When Sarah was diagnosed with Stage 3 breast cancer in 2020, her primary concerns were not menopause or her marital relationship. Having given birth just eight months prior, she suddenly faced the challenges of chemotherapy, lumpectomy, and radiation. By September 2021, her cancer had advanced to Stage 4.
A few months later, blood tests revealed she had entered early menopause at just 37 years old.
“Being so young, it was unexpected. I experienced severe hot flashes and vaginal dryness to the point of feeling abrasion while walking or sitting, let alone during sex. I wondered, ‘Why am I so abnormal?’” she recalled.
This condition strained her marriage. “My husband’s needs were unmet, but discussing it was difficult for him. His frustration manifested in other areas, leading to frequent arguments,” Sarah told CNA Women.
“At my lowest, I questioned, ‘Why fight cancer? What’s the point of enduring such tough treatment if I’m constantly arguing with my husband?’” she said.
Like Sarah, many cancer survivors face challenges beyond medical treatments.
“It’s common for patients to initially experience a hit to their self-confidence, self-esteem, and trust in their bodies due to sudden physical and functional changes,” said Assistant Professor Irene Teo, principal clinical psychologist at the Department of Psychosocial Oncology, National Cancer Centre Singapore (NCCS).
“Sexuality remains one of the underrated and undertreated issues in cancer survivorship, not only in Singapore but worldwide,” Asst Prof Teo added.
According to a study by NCCS and KK Women’s and Children’s Hospital (KKH), one in six women with a history of breast or gynecological cancer reported sexual dissatisfaction.
Physical and Functional Changes During Cancer
“Cancer is a life-changing event that affects patients physically, psychologically, and socially. Some side effects may be long-term,” said oncologist Dr. Joline Lim, a consultant at the Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS).
Beyond temporary hair loss, patients may experience peripheral neuropathy (numbness of the limbs), a side effect of chemotherapy. While this typically improves post-treatment, some may live with permanent nerve damage, Dr. Lim noted.
Certain cancers require the surgical removal of breasts, ovaries, uterus, or other anatomical changes. Colorectal tumors may necessitate a colostomy, creating an opening in the colon through the abdomen where waste is rerouted to a collection bag, affecting daily living and self-image.
June, diagnosed with breast cancer in 2010, underwent a mastectomy at 28, just nine months after her wedding.
“I was in denial. Leading up to the surgery, I often woke up hoping it was a nightmare. When reality hit, I broke down. The thought of waking up with a flat chest and a scar was too much,” she said.
She chose breast reconstruction, retaining her nipple but losing sensation permanently.
“My scars and loss of sensation worried me about its impact on my marriage. But my husband never despised me. He prioritized my health and recovery over physical intimacy,” June shared.
Weight gain is another common side effect, especially for women undergoing hormonal therapy or early menopause. Long-term steroid use can also lead to weight gain and water retention, Dr. Lim added.
Lisa, diagnosed with Stage 3 thyroid cancer in 2016, underwent surgery to remove her thyroid and lymph nodes. Previously an ultra-marathoner, she quickly gained 8kg. “I feel frumpy and lethargic,” she said.
Despite her weight gain, she refuses to buy larger clothes, holding onto hope that she will return to her previous size. “Otherwise, you’re stuck in T-shirt and shorts or pajamas.”
Dealing with Sexuality, Intimacy, and Sex
Many loved ones and friends do not understand the long-term impact of cancer and its treatment.
“Patients often receive strong support during treatment, but it wanes as they appear to return to their pre-cancer lives,” said NCCS’ Asst Prof Teo.
“This is natural as patients look and feel stronger. But symptoms like fatigue and neuropathy can have lasting effects that are invisible to others,” she added, sometimes straining relationships.
Lisa’s constant allergies, a result of her treatment, affected her sexuality. “When you’re always dealing with allergies, intimacy is the last thing on your mind. I was irritable and had mood swings. Initially, my partner was sympathetic, but eventually, he told me to deal with it,” she said.
For young women in their reproductive years, chemotherapy can cause sub-fertility issues. Patients are counseled on these effects and offered the option of egg freezing, but this doesn’t help late-stage cancer patients like Sarah.
“Our dream was to have three kids. We only have one. I have frozen eggs, but chemotherapy means I can’t carry them myself. Surrogacy isn’t allowed in Singapore, so we can’t have more kids,” Sarah said.
Asst Prof Teo noted that women in their thirties and early forties struggle with how these changes affect life milestones like dating, marriage, or starting a family.
Coping with Changes
Supportive families aware of the patient’s challenges and treatment side effects can be a lifeline, said Asst Prof Teo. “It’s normal for romantic or marital dynamics to change during the cancer journey. While sexual intimacy often takes a backseat, many couples report increased emotional closeness.”
Patients concerned about sexual intimacy can seek professional help. NCCS, for instance, offers a multi-disciplinary Women’s Wellness and Intimacy Clinic addressing sexual challenges during cancer treatment.
Sarah’s marriage improved after consulting a sex therapist, leading to better understanding and support from her husband.
For some, these struggles lead to personal growth. June, despite her mastectomy scars, now embraces her body. Her advice: “Be confident about your body. These are our battle scars. We’ve conquered and survived. Our bodies will change with age anyway, so don’t fret.”
Despite Stage 4 cancer, Sarah pursued a coding course and transitioned from an administrative role to an engineering position.
“The majority of cancer survivors require adjustment time and then live meaningful lives. Many describe their cancer experience as having a significant impact on their life priorities,” said Asst Prof Teo.
