Intimacy After Breast Cancer

Frequently Asked Questions

Navigating intimacy during and after breast cancer can be challenging, but you are not alone. It’s natural to experience changes in sexual health, body image, and relationships, and support is available. Many healthcare professionals can offer guidance, yet survivors and providers alike may feel uncertain about how to start these conversations.

Changes in intimacy and sexual health are common for breast cancer survivors and can significantly impact overall well-being. We encourage you to speak with your cancer care team about how treatments, medications, and survivorship may affect your body and intimate relationships.

This FAQ page is designed to help you understand how healthcare providers can support intimacy concerns and highlight professionals who work alongside breast cancer survivors in our communities. We recognize that discussing topics like sexual health and intimacy can feel vulnerable, but you deserve compassionate, informed care. Explore provider insights here to help guide your next steps in redefining intimacy and discovering what brings you comfort and joy.

Oncology Certified Nurse - Chemotherapy

Leslie Kathman MSN, APRN, FNP-C, OCN

Morrison Cancer Center

What safety precautions during active chemotherapy AND/OR radiation should be taken when participating in intimacy acts? How long should they be implemented for?(i.e. Open mouth kissing, sexual intercourse, skin to skin hugging, caregiver assisted showering/toileting). General rule of thumb is that for 48 hours post chemotherapy any sexual intimacy would require a condom or barrier method, this excludes kissing/hugging/etc. As for toileting this same rule would apply, it is recommended that the toilet is flushed twice with each use of the toilet or that the patient utilize their own toilet x48 hours. If a patient would get sick, have an accident or need assistance with bodily fluids the caregiver would need to utilize two pairs of gloves. If someone is on an everyday oral chemotherapy these rules would apply to every day. Radiation restrictions are highly dependent on the type of radiation they are receiving.
What medications or treatment CAN be transferred to a partner through bodily fluids? Any medication that is considered a chemotherapy/anti-neoplastic agent, to error on the side of caution it is best to consider all oncological medications under this category until you can address on an individual basis with your primary medical oncologist. This would also include oral chemotherapy agents.
Are there types of sexual acts that should be avoided during active treatment? (i.e. Oral, penetrative, anal, etc)? All forms except for kissing should be avoided for 48 hours post chemotherapy administration, unless there is a barrier method utilized. If a patient's laboratory monitoring shows abnormalities there may be additional recommendations such as not engaging penetrating intercourse.
How do estrogen suppressing medications impact drive and health of vaginal tissues? Many of these medications can cause atrophy of vaginal tissues and can be very drying. This can make intercourse very uncomfortable. Sex drive can be greatly reduced as a result of the overall decrease in Estrogen.
Many individuals with limited sensation still seek opportunities to enjoy self care activities (i.e. Pedicure, manicure, massage). Are there products or services that breast cancer patients must avoid or be cautious of? (i.e. High water temperatures, essential oils, vigorous scrubbing, hot stones, hormonal lubricates) How long should these be avoided? Breast cancer survivors who have had surgery to their breast including surgical intervention to the axillary lymph nodes need to avoid any needle pokes (including acupuncture) and squeezing (including vigorous massage or blood pressures) to the affected extremity. These recommendations are typically for life as lymphedema can develop at any time. Utilizing hormonal lubricants would depend on the type of breast cancer that they had and this should be discussed with their primary oncologist prior to utilizing any hormone-based treatments. If a patient has a sensory change from chemotherapy they may not feel water temperatures correctly, they may need to test water temperature in a different way to ensure safety.
How does your clinic/organization address sexual health and intimacy? Yes, we address throughout their treatment time and survivorship. However, we do not have dedicated staff for this.
Do you discuss intimacy questions regarding body image for pre/post surgical mastectomy patients? Not specifically, we do address their needs for orthotics or reconstruction. We are fortunate that most of our patients that undergo mastectomy see our breast surgeon and her offices handles a majority of these questions/concerns.
What time period should an individual wait after mastectomy to perform self exploration with vibration and/or soft touch? I have never encountered this situation, but I would say if they are cleared from a surgical standpoint for all other activity they would be free to proceed with self exploration.

