February 2001: Intimacy and Sexuality

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How to talk about husband's feelings?

Question from Beffie: When my husband and I are intimate, I feel him tense up when he goes to touch me. He says there isn't a problem. How can I get him to open up about his feelings?

Answers —Leslie Schover, Ph.D.: Your husband may be tense, but you also may be very sensitive right now. Sometimes it helps just to start with some lovemaking and let nature take its course. If your husband remains tense, then it may be time to talk more about feelings.

Marisa Weiss, M.D., president and founder: How would she bring it up?

Leslie Schover, Ph.D.: Sometimes it is helpful to bring up issues about sex outside the bedroom. Sometimes it is nice to wait until you have some private time when you are both relaxed. That will help make the conversation more relaxed.

Marisa Weiss, M.D., president and founder: It's also helpful not to make it sound like a criticism, but rather something that you noticed that you were concerned about, that you wanted to help make it better for both of you.

After surgery, how to feel whole again?

Question from Two Fancy: How do you get over feelings of not being whole, when half of your breast has been removed?

Answers —Leslie Schover, Ph.D.: It takes some time to start feeling good about yourself again. Sometimes it helps to focus on the things about yourself that were attractive before, instead of focusing on the small part of yourself that has changed. It may help to do things that make you feel vital and attractive. Physical exercise, wearing clothes that you like, and getting comfortable looking at and touching the area of your scars are all things that can help.

Marisa Weiss, M.D., president and founder: Body image is usually much more of a problem for the woman herself than for her partner. The fact that sex usually occurs in the dark and under covers may give you a little bit more comfort or help you feel less exposed. I would recommend Dr. Schover's book, "Sexuality and Fertility After Cancer." This is a great resource.

Leslie Schover, Ph.D.: It has some exercises to help you get comfortable with your body again.

Marisa Weiss, M.D., president and founder: Don't expect that you will feel better about your body overnight. It will take time. But you also have to be willing to choose to support and nurture yourself and let go of some of your self doubts.

Herbal remedies for increasing sex drive?

Question from Rachelle: Are there any herbal topical cremes or pills that I can take to increase my sex drive and not interact with my medicine therapy?

Answers —Leslie Schover, Ph.D.: I do not know of any natural herbal preparations that truly can increase a woman's sex drive. Even the big drug companies have not yet found a drug that can increase desire for sex.

Marisa Weiss, M.D., president and founder: How about Viagra?

Leslie Schover, Ph.D.: Viagra does not work on the brain. It works on the genital area and it has nothing to do with sexual desire.

Marisa Weiss, M.D., president and founder: What does it help with?

Leslie Schover, Ph.D.: Well there is no evidence right now that it helps women with anything. If it did help, perhaps it might help women who have vaginal dryness and cannot take estrogen. It might promote more vaginal lubrication when women get sexually aroused, but so far there is no proof it works that way.

Marisa Weiss, M.D., president and founder: But Dr. Schover, have there been studies of Viagra in women?

Leslie Schover, Ph.D.: Yes there have, and they have been very disappointing.

Does tamoxifen affect sex drive?

Question from Allison: Does tamoxifen have any effect on sexual drive? I seem less interested since my surgery.

Answers —Leslie Schover, Ph.D.:  That's a good question. There is not much evidence that tamoxifen decreases sex drive. In studies of women with breast cancer, tamoxifen does not appear to cause sexual problems. In the breast cancer prevention trials, however, women who were at risk for breast cancer had a few more problems on tamoxifen compared to a placebo or sugar pill.

Marisa Weiss, M.D., president and founder: But I thought libido in that study was actually a little bit higher?

Leslie Schover, Ph.D.: The problems really weren't with sex drive, but with vaginal dryness.

Marisa Weiss, M.D., president and founder: Part of the problem that women have with loss of sexual interest after breast cancer treatment, while on tamoxifen, may come from the lingering side effects of early menopause due to chemotherapy.

Leslie Schover, Ph.D.: Some chemotherapy effects on sexual desire may have to do with changes in the hormones called androgens. Testosterone is one androgen. In women, about one half of the androgens in the blood stream come from the ovaries. When chemotherapy damages the ovaries, women's androgen levels go down. This could affect a woman's desire for sex; however, we do not know whether it is safe to give testosterone replacements to women who are breast cancer survivors.

Remaining breast not sensitive as before?

Question from Teaching Toddlers: I had a single mastectomy in 12/8/00, and my breasts were always sensitive. My remaining breast is not sensitive like it was before. Why is this?

