romanticised Hollywood depictions of illness).

    I helped nurse my father through two years of cancer treatment. Despite how much I loved him and how close we were, I sometimes found the experience frightening and disgusting. Part of that is the visceral realities of how a human body reacts to terminal cancer. Part of that, I think, is the way it makes you confront your own mortality, and maybe that’s partly what disturbed Jessie’s boyfriend so much. While his attitude as reported sounds pretty insensitive, I bet there were also much more complex feelings underlying it. Our society does such a poor job dealing openly and honestly with issues of illness and death that I can imagine if he was a young man who’d never had to face anything like this before, he may not have had any better ways to articulate, or even understand, his own feelings.


  4. Oh, give me a break. I’ve done the drains and there’s blood and it’s not easy, but my wife had just come out of surgery. That is the least of the problems when it comes to cancer. I was grateful that my wife didn’t have more advanced cancer. Historiann is right — the bf is immature and not ready to deal with a relationship in all its dimensions. If you are with someone long enough that will mean serious illness at some point.

    BTW, when it comes to helping someone who is sick, you do the best you can and deal with it. Word to the bf: grow up, be strong, and act like a woman!


  5. “As a side note, I think this is partly because of the ridiculous false expectations set up by romanticised Hollywood depictions of illness”

    Oh, yes. Their depictions show illness and death as beautiful, uplifting things. I was one of the caregivers for my mother through ovarian cancer, and it was awful for everyone.

    That said, the bf is a complete jerk, and unfortunately, his behavior isn’t that off. I read about a woman who was diagnosed with CF and one of her husband’s early questions to the doctor was ‘how would this affect their sex life’.


  6. I don’t know what to say. This is a little close to home.

    But I’m sadly not surprised at the general gendering of medical practice. It may well be, too, that medical practitioners focus on the basic mechanics of sex, and privilege those parts (?) above others? I’d have to know more about how med schools teach oncologists to handle pleasure centers. Men (he says, remembering a high school biology book from 1986) have fewer? One? In any case, something needs to change. The comments here chill me.

    As for the boyfriend, I’m not sure it is fair to ask him to “man up!” (I’ll avoid Liz Lemon’s phrase). Yes, I think that cancer is one site where a relationship gets tested, and people need to find new strength to commit to a changed partner. There are, in any relationship, a million such sites. So if he can’t handle this, how will he handle a stillbirth, the death of the father, Alzheimers, the death of a child, a career collapse, etc. You get the idea. Maybe it was better that he left now. We all need more durable help getting through the days and years – through these myriad sites of loss.


  7. Thanks for your thoughts on this, especially those of you who have nursed family through cancer treatments. I don’t (yet?) have that experience.

    It seems like there’s another gendered conversation implied here, namely, how would we or society judge a young woman who dumped her boyfriend after a major surgery or health problem because she found it too icky? I wonder if my reaction to the bf has a lot to do with my resentment that men are let off the hook a lot easier than wives and daughters when it comes to nursing and intimate body care. (And remember–Jessie didn’t have cancer–she had the surgery to avoid the cancer, which I assume would make her recovery easier or at least less anxiety provoking.)


  8. Oh, and I mean to say: Barb, your experiences are sadly not all that surprising to hear about, even with a female doctor. Physicians are (from what I’ve seen of med students) deeply conventional people. They’re people who have succeeded by fitting into a complex system as they found it. (This is not a slam–to a large extent, so are Ph.D. academics!) But what it means is that even very smart women don’t necessarily identify as feminists and aren’t inclined to question or challenge the beliefs and values that underlay their training.


  9. My problem with the boyfriend isn’t really that he had trouble dealing, or even that maybe he didn’t want to do deal (as somebody pointed out, he was her bf, not her long-term partner) – I get that. Nobody knows how ze will react to such a situation, and I don’t think bailing because someone ze is dating has a life-threatening illness is in and of itself the worst thing ever. (Although it’s appalling that he thought he had a “say” in what happened to her body!) What sticks in my craw is the idea Jessie puts forward in the end that we “give teh menz more credit for trying.” Men are not toddlers, who require positive reinforcement and cookies for not acting like tools during a life-threatening illness, or for not cheating on their pregnant wives, or for doing the dishes or any of the other five million things women are supposed to be super grateful that men occasionally do like it’s some great gift. To me, the tone of the story is all about how the bf deserves special consideration and compassion because he’s a *man* being asked to be a caregiver.

    I have a good friend who had a preventive double mastectomy and reconstructive surgery, as a young woman. It was devastating, physically and emotionally. Her husband was a giant tool, a total support no-show. Of course that fit into the general pattern of behavior, not an exception – he didn’t help around the house, take care of his children, etc etc.

    A less life-threatening note, but still about breasts, men are *all the time* acting as though they have ownership over their wife’s/girlfriend’s body, her breasts in particular. As though if something happens to them (the breasts), it’s about them (the menz) rather than their wives. A good example is all those comments nursing mothers make about how their husbands were “jealous” of the nursing and felt like something was being “taken away” from them. Hey, menz, women’s bodies actually belong to *themselves*, not to you!


  10. perpetua–I think we were writing at the same time. This is exactly what I was getting at with my comment about the gendered nature of nursing: “To me, the tone of the story is all about how the bf deserves special consideration and compassion because he’s a *man* being asked to be a caregiver.”

    Interesting point about nursing infants–many women may feel like that’s a period in their lives when in fact their breasts don’t belong to them, because of the nutritional demands of mewling infants! Breasts really are a kind of liminal body part that are oddly central to other familiy members’ experience of domesticity/family life. (That said, I think it’s totally reasonable to privilege the interests of the mewling infant over that of the infantile husband/male partner.)


  11. @ Historiann: on mewling infants & infantile husbands – she can privilege one over the other, or tell both of them to f&*k off! (While I said that jokingly, studies say, unsurprisingly, that female victims of sexual assault often find breastfeeding traumatic.)


  12. (oh, and last aside post: I know women feel like their breasts and bodies generally don’t belong to them during pregnancy/ breastfeeding. This is purely self-reflective, but I didn’t feel like that – I felt like my breasts were *mine* to do with what I wished. And what I wished was to feed my baby with them. But I can understand why it doesn’t feel like that to other women, who after many months of BF are like, “get OFF of me!”)


  13. I cleaned my mother’s drains and had a very hard time with it, perhaps more the emotional effect than the physical one (although the physical part of stripping the drains was in my experience pretty awful — I clearly don’t have the stomach that RadReadr has).

    One concern no one has mentioned is that (last I knew) breast cancer can manifest regardless of having had breasts removed. It does so on the chest wall rather than the breast, but there you are, still with cancer, albeit the likelihood is probably reduced.

    @ perpetua, I have enjoyed nursing, but when my baby recently weaned herself I told my partner that they need some alone time. In other words, “get OFF of me!”


  14. He was like, yes, breasts are just secondary sexual characteristics, so they are expendable. So I wonder if there might be a more complicated history of all this? (surprise!)

    There sure is. That history is one of excessive medical arrogance and paternalism, and the notion that patients should not participate in the decision-making surrounding their own treatment.

    While the medical profession for the most part takes the position that this was all about the “bad old days”, and is now completely a thing of the past, anyone with half a fucking brain knows that is far from the case.


  15. Perpetua, can you point me toward the studies about abuse survivors and breastfeeding? I’ve gotten that sense from women I’ve known, but I didnt’ know anyone had studied it.


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