Certified Oncology Nurse - Radiation

Lillian Simpson, MSN, APRN, FNP-C, AOCNP

CHI Health Regional Cancer Center, Good Samaritan

What safety precautions during active chemotherapy AND/OR radiation should be taken when participating in intimacy acts? How long should they be implemented for?(i.e. Open mouth kissing, sexual intercourse, skin to skin hugging, caregiver assisted showering/toileting) . From a radiation standpoint, there are no restrictions on intimacy. Radiation does not pose a risk to anyone around you. The breast may feel more tender or painful and the skin over the treated breast may become irritated but this would not preclude a person from engaging in these activities. If you do develop these side effects, they typically improve within 2-4 weeks after the completion of radiation.
What medications or treatment CAN be transferred to a partner through bodily fluids? With breast radiation you are not at risk to anyone around you and cannot transfer radiation to others.
Are there types of sexual acts that should be avoided during active treatment? (i.e. Oral, penetrative, anal, etc) Breast radiation does not restrict any sexual intimacy or act.
How do estrogen suppressing medications impact drive and health of vaginal tissues? This does not apply to radiation.
Many individuals with limited sensation still seek opportunities to enjoy self care activities (i.e. Pedicure, manicure, massage). Are there products or services that breast cancer patients must avoid or be cautious of? (i.e. High water temperatures, essential oils, vigorous scrubbing, hot stones, hormonal lubricates) How long should these be avoided? We encourage our patients to continue living their life, however there are few restrictions during radiation. Some herbal supplements may interact or decrease the effectiveness of radiation. We also do not recommend getting any IV doses of certain vitamins during radiation for the same reason. Make sure your radiation oncologist reviews your medications and supplements. Additionally if you develop certain side effects you may have some restrictions to promote recovery and healing. For example, if the skin peels or becomes open you need to keep it clean, well moisturized, and limit irritation.
How does your clinic/organization address sexual health and intimacy?
See below
Do you discuss intimacy questions regarding body image for pre/post surgical mastectomy patients?
Answer to 6 & 7
We are here to support our patients in all aspects of health. If the patient has specific questions or concerns, we are happy to discuss them. Additionally, we screen all patients for any type of distress using a screening tool that includes sexual health and intimacy. If a patient indicates sex and intimacy as a concern, we work with them to address concerns and provide support. Our clinic also has a mental health provider available to our patients who can help address body image. We also offer a survivorship program called, “A Time to Heal” that addresses many topics of survivorship including intimacy and offers patients a safe place for discussion and connecting with others going through similar life events. Lastly when we discuss these issues we can and will refer to appropriate providers, i.e. pelvic floor physical therapists, menopause specialists and endocrinologist if needed.
What time period should an individual wait after mastectomy to perform self exploration with vibration and/or soft touch? This does not pertain to radiation oncology and would need to be answered by a surgeon.