Answer —Leslie Schover, Ph.D.: If there was no surgery on your remaining breast, the change in sensitivity may be emotional. Or it could be related to hormone changes, if you have gone through that if you have had chemotherapy after your surgery, for example. Many women say that touching and caressing of their remaining breast doesn't feel good after a mastectomy because it reminds them of their breast cancer. Instead of focusing on good feelings when their breast is touched, they get distracting thoughts about their other breast or their cancer, and that takes away from their pleasure.

Painful sex after treatment?

Question from WY Carla: I'm finished with my treatment, but am taking tamoxifen. Lately, sex has been painful. I just can't get wet enough.

Answers —Leslie Schover, Ph.D.: Lack of vaginal wetness or lubrication is a very common problem for breast cancer survivors. It is often related to being in menopause and not being able to use estrogen safely. One product that helps many women is Replens. Replens is a vaginal moisturizer and comes as a gel in a tampon applicator. You use it 3 times a week before bedtime, and it helps the vagina stay moist all the time. Some women think Replens gives them too much vaginal discharge. That can be a problem in the first week or two, but often decreases over time. You need to use Replens for up to 2 months to get the full benefit from it. I also tell women to use a good water-based lubricant just before lovemaking. Many women like Astroglide or Sylk.

Marisa Weiss, M.D., president and founder: MoistAgain or KY liquid.

Leslie Schover, Ph.D.: It is helpful to put the lubricants both on the head of your partner's penis and around the vaginal entrance so that penetration is smooth instead of irritating.

Suggestions to increase libido?

Question from Lavender: I'm a bc survivor, had a mastectomy, am on tamoxifen, take Paxil for hot flashes and my libido is low. Any suggestions to increase libido? I'm in a wonderful marriage with a man I love.

Answers —Leslie Schover, Ph.D.: Unfortunately Paxil is a double edged sword. Although it helps with hot flashes, it often decreases sexual desire and even more so makes it difficult for a woman to reach orgasm. There are other drugs in the same family that may help with hot flashes, but with fewer sexual side effects. Effexor or Celexa may be worth a try.

Marisa Weiss, M.D., president and founder: Having a partner that you love is an essential ingredient that you already have.

How to talk to husband about breast sensitivity?

Question from Two Fancy: I'm 6 years out from breast cancer, and I don't know how to tell my hubby that I hate it when he touches or tries to play with my breast.

Answers —Leslie Schover, Ph.D.: I think it is important to be assertive about something so important to you.

Marisa Weiss, M.D., president and founder: And I love the way Leslie expresses herself.

Leslie Schover, Ph.D.: I think you need to find a safe place and time outside the bedroom to talk to him about your feelings. You may want to say that you know he enjoys touching your breasts but that you find it distracting or unpleasant or a turn-off, and would like to find a way of lovemaking that would be better for both of you.

Marisa Weiss, M.D., president and founder: After talking, you might find a good compromise. You may agree that you feel comfortable with his touching the breast that was not affected by breast cancer and leaving the other one alone. You may even need to change your position in bed in order to have his free hand touch the one that you would feel comfortable having him touch.

Leslie Schover, Ph.D.: If neither breast gives you good feelings, then the two of you can find some new areas to touch or things to try during lovemaking—perhaps telling each other a sexual fantasy or trying a different kind of caressing so that breast caressing won't be missed so much.

Marisa Weiss, M.D., president and founder: And you may find that over time, your own desires may shift. What might feel uncomfortable today could become not just comfortable, but even exciting again in the future. Your sex life has been, and probably always will be, an exploration.

Safe to use an Estring with tamoxifen?

Question from Ellen: Is it safe to use an Estring when you are taking tamoxifen?

Answers —Marisa Weiss, M.D., president and founder: The Estring emits a very low level of estrogen within the vagina and a little bit of that also gets into the bloodstream. Most oncologists, but not all, feel comfortable with a woman using this form of estrogen replacement. It should be reserved for women who are having significant vaginal symptoms that have not responded to other kinds of treatments that don't involve hormones.

Leslie Schover, Ph.D.: Using tamoxifen with the Estring may have some protective effect from the small amount of estrogen that could escape into the bloodstream.

Will reconstruction scars improve?

Question from DLS: I'm proud of my new breast, but will the scars get any better with time?

