Breast cancer typically brings on one of the biggest libido-killers: fatigue. Recovering from a mastectomyand perhaps reconstructioncan sap your energy, as can chemotherapy and radiation. "Fatigue is a bigger problem because it can be pervasive and it can last a lot longer" than other physical changes such as hair loss or dry skin, says Helen L. Coons, PhD, president and clinical director of Women's Mental Health Associates in Philadelphia.
If you're on hormone treatment, you may be plunged into early menopause, and for some people that includes low desire and vaginal dryness, which can make sex painful. (Younger women and women who've had chemotherapy are generally more likely to report problems with sex.) Leslie R. Schover, PhD, professor of behavioral science at the University of Texas M. D. Anderson Cancer Center in Houston, suggests a vaginal lubricant and/or a vaginal dilator to make sex less painful. "Being on an antidepressant or anti-anxiety medication can also blunt sexual desire," she says.
Accepting how your body may have changed is obviously crucial to feeling sexual again. Scars, a new breast shape, or a missing breast or reconstructed one may take some time to get used to. As difficult as it can be to talk about these things with your partner and your doctor, if you're not bouncing back to your usual sexual self over time, it is something to bring up.