What Sex and Intimacy Really Look Like After Breast Cancer

Dana Donofree, 43, was diagnosed with stage one triple positive breast cancer in 2010, the day before her 28th birthday and three months before her wedding.

Over the next year, she underwent a bilateral mastectomy with implant reconstruction and eight rounds of chemotherapy that propelled her into temporary menopause.

While her grueling cancer treatment took a toll on her, both physically and emotionally, Donofree says the impact on her body image was particularly devastating: “I called my newly reconstructed breasts Franken Titties. That’s what I felt like: Ms. Frankenstein sliced and diced and put back together.” Her breasts and tattooed nipples, which had no sensation, felt like foreign entities. She also had to grapple with the impact of being thrust into menopause: “vaginal dryness, atrophy, pain—you name it, I had it,” Donofree recalls.

She postponed her wedding for a year due to the aggressiveness of the treatment. She also avoided intimacy with her then fiancé. “He still saw me as beautiful, and showered me with love and affection,” explains Donofree. “The problem was, I wasn’t in love with myself. I could not look in the mirror for over a year. I felt stripped down to the bare minimum: my hair, eyelashes, and nipples were all gone.”

Almost 90 percent of breast cancer survivors report significant changes to their sexual health, like low libido, vaginal dryness, and body image concerns, according to a 2025 study published in the journal JCO Oncology Practice. Almost 85 percent said these changes caused them significant distress, and nearly 75 percent said these changes affected their relationship with their partner.

“Survivors have to cope with changes in two major erogenous zones: their breasts and their vaginas,” notes Jeanne Carter, PhD, a psychologist at Memorial Sloan Kettering Cancer Center who works closely with breast cancer patients. “But even more than that, they have to grapple with changes in how they feel about themselves.”

While these feelings are normal, she stresses, part of the problem is that patients’ healthcare teams don’t bring them up. The JCO study found that over 70 percent of survivors had to broach the topic with their doctors themselves. “When I started work at Memorial Sloan Kettering fifteen years ago, I was shocked at how few of my colleagues realized that sexual health and intimacy were issues among their breast cancer patients,” recalls Shari Goldfarb, MD, a breast oncologist at Memorial Sloan Kettering. “I literally handed out questionnaires to my waiting room, and 76 percent of my patients reported some type of sexual dysfunction. Eighty-five percent of them said they wanted their doctors to discuss it with them. It needs to be part of every woman’s breast cancer treatment plan.”

Why Intimacy Is an Issue

When Caitlin Kiernan, 54, was diagnosed with stage one breast cancer in 2012, she was focused on standard cancer treatment side effects such as hair loss. She was unprepared for the toll it took on her libido. “I had just exited a relationship, and when I began to date again post-treatment, I couldn’t have an orgasm. I was so dry, and I was constantly having hot flashes,” recalls Kiernan, who is the author of Pretty Sick: The Beauty Guide for Women with Cancer. When she started to date her now-husband, Kenny, “we would go to bed, and I’d be sweating with intense night flashes,” she says. “I felt embarrassed and upset. He’d want to cuddle together, but it was impossible—I was just so hot.”

Many symptoms breast cancer survivors experience stem from a temporary form of menopause, caused either from chemotherapy or the use of hormone therapy to help prevent recurrence of hormone receptor-positive breast cancers, explains Goldfarb. These medications are typically taken for five to 10 years. But there may also be changes in nipple sensation after breast cancer surgery. “Even with lumpectomy, women may experience sensation loss due to nerve damage, although that sometimes can get better over time,” she notes.

Emotions also play a significant role in low libido. “Many of these women are just exhausted,” says Goldfarb. “They’ve navigated their breast cancer diagnosis and treatment while they’re also juggling other responsibilities like work, children, and their careers. They may be able to power through their chemotherapy, but once that’s done, they crash.