Answers —Marisa Weiss, M.D., president and founder: Yes. Surgical incisions do get better over time. The pinkness and the heaped up nature of the incision do improve substantially over the first year or so. As they pale and flatten out, they become less noticeable and your new breast is likely to feel more and more like what you had hoped for.

Leslie Schover, Ph.D.: Over time, you also get more accustomed to how your breast looks and feels, and then that makes you more comfortable.

Marisa Weiss, M.D., president and founder: Also, over time, you can fantasize that your new breast can have similar feelings that the old breast did, and maybe it's even possible for you to experience some pleasure from being touched there. Each one of you is uniquely you. This may be possible for you, or you may think that this is not a possibility. Just give it some thought and keep your mind open to this.

Opt for nipple replacement?

Question from Judy M.: I have had reconstructive surgery and it is time to decide whether or not to opt for nipple replacement. While it seems sensible to do so having come this far, I wonder if it is really worth it for this 65 year old, single woman.

Answer —Leslie Schover, Ph.D.: Research has shown that women feel more positive about their breast reconstruction when they add the nipple reconstruction. Some women say that after the nipple reconstruction, they felt more pleasure when their breast was touched. Even as a single woman or as a woman in her middle years (because to me now, 65 is middle aged!), I think it is worthwhile to have a nipple reconstruction just to feel more whole again. If you are unsure about going through the reconstruction, you may be able to get a prosthetic nipple made from silicone that can be glued on to your breast mound for several days at a time.

How to increase self esteem after surgery?

Question from Skylar: I've always liked my breasts. In fact I told hubby that I wear revealing shirts to draw attention away from other parts of my body like my huge hips. How can I make my self esteem rise so I can feel attractive again?

Answer —Leslie Schover, Ph.D.: Just as you always loved your breasts, I am sure there are other qualities about yourself that have been important to you. Of course, losing your breast is a very significant loss, but as a whole person it is important to remember all of the things about you that are still valuable and loveable.

Do implants make a difference sexually?

Question from Alex: I've just been diagnosed with breast cancer and was told I might have to lose one of my breasts. My hubby wants me to get an implant but I'm afraid it won't be the same. Does it make a difference sexually?

Answer —Leslie Schover, Ph.D.: When you have breast reconstruction, whether it is with an implant or with your own tissue, the new breast will not have the same sexual sensation as your breast did before. The nerve that helps you feel sexual pleasure when your breast is touched will be gone after surgery. The new breast will often feel numb at first, and will never regain the same kind of feeling. Having breast reconstruction can help a woman feel more attractive and more whole, however. Women who have lumpectomies tend to enjoy breast caressing somewhat more than women who have a mastectomy and breast reconstruction. It is very important to have a breast reconstruction because it is what feels right for you, and not only to please a partner.

Normal for chemo to affect pubic hair?

Question from I am Curious Orange: I am a 10-year survivor. I did the chemo and my hair grew back nicely. However, my pubic hair is very sparse--heaven forbid, leaving a C-section scar visible. OK, I know I have a lot to be thankful for--and I am! Still, this makes me feel very shy. Is this a normal chemo thing, or is it just my age (51)?

Answers —Marisa Weiss, M.D., president and founder: A decrease in pubic hair is often related to being thrown into menopause early. So that may be what you've experienced. There are some types of chemotherapy that make you lose all of your hair everywhere, like the Taxanes. It may take longer for pubic hair to come back compared to how long it takes for hair to return on top of your head. Until you are where you want to be, you might feel more comfortable with sexy underwear. Often, these body changes are much more noticeable to you than your partner. But of course, what's going through your mind usually has a more profound impact on your ability to experience sexual pleasure.

Leslie Schover, Ph.D.: Remember, too, that in some cultures, women shave their pubic hair and some men find the bare genitals more erotic.

Does radiation affect sexuality?

Question from Corgi Lab: Does radiation therapy have any effects on sexuality, like chemo does?

Answer —Marisa Weiss, M.D., president and founder: Radiation therapy directed to the breast does cause some breast changes like breast swelling and redness of the skin. It has no effect on your hormone levels. However, if your breast is irritated, or uncomfortable, you probably don't want it touched, and this can have at least a temporary effect on your sex life.

Remedies for scars, dry skin?

Question from Gina: Do you have any recommendations as far as lotions or creams to use on the breast after a lumpectomy and radiation therapy to help with the scarring and dry skin?

