Body image, gender and cancer

Breast cancer treatment may include breast-conserving surgery (removing part of a breast) or a mastectomy (removing one or both breasts). Having a mastectomy is different from top surgery.

After a mastectomy, you may choose to have a breast reconstruction or “go flat”. Some people who go flat choose to have a tattoo to cover scars or express themselves. Your decision may depend on whether the surgery helps your body better reflect your gender. Your cancer care team may talk to you about reconstruction, but the choice is yours. For more information on body image and gender identity after breast cancer surgery, visit Breast Cancer Network Australia.

Removal of the ovaries can affect how you experience sexual intimacy. This can often be managed with menopausal hormone therapy.

Most people can still have orgasms as the clitoris and labia remain and control much of sexual sensation. However, orgasms may feel different.

Surgery for vulvar cancer may remove part or all of the labia and, in some cases, the clitoris. This can affect your sense of identity, confidence and sexual pleasure. A fulfilling sex life is still possible, but it may take time to adapt. Talk to your doctor; they may refer you to a sexual health physician.

Some people who have had a testicle removed may have less confidence and feel less sexually desirable. For cisgender men, the loss of a testicle may make them feel less masculine. Some people adjust quickly to having one testicle, while others find that it takes some time. If you’re self-conscious about how your scrotum looks, you may want to consider having an artificial testicle (called a prosthesis) inserted.

Trans women or non-binary people with testicles may also have a testicle removed for cancer. For some, this could affirm their gender; for others, it could feel distressing.

During surgery, the tubes from the testicles are sealed and the prostate and the small glands called seminal vesicles are removed. This means semen is no longer ejaculated during orgasm. The pleasure from rubbing or stimulating the prostate during anal sex will also be lost. This may also affect erectile function. Talk to your doctor about ways to manage these changes.

After prostate cancer treatment, your penis may be a bit shorter (only by about 1–2 cm) or be a different shape. After treatment for cancer of the penis, all or part of the penis may be removed (partial or total penectomy). If the size of your penis is affected, you may avoid intimacy for fear of rejection. Your cancer care team can recommend a range of methods to change how the penis looks. For more information, visit the Prostate Cancer Foundation of Australia to download their booklet Understanding Prostate Cancer for LGBTIQA+ People.

Surgery can cause scarring. Sometimes people worry because a scar looks or feels red, tight or uncomfortable. This may make you feel self-conscious, even if others can’t see it. Ask your doctor about creams that may help the scar heal and become lighter in colour. In some cases, you may choose to have surgery to make a scar less noticeable.

Some targeted therapy, immunotherapy and hormone therapy drugs can cause itchy, red and dry skin. Radiation therapy can also cause skin issues. Skin changes can make you feel self-conscious. Your doctor may be able to suggest creams to help.

If most of the lymph nodes are removed from your armpit, groin or pelvic area, lymph fluid may no longer drain properly, and your arm or leg may swell. This is called lymphoedema. This may be permanent, but the pain and swelling can usually be managed.

You may need a temporary or permanent opening in the body (stoma) after surgery for some types of cancer (e.g. bowel or bladder cancer). A stoma allows stools (poo) or urine (wee) to collect in a bag attached to your abdomen. The bag can then be emptied. It can take time to get used to a stoma. You may worry that it can be seen under clothing, but it’s not usually noticeable. For more information, see Sex with a stoma.