Family Nurse Practitioner

Carelene R. Springer, MSN, APRN, FNP-Cm AOCNP

Morrison Cancer Center

What safety precautions during active chemotherapy AND/OR radiation should be taken when participating in intimacy acts? How long should they be implemented for?(i.e. Open mouth kissing, sexual intercourse, skin to skin hugging, caregiver assisted showering/toileting)
What medications or treatment CAN be transferred to a partner through bodily fluids? All chemotherapy is in the bodily system for at least 48 hours after administration.
Are there types of sexual acts that should be avoided during active treatment? (i.e. Oral, penetrative, anal, etc) Discourage intercourse, but if they do wish to engage, then the male should wear a condom. If females are undergoing treatment and are premenopausal we recommend two types of birth control (oral contraceptives+condom, we have used Zoladex injections when needed).
How do estrogen suppressing medications impact drive and health of vaginal tissues? Unfortunately the aromatase inhibitors do cause issues including vaginal dryness leading to painful intercourse. Decrease in libido is also related to the use of AI's.
Many individuals with limited sensation still seek opportunities to enjoy self care activities (i.e. Pedicure, manicure, massage). Are there products or services that breast cancer patients must avoid or be cautious of? (i.e. High water temperatures, essential oils, vigorous scrubbing, hot stones, hormonal lubricates) How long should these be avoided? During treatment I recommend patients enjoy self care activities as they wish but much of that is dependent on what type of cancer they and the type of treatment they are receiving. If a person's treatment causes severe neutropenia, I request they don't engage in activities where there is a chance they could have "broken skin" (pedicure, manicure). if platelets are low - no vigorous massage. Light massage, hot stone massage, etc. are fine. Studies show vaginal estrogen is ok, even for breast cancer patients, non-hormonal lubrication is also ok.
How does your clinic/organization address sexual health and intimacy? I am the one who talks with patient about sexual health. I broach the subject during chemotherapy education and offer that I am available to talk at any time. Many patients schedule private time with me (without their spouse).
Do you discuss intimacy questions regarding body image for pre/post surgical mastectomy patients? As a breast cancer survivor myself, I am very in tune to body image issues and ALWAYS talk with breast cancer patients, both male and female.
What time period should an individual wait after mastectomy to perform self exploration with vibration and/or soft touch? That is a question that can't be answered across the board. A lot of it depends on healing. Once incisions are healed there are no restrictions.
What safety precautions during active chemotherapy AND/OR radiation should be taken when participating in intimacy acts? How long should they be implemented for?(i.e. Open mouth kissing, sexual intercourse, skin to skin hugging, caregiver assisted showering/toileting)
1. During – and for 48 hours after – chemo
  1. Flush the toilet twice after you use it. Put the lid down before flushing to avoid splashing. If possible, you may want to use a separate toilet during this time. If this is not possible, wear gloves to clean the toilet seat after each use.
  2. Both men and women should sit on the toilet to use it. This cuts down on splashing.
  3. Always wash your hands with warm water and soap after using the toilet. Dry your hands with paper towels and throw the paper towel away.
  4. If you vomit into the toilet, clean off all splashes and flush twice. If you vomit into a bucket or basin, carefully empty it into the toilet without splashing the contents and flush twice. Wash out the bucket with hot, soapy water and rinse it. Empty the wash and rinse water into the toilet, then flush it. Dry the bucket with paper towels and throw the paper towels away.
  5. Caregivers should wear 2 pairs of throw-away gloves if they need to touch any of your body fluids. (These can be bought in most drug stores.) They should always wash their hands with warm water and soap afterward – even if they had gloves on.
  6. If a caregiver does come in contact with any of your body fluids, they should wash the area very well with warm water and soap. It’s not likely to cause any harm, but try to take extra care to avoid this. At your next visit, let your doctor know this happened. Being exposed may lead to problems, and extra care should be taken to avoid this.
  7. Any clothes or sheets that have body fluids on them should be washed in your washing machine – not by hand. Wash them in warm water with regular laundry detergent. Do not wash them with other clothes. If they cannot be washed right away, seal them in a plastic bag.
  8. If using throw-away adult diapers, underwear, or sanitary pads, seal them in 2 plastic bags and throw them away with your regular trash.