Answer —Marisa Weiss, M.D., president and founder: You can enjoy, by yourself or with a partner, the application of all kinds of lovely creams to help the healing of your skin in the breast area. Many women like aloe preparations. A simple and very effective one is A & D Ointment. In general, use a cream that has a petroleum base without much fragrance in order to moisturize the skin and not irritate it. If you are up for adventure, you can apply it yourself or do it as a team.

Androgen level affected by chemo?

Question from Jayline: How do you know if your androgen level has been affected by chemo?

Answers —Leslie Schover, Ph.D.: You can actually have a blood test that will tell your free and total testosterone level. It has been very popular lately to give women replacement androgens. I would be very careful about using testosterone after breast cancer and certainly think that a woman should have a blood test first showing that her own testosterone is almost down to zero.

Marisa Weiss, M.D., president and founder: Androgen replacement usually only involves a little bit of androgen because a little bit can go a long way when it comes to this hormone.

Breast caressing different after lumpectomy?

Question from Michelle: Ever since my lumpectomy, I feel like my husband is performing a breast exam during sex. He insists that he's not, and that it's me. It's just different now. Is it me? Do you have any advice for me?

Answer —Leslie Schover, Ph.D.: It could be that he is touching you differently out of a fear of hurting you. Men often worry that they will be too rough and hurt their partners or wives after breast surgery. It may also be that you have become very sensitive about breast caressing. It may help if you try to have a sexual image in your mind while your husband is touching your breast. Maybe you can recapture some of the good feelings that you had about breast caressing in the past.

Ways to regain desire for sex?

Question from Cara: My husband says he's still attracted to me and wants to make love, but I'm so emotionally and physically wiped out by all this that I just don't have the desire. What should I do?

Answers —Leslie Schover, Ph.D.: It may take a while for you to regain your normal desire for sex. Think of all the reasons that breast cancer treatment can interfere with desires. You may be mildly depressed. You may be fatigued, especially if you are going through chemotherapy or radiation therapy. You have to get used to coping with the breast cancer and with changes in your body. You may be taking medications that interfere with desire, such as pain medicine, anti-nausea medicine, or anti-depressants. All of these things can affect your desire for a while.

Marisa Weiss, M.D., president and founder: Many women stop having sex upon their diagnosis and may even go on without it through treatment, so sex may have left your intimate life for a significant period of time. Trying to bring it back into your life with your partner involves a transition. You may have to get used to it again before you can enjoy it again.

Leslie Schover, Ph.D.: Sometimes it helps to start small. Try kissing and cuddling on the couch without trying to go to bed afterwards. Or try giving each other back rubs to see if you can get into a more sensual mood.

Reason for increased sex drive?

Question from Janet W.: Lately I actually want to make love to my partner MORE. Why do you think that is?

Answer —Marisa Weiss, M.D., president and founder: I have taken care of a number of women who have experienced this. In my discussion with them, we kind of discovered together that their increased desire represented their need and commitment to feel alive and present in the moment; that sometimes the diagnosis of breast cancer makes you really identify and appreciate the things, the people, the feelings, the words that you cherish most. And for the women I have taken care of, it seems that sex became a highlight, as it was during and after sex that they felt most connected with their partner and most vital and alive.

Suggestions for spicing up marriage?

Question from Deandra TX: Facing the possibility of death has made me realize how passionless my marriage has become. What can I do to shake things up?

Answers —Marisa Weiss, M.D., president and founder: Before a breast cancer diagnosis, many women may have been in marriages that met some, but not all of their needs and somehow things seemed to work okay. For many women that I take care of, the breast cancer diagnosis really brings to light what things matter the most. If you are in a relationship that is not fulfilling your needs or is not providing you with excitement, you may be thinking about the same issues you are now expressing. It is certainly possible to improve a relationship that needs work.

Leslie Schover, Ph.D.: You may want to begin by trying some new ways of getting aroused in your sexual relationship. Sometimes it helps to wear sexy lingerie or to watch an erotic movie together. Read erotic stories together. Or just initiate sex in a more passionate and spontaneous way.

Thoughts of younger men attributed to fear?

Question from Cherry: Since my cancer I've thought of younger men, or I am having thoughts of them. I feel over sexual. Is this part of the fear of dying? That I'm wanting more youth?

Answers —Leslie Schover, Ph.D.: I suppose that is possible, but these may also be normal feelings that women have at stages of their lives when they think about what they may have missed or would still like to experience. I hope you meet a nice, younger man! In a recent survey of breast cancer survivors, those most satisfied with their sex lives were the small group who had found a new partner since their diagnosis.

