Body image, sexuality, and family planning: LGBTQ+

If you have breast cancer and you’re a member of a sexual and gender minority (SGM) community, you may have unique concerns and experiences when it comes to your body and sense of sexuality, gender, and self. If you are planning to have children, your conversations with your care team and the choices you make about fertility and family planning are likely to be different than they are for heterosexual people.

Breast cancer and body image as an LGBTQ+ person

Being diagnosed with, and treated for, breast cancer is one of many experiences that can affect your body image and self-esteem. How you feel about your body image during and after treatment depends on many things, including your sexual orientation and gender identity (SOGI).

Everyone responds differently to the physical changes of breast cancer. Your self-esteem and body image can be related to:

• The type of treatment you’ve had (and how your body may have changed as a result)
• What breasts, hair, and other physical features mean to your identity
• How you felt about your body and sexuality before diagnosis
• A personal history of sexual abuse
• A personal history of eating disorders
• A personal history of serious illness
• Whether you have a disability
• Media messages (TV, ads, or social media) and culture-specific norms

Your past experiences and relationships, personality, and support system also play a role in how breast cancer will affect your body image.

Breast cancer treatment side effects can affect how you feel. You may be tired and scared at times; depression and anxiety are also common before, during, and after treatment. Physical side effects of treatment, including surgery and certain medicines, can include:

• Changes in how your breast or breasts look and feel
• Hair loss
• Lymphedema, a condition in which extra lymph fluid builds up and causes swelling under the skin of the hand, arm, breast, chest, or torso
• Skin changes
• Weight gain or loss

Some side effects can be managed with medicine, prescription or over-the-counter skin care products, or physical therapy. To reduce the risk of chemotherapy-related hair loss, scalp cooling or cold cap therapy may be an option. Other side effects are harder to treat. Either way, changes to your body can affect your body image, self-esteem, and sexuality.

No two people share the same feelings about their body image, and no two people experience their breast cancer diagnosis or treatment the same way either. How you react to and cope with your body image during and after treatment is unique to you and your life, whether you’re cisgender or transgender, lesbian, gay, bisexual, heterosexual, or asexual. If you’re experiencing challenges related to body image and sexuality, you are not alone. LBBC has resources for emotional support that can help.

Breast reconstruction surgery

If your healthcare team recommends mastectomy (removal of one or both breasts), and having breasts is important to you, ask your team about breast reconstruction.

Breast reconstruction, or surgery to reshape or rebuild the breast after a mastectomy, can have a positive impact on body image after mastectomy if having breasts is important to you. Reconstructive techniques can also be performed after large lumpectomies to restore the shape and size of the breast.

Some people decide to have reconstructive surgery after mastectomy or lumpectomy, and others choose not to. Deciding not to have reconstruction is sometimes called “going flat.” This decision can be based on many factors, including:

• Risk of complications of having reconstruction
• Political and cultural views
• Gender norms and standards of beauty and femininity
• Opinions of partners (relationship status)
• Social support and influence
• Age

Reconstructive surgery is a personal choice—based on your personal, emotional, and body image needs—that only you can make for yourself. There is no right or wrong decision.

If you are a member of the LGBTQ+ community who has chosen mastectomy as part of your treatment for breast cancer and you aren’t sure whether you want breast reconstruction, ask your breast surgeon for a referral to see a breast reconstruction surgeon. It can help to understand your options and what the surgery may involve, including how long it may take to recover. You may also consider talking to a mental health professional who specializes in treating LGBTQ+ people with cancer to help you decide if reconstruction is right for you. Your hospital or cancer center may be able to direct you to the right person.

Additional resources that can be supportive for making breast reconstruction decisions are available at Cancer.net.

Sexuality and intimacy

Body image can have a big effect on your intimate and sexual relationships, because those areas of your life are likely linked with how you feel about your physical self.

Many people in treatment for breast cancer face challenges regarding sexuality and sex. If you are a member of an SGM community, these challenges may be different than those of cisgender, straight people. It may be helpful to find support and help among other LGBTQ+ people who are being treated—or have been treated—for breast cancer.

Treatments—and the fatigue, discomfort, and pain that sometimes go with them—may weaken a person’s sex drive. Stress can have the same effect. Meanwhile, holding hands, hugging, and doing other non-sexual things with your partner can maintain the intimacy in your relationship, even if you aren’t having sex. Learn more about ways to manage sexual side effects.

Communicating with your partner about sexual life

If you are in a relationship, try to be open and honest with your partner about what you’re feeling, and encourage your partner to do the same. Seeking advice from a couples counselor or sex therapist may also be helpful.

If you’re single, it can feel stressful to tell potential new sexual partners about your history of breast cancer. It may help to take a new relationship, and expressions of attraction and intimacy, slowly.

Visit Talking with your partner about sex for more support and information.

Fertility and family planning

If you’re thinking about getting pregnant in the future, and you identify as someone who is LGBTQ+, your plans and choices about fertility and family planning are likely impacted by your sexual orientation, your body, or both. Being treated for breast cancer will affect those decisions and plans, too.

Some breast cancer treatments, such as chemotherapy or ovary removal, can interfere with the ability to get pregnant by causing irregular menstrual cycles or triggering early menopause. And some treatments can harm an unborn baby, such as chemotherapy in later trimesters of pregnancy. Endocrine (anti-estrogen) therapy to treat hormone receptor-positive breast cancer is never safe for an unborn baby.

Still, there are options for preserving fertility and having children. These include freezing eggs or embryos for later use and pausing an endocrine therapy plan long enough to get pregnant. If having children is important to you, let your care team know. Ask about fertility treatment options. You can learn more about how certain breast cancer treatments impact fertility—and ways to preserve fertility—in the Breast cancer and fertility section.

Getting information about fertility from your care team

Research shows that for people diagnosed with breast cancer, fertility options aren’t discussed as often as they should be.

Your doctors may only focus on treating the cancer. Some people find that their doctors don’t always bring up relationship status, personal life, or goals, including the issue of fertility. And if you’ve come out to your doctor, in some cases, it can feel like they may be assuming that you aren’t interested in having children because of your sexual orientation, sex assigned at birth, or age. Whatever the situation, if you think you may want to get pregnant at some point, it’s important to speak up as early as possible.

“I wish I had been asked: Do you want kids? Do you have a partner? Tell me more,” shares Victoria Seamon, MA, LPCC, a therapist and LBBC Young Advocate who was diagnosed with breast cancer in 2020 at age 34. “Things look very different when you’re in a same-sex relationship.”

Victoria adds, “There’s way more planning involved with pregnancy for same-sex couples. There’s a lot at stake to not have a guaranteed pregnancy. When I compare that to heterosexual couples, they may not have to invest as much money, and resources are more easily accessible.”

Ask your doctor about your specific concerns. If your doctor doesn’t respond well, or doesn’t provide the information you need, seek a second opinion to find another doctor with whom you’re more comfortable.

If having children is important to you, let your doctor know as early as you can so you can learn about fertility preservation options before beginning treatment. It’s also important to know that egg harvesting can be an option for some people after active treatment if there wasn’t an opportunity to do it before treatment.