How to Reignite

When Donofree finished her breast cancer treatment, she decided to have a tattoo of a cherry blossom tree placed strategically over her mastectomy scars. “I wanted its outlines to mimic the lines of a demi-bra because I couldn’t find any pretty lingerie to put on my body after my surgery,” she explains. “It was a way to give myself back power.”

For Kiernan, empowerment came in the form of implants that took her from a B cup to a C cup. She had opted against a nipple sparing mastectomy because she worried the procedure would leave behind rogue cancer cells that would trigger a recurrence. Her implants were a way to gain some agency over her new breasts. “Before my cancer, I always had bigger hips than breasts, so I felt like my new set balanced me out,” she explains.

Here’s what both breast cancer experts and survivors suggest to help spark your sex drive again and enhance intimacy.

Vaginal lubricants. Carter recommends products that contain hyaluronic acid, which are more hydrating than over-the-counter lubricants, to help treat vaginal dryness and pain. Her research has found that vaginal moisturizers are most effective in postmenopausal cancer survivors if they’re used at a higher frequency than what you’d typically use in menopause—about three to five times a week, she explains.

Vaginal estrogen. When Donofree was on hormone therapy, she took vaginal estrogen to help counteract symptoms like dryness. While in the past doctors were reluctant to prescribe it among women with breast cancer, new research is reassuring, says Goldfarb. A 2024 JAMA study of over 49,000 women with early-stage disease found there was no increased risk of breast cancer death among vaginal estrogen users. “The goal is to use the lowest dose, which is 4mg twice weekly,” explains Goldfarb.

Pelvic floor physical therapy. Strengthening your pelvic floor muscles can help you get sexually aroused—and have an orgasm. “When you use these muscles, you bring oxygen-rich blood to your genital area,” explains Carter. She also recommends her patients use Perifit, a small device and a mobile app that allows you to play video games using your pelvic floor muscles.

Medications. Menopause hormone therapy can relieve many menopause-related symptoms like hot flashes. But it’s not generally considered safe to use in women with breast cancer, says Goldfarb. There are several other drugs your doctor can prescribe that help. That includes oxybutynin, a drug usually used to treat an overactive bladder, as well as antidepressant drugs such as sertraline (Zoloft). A new drug, fezolinetant (Veozah), was FDA-approved in 2023 to treat hot flashes, but it can interfere with some breast cancer therapies, notes Goldfarb. Another option waiting for FDA approval is elinzanetant (Lynkuet), which won’t interfere with any breast cancer treatments, she adds.

Sex toys. “I’m a big believer in ‘if you don’t use it, you lose it,’” says Kiernan, who has turned to vibrators to help her get through rough patches. “My husband and I have made it a thing to test out new lubricants and have fun with it,” she adds. “It was a way to make intimacy, which could sometimes feel traumatic, fun and playful—an inside joke between the two of us.”

Online support. It can be hard for breast cancer survivors to join support groups. “Women are terrible about making time for themselves, so we often try to work with patients for a couple of sessions to give them some of the tools that can help them with sexual intimacy,” explains Carter. However, there are resources available online that you can turn to. The Komen Foundation, for example, has a webinar on sexual health with metastatic breast cancer and another on regaining intimacy after breast cancer.

Bras geared toward breast cancer survivors. Donofree was devastated after her mastectomy when she pulled out all her beautiful, lacy bras and realized she couldn’t wear them anymore. “Even after my reconstruction, the only bras I could wear were sports bras and camisoles. I couldn’t imagine doing that for the rest of my life.” Donofree drew on her previous experience in the fashion industry to launch AnaOno Intimates in 2015, which specializes in bras specifically designed for women who have undergone mastectomies, lumpectomies, and breast implants.

“The ‘mastectomy bra’ has been around for 40 years—it’s defined as a medical device, and it looks like one,” she says. “I didn’t want to spend the rest of my life wearing one. We deserve to feel feminine, and pretty, and sexy, just like any other woman.”