Marisa Weiss, M.D., president and founder: Learning from this survey, you may be able to uncover a new side of your current sex partner. It's worth investigating.

How to get relationship back to normal?

Question from Martha: I've just recently gotten over my short term battle with breast cancer, but I haven't even thought about being a wife to my husband as of yet. Is this normal? He hasn't mentioned it either. What should I do?

Answers —Leslie Schover, Ph.D.: Many couples go through a period where they discontinue their sex life. This only becomes a problem if the partners do not make an effort to be sexual with each other again once the major stress of the diagnosis and short-term treatment is over. Getting back to normal may be easier if you start slowly. As we said earlier, try some kissing on the couch or giving each other back rubs, or taking a bath or shower together.

Marisa Weiss, M.D., president and founder: A candlelit dinner or have fun with a popular book called 101 Nights of Grrreat Sex—Secret Sealed Seductions for Fun Loving Couples.

Advice for dating after mastectomy?

Question from Rhonda: I recently divorced. Now I'm back on the dating scene again, and with the absence of one breast I'm wondering how I should deal with new men in my life. Should I be upfront and bold by not wearing a falsey, or should I cover it up? Any advice in this area?

Answers —Leslie Schover, Ph.D.: I think the first rule in dating after breast cancer is to make sure that your partner cares about you as a friend before revealing too much. Whether to let him see your scar or to wear a falsey is probably less important than telling him about the breast cancer to begin with. The timing for that is always delicate.

Marisa Weiss, M.D., president and founder: The person you tell about your diagnosis will respond to your cues. In fact, in general, you yourself have the biggest influence on how your potential partner may react to the news. While it is tough to find the 'perfect' time to spill out the information, you can at least practice talking about it to a mirror or to a trusted friend before you actually have to do it.

How to discuss experience with new man?

Question from Mara: I have avoided relationships with men ever since my surgery. How does one bring up the subject with a new beau?

Answers —Leslie Schover, Ph.D.: I think that just as you tell someone new other intimate things about yourself, you can bring up your breast cancer experience.

Marisa Weiss, M.D., president and founder: I think it's important to let potential partners know what to expect. If you tell them that you had breast cancer, you probably also need to let them know if you still have a breast or not. There may be many questions that instantly come to this other person's mind, and that person may not express those concerns. If you reveal your breast cancer diagnosis and also tell them in a few sentences when it happened, what was done, and how you feel about it now, you can make a big difference in how comfortable or uncomfortable they may be. Many men know somebody close to them who has been affected by breast cancer. Breast cancer, unfortunately, is not so uncommon. It's not as if you have had a rare disorder. There is a high level of awareness out there among both women and men.

Leslie Schover, Ph.D.: It helps to put yourself in someone else's place. Think how you might feel if you were attracted to a new man and found out that he had surgery for prostate cancer and might not have normal erections. Would you still want him as a potential dating partner? Would you be willing to cope with a problem in your sex life together? Men who might reject you because of your breast cancer are not the kind of men you need in your life.

Any alternates for lingerie?

Question from Alison 2: Dr. Schover, ‘sexy lingerie’ just shows scars and makes us feel repulsive. Any other ideas?

Answers —Leslie Schover, Ph.D.: Some women are more comfortable with romantic low lighting. It may help to begin by making love with just one candle in the room and get used to how you feel in that situation before you expose your body more fully to your lover. You may also find lingerie that covers your scars, depending on how kinky you like your lingerie. For example, some women wear bras that have the nipple area cut out.

Marisa Weiss, M.D., president and founder: Sometimes you have to be creative. If there is lingerie that you used in the past that you still really love, you can add lace or fur or other materials to cover the scars if that would make you more comfortable.

Distant relationship result of breast cancer?

Question from KT: My partner and I have become very distant emotionally and sexually and I think I'm the one asking the serious questions, like is this really good enough for me? How do you know what's real and what's a result of the aftermath of the breast cancer?

Answers —Leslie Schover, Ph.D.: Whatever you experience has reality. It may be related to the breast cancer but often breast cancer exaggerates the problems that were already there. Relationships rarely change completely because of breast cancer. They just become more true to what they were before.

Marisa Weiss, M.D., president and founder: There is no question that after any life-threatening challenge, you come to realize what's important to you and how precious you and the people in your life are. If you find yourself in a relationship that is unfulfilling, after a breast cancer diagnosis, you may all of a sudden feel an urgency to make it great. I think it's worth your stopping, looking around, listening, and thinking about what you share together and what you hoped you could have in a relationship together. Be patient, but also be open minded to making changes if you think they are necessary.

