When it comes to revealing your cancer treatment results, timing is everything.
Rebekah Repper of Sanford, N.C., was 35 and married when she received a diagnosis of ductal carcinoma in situ in her left breast in 1998. She underwent a mastectomy, healed well and moved on with her life, giving birth to a son 13 months after her surgery. Although Repper says her husband supported her throughout treatment and recovery, they eventually decided to divorce.
As she entered this new phase of her life, an important question emerged: when and how should she tell a prospective sexual partner about her cancer experience and the fact that she has only one breast and a scar that runs from her sternum to her armpit?
“This is an issue I hear quite often, especially when I lecture,” observes Sueann Mark, PhD, a clinical sexologist in San Francisco. “It’s the number one question I get from single cancer survivors.
”Uncertainty regarding the “when” and “how much” is understandable, therapists say. Bring up the issue too soon and you risk scaring away a potential partner; bring it up too late and the person may become angry that you withheld such an important detail.
No Single Answer
“There is no one-size-fits-all answer,” notes Mark, who is a breast cancer survivor. “I can’t say ‘on the third date’ or ‘the fifth date’ or ‘in your online profile.’ It’s different for everyone.”
But for those who bear physical scars of their cancer journey beneath their clothing, it’s definitely time to talk when intimacy appears imminent.
That’s what Repper did, though she had concerns about the reaction to her mastectomy scar. “That’s not something you want to spring on a partner as a surprise,” she observes.
When Repper found herself in a serious relationship with a man she truly cared about, she was upfront about her mastectomy. “I told him that it is not a ragged injury but a surgical scar, but nonetheless, I was missing a breast.” Her boyfriend was unfazed.
Men Equally Affected
The physical effects of cancer treatment also affect men and require the same pre-intimacy conversation. Craig Roderique, 56, of Blanchard, Okla., received proton therapy for prostate cancer in 2010, which left him with sexual dysfunction that requires the use of Viagra (sildenafil). The former air traffic controller says he delayed bringing up the subject with the woman he had started dating until it became apparent that their relationship was progressing.
He says his approach was simple. “I told her what I had gone through and waited for her response, which was totally positive,” Roderique says. “Because we seemed to be clicking at that point, she was totally sympathetic, and there was no negative impact on our relationship from that point forward.”
Body image and self-esteem issues can be even more pronounced when the physical effects of cancer are apparent, as Catherine Danielson of Lake Havasu City, Ariz., learned when she underwent a total laryngectomy in 1999 for throat cancer. Danielson uses an electronic voice box, which she believes has cost her several potential relationships. “The unintentional rejection would really sting,” she says, “but eventually I came to be content with myself.”
Recently, Danielson initiated online contact with a man she knew when she was a teenager. Before they spoke for the first time, Danielson explained via e-mail that she had been treated for cancer and now used a voice machine.
“You’re still you, right?” he wrote back. They are now engaged to be married.
Addressing the Issue
Mark says the way you deliver the information is important. “If you go into that conversation feeling timid, ashamed or nervous, then that’s the sort of message that gets communicated. If, on the other hand, you approach the conversation with, ‘I have cancer as part of my history, but it doesn’t define who I am, and I’m ready to move forward with my life,’ that’s a very different thing.”
Mark speaks from experience. She received chemotherapy followed by a mastectomy and six weeks of external-beam radiation to the breast and armpit to treat her breast cancer. Her reconstructive surgery included a silicone implant on the mastectomy side and a lift for her healthy breast. Since then, she says, she has gone on blind dates set up by friends and has done some online dating.
“I am more than a cancer survivor, so I want to let a potential partner know about my other qualities first,” Mark notes. “That way, they can put the cancer history in perspective and know the whole of me rather than focusing just on the cancer.”
Mark admits to being a little nervous when discussing her cancer history because she doesn’t know how someone will react. “I am a survivor, and I can’t change that,” she says. “If someone has a problem with it—enough to reject me because of it—there’s nothing I can do about that. Plus, I wouldn’t want to be with that person anyway. I don’t take that kind of rejection personally, though.”
Mark says she has had very few negative reactions. “There was one particular guy who, when I told him about my treatment, was impressed by how I dealt with cancer and moved beyond it and saw it as an asset. There have been many men I’ve dated that I didn’t get to the point of revealing my cancer history because it was clear there was no spark. In those situations, I’m glad that I didn’t reveal it in my online ad or on the first date. It is a little stressful to do the big reveal, and it would be a waste of my time and emotions to go through that if there’s no long-term potential.”
Mark’s experience with breast cancer has also influenced the way she relates to her clients. After her diagnosis, she chose to specialize in the unique sexuality needs of cancer survivors, a population she did not specifically work with previously.
“I find that since we share a common history of cancer treatment, I actually reveal more personal information, mainly treatment-related experiences, than I would with clients who are not survivors,” she reports. “Even with my general clients, I teach them the lessons of a survivor as a model for dealing with various life obstacles. I think the general public could learn a lot about resiliency and coping from cancer survivors, including our attitudes around sexuality and how that affects behavior.”
Belinda Beavers, a cervical cancer survivor in Peachtree City, Ga., believes telling potential partners about her cancer is complicated by the fact that it was caused by the human papillomavirus, which is sexually transmitted. Beavers, a flight attendant, received her diagnosis after breaking up with a long-time boyfriend, and when they got back together and he learned of her diagnosis, he didn’t take it well, despite the fact that he may have given her the virus.
“Because it is transmitted sexually, there is either blame or suspicion or guilt—all kinds of negative emotions come into play,” Beavers says. “And if you don’t have a strong, supportive relationship and open communication, it’s ripe for all kinds of confusion and could be the end of the relationship.”
This is what happened to her, she says, adding that she isn’t dating now because of added complications of being thrown into early menopause and all the accompanying side effects after a hysterectomy.
Where to Talk
The location of the “I have something to tell you...” conversation is just as important as what you say, says Mark, who warns against waiting until you are in bed because it’s such an intimate setting. “A long car drive can be a good opportunity to talk about such an emotionally charged subject because you have nothing to distract you from the conversation.”
Heidi Schultz Adams of Austin, Texas, used a first-date hike with the man who later became her husband to bring up the fact that she had been treated for Ewing’s sarcoma in her left tibia at age 26. Radiation treatments had left her ankle discolored and slightly thinner than the other, and her doctor had strongly cautioned her against injuring it.
“I was very open and transparent about it,” says Schultz Adams, who was 29 when she began dating her husband. “I explained that I had to be super careful [on the icy path], and he was very solicitous. I think he felt it was a great opening.”
When it comes to telling a new partner something as personal as your cancer history, Schultz Adams, founder of Planet Cancer for young adult cancer survivors, suggests simply going with what feels right. “I’ve talked with a lot of people, and some say ‘tell him right away,’ and others say ‘wait until you know him better,’” she says. “But if you’re always weighing that in your mind, then you’re just going to be worried. Every case is different. You just have to trust your instincts.”