Help with desire for sex, vaginal dryness?

Question from Shiloh: I am three years out from treatment, and intimacy and sex have gone by the wayside. I am taking tamoxifen and my libido is gone. It was suggested to use an Estradiol vaginal ring to help with the vaginal dryness. When I read about the contraindications, it really concerned me. My oncologist does not want me to use soy products, so what am I to do? I would love to get that old feeling back.

Answers —Leslie Schover, Ph.D.: There are two separate problems here. One is your desire for sex, and two is the vaginal dryness. As we said earlier, the Estring is being used by many breast cancer survivors as one of the safest ways to get some estrogen to the vagina without much getting into the bloodstream. There is still some controversy about its safety, however. The Estring will not help your desire for sex, although if intercourse is dry and painful, that certainly may be part of the problem. Estradiol does not act in the brain to promote sexual desire. Some natural ways to promote desire may include thinking about what put you in the mood for sex before. For some women, that could be dancing or playing tennis or seeing a movie with a great love scene or spending a quiet evening just talking and cuddling with their mate. Sometimes these activities have dropped out of your life. If you put a high priority on taking time for intimacy and closeness, it may help your sex life return to normal.

Marisa Weiss, M.D., president and founder: Having fun together, doing non-sexual things outside the bedroom, will definitely help you re-kindle a sense of fun and desire in the bedroom. It's also okay--perfectly normal--to fantasize before and during sex. If you haven't done this in the past, now might be a time that you could experiment with this. There are many stores out there that sell all kinds of tricks and playful items that may help you along your way. Be open minded, and realize that this important aspect of your life will take time to restore.

Sexy lingerie to hide mastectomy scars?

Question from LavenderBeffie: I read you have info on where to purchase sexy things that don't show a scar for one breasted women?

Answers —Leslie Schover, Ph.D.: I told Marisa that she would have to give the sexy lingerie information, because I buy my underwear in bulk at Sadie's Big Girdle Outfit. (smile)

Marisa Weiss, M.D., president and founder: I loved hearing that from you the first time, and it's just as good hearing it from you tonight! There are all kinds of places available in your area and at a distance through the internet that will sell you any kind of 'getup' that you could ever imagine, from black lacy teddies to little outfits that are costumes in people's fantasy lives. Go to one of these places and see if any of them turns you on. This can be fun, and it should be fun. One of the most important things after a breast cancer diagnosis, I think, is for you to start to re-claim the parts of your life that gave you pleasure or that gave you meaning. Sex and intimacy is one of those really important areas. goodvibrations.com has an online catalog, and their number is 1-800-982-4405. Another good site is www.evesgarden.com.

Leslie Schover, Ph.D.: The Sexuality Library is a catalog put out by the Good Vibrations people that has books and videos.

Marisa Weiss, M.D., president and founder: For those of you who have never done this before, you might try getting books on sexual erotica and reading it to each other. Also xandria.com is a good site.

Support groups for self-esteem issues?

Question from Sadie: At 48, my marriage of 30 years ended after my surgery and treatment. Are there support groups to help with self-esteem issues?

Answers —Leslie Schover, Ph.D.: There are many support groups for breast cancer survivors. Some are online--you might look at breastcancer.org and do a search under Resources. You also might be able to find face to face groups in your community at the local hospital or the American Cancer Society.

Marisa Weiss, M.D., president and founder: The Wellness Committees have chapters in many cities. Or the Y-Me, or Komen Foundation.

Leslie Schover, Ph.D.: If you cannot find a group of women with a similar history, you may want to talk to a mental health professional one-on-one about your unique situation.

Marisa Weiss, M.D., president and founder: The loss of self esteem is very common after a breast cancer diagnosis. Breast cancer forces you to stop in your tracks and re-examine everything. Many women, over time, do find ways to feel good about themselves again. It is a process that can be fostered by connecting to people you care about, to new people that may share your same concerns through a support group, connecting to doctors, nurses, psychologists and other professionals who have a lot of experience helping people with this important and manageable issue. Probably the most important first step is to decide that you need to be your own best friend. Stop being critical of yourself. Be more accepting of who you are, try to be more acknowledging of how wonderful you are, and give yourself credit—a LOT of credit—for all that you have been through. For everyone who has joined this conference today, you've already taken a very big and important step in helping yourself. And we hope that you can take the next step with the information we have provided, and with other resources on our website, www.breastcancer.org.

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