Pelvic Floor Physical Therapist

Nicole Niu, PT, DPT, WCS

Pelvic Wellness Physical Therapy

How does your clinic/organization address sexual health and intimacy? As Pelvic Floor Therapists and Certified Women’s Health Specialists we are well-versed in treating both men and women for sexual health and intimacy concerns. Treatment looks very different for each individual and where they are at on their journey. The first priority is gaining insight about what concerns or difficulties they are having with intimacy. We seek to determine if their blocks are more emotional or physical or a combination of both, as well as what intimacy looks like to them. We then develop a treatment plan from there to help reach their specific goals.
How does breast cancer and treatments (chemo, radiation, etc) affect the pelvic floor? Treatment from cancer can cause changes in the muscles and tissues surrounding the pelvic floor which can result in pain, dysfunction, and weakness. While these treatments may be necessary, their aftereffects can impact organ function, posture, and overall stability. Weakness or tightness in the hips, abdomen, pelvis, and lower back can make daily activities more difficult. Some cancer treatments leave behind soft tissue restrictions, painful scarring, and altered sensation.
1. Depending on the type of cancer and treatment received, survivors may experience factors that influence their pelvic and sexual health including:
2. Pelvic floor muscle tension or weakness – from surgery, radiation, or guarding patterns developed due to pain.
3. Vaginal dryness & tissue changes – common after chemotherapy, radiation, or hormone therapy.
4. Pain with intimacy (dyspareunia) – often caused by scar tissue, nerve sensitivity, or hormonal shifts.
5. Decreased libido & body confidence – cancer treatment impacts not just the body, but also emotions and self-image.
What can patients do at home now to determine if pelvic floor PT is appropriate to address their sexual health concerns? Understanding what we treat as pelvic floor physical therapists is helpful in knowing if we can help. Below are some common symptoms we help with after cancer treatment. Going through these and asking if they are experiencing any of these would be helpful in knowing if pelvic floor therapy would be a good fit. These symptoms include, but are not limited to sexual health concerns.
1. Sexual Health Challenges
  1. Pain or discomfort during intimacy (dyspareunia).
  2. Vaginal dryness, irritation, or reduced sensation.
  3. Difficulty with arousal, orgasm, or penetration.
  4. Erectile dysfunction or penile pain.
2. Pelvic Pain & Discomfort
  1. Pain in the pelvic region, hips, lower back, or abdomen.
  2. Pain with sitting, walking, or certain movements.
  3. Sensations of tightness, burning, or pressure in the pelvis.
3. Bladder & Bowel Dysfunction
  1. Increased urinary urgency or frequency.
  2. Leaking urine (incontinence) with sneezing, coughing, or exertion.
  3. Painful urination or difficulty fully emptying the bladder.
  4. Constipation, straining, or fecal leakage.
4. Post-Surgical or Radiation-Related Changes
  1. Abdominal or pelvic scar tissue that feels tight or painful.
  2. Pelvic muscle weakness or lack of coordination.
  3. Changes in posture or core strength affecting balance and stability.
5. Emotional & Nervous System Symptoms
  1. Feeling disconnected from your body or avoiding certain movements.
  2. Fear of pain leading to muscle guarding and tension.
  3. Stress, anxiety, or reduced confidence related to intimacy or body changes.
What educational resources does your organization provide patients on intimacy and sexual health during cancer treatment and survivorship? We provide resources based off of each patient’s unique needs. This may include books about reclaiming connection to the body or ideas for seeking new ways of arousal. Other times this may include dilators to help with vaginal tissue mobility or handouts on intimacy positioning based on their specific findings. We also have a handful of sex therapists we refer out to and understand how valuable this piece can be as adjunctive treatment to what we are working on.
Are there precautions or contraindications to pelvic floor PT during breast cancer treatment and survivorship? There are times during active radiation or the immediate post operative period where PT would be contraindicated. Most times we are “in the clear” around 6-8 weeks after treatment has concluded but this is on a case-by-case basis and we are happy to discuss this with each of our patients.

Massage Therapist

Chelsea Sullivan, LMT

If I am actively receiving chemotherapy or radiation are there precautions or contraindications to massage therapy?
Contraindications: No deep tissue work, pressure should be between 0-3, avoid areas of radiation, avoid areas with scars/scabs/surgery sites until healed, no close work (at least 1 hand length away) from a port, piccs & catheters, if lymphedema or removed nodes - would need to reroute strokes and see a therapist that is certified in Lymphedema (or the therapist would have to avoid that area affected/watershed), depending on the client's treatment plan, may need to adjust their massage schedule/treatment for the session, low WBC number, if the therapist or the client are not feeling well it is best to not offer massage, blood clots, DTV.
Precautions: positioning of the client, possible blood clots, skin sensitivity, could easily bruise, DVT, dry skin, susceptible to fractures, possible burned skin with radiation, scar tissue, immune compromised, a decrease in ROM, hand/foot syndrome, possible sores, therapist might need to wear gloves depending on clients treatment process, edema, reconstruction, mucouses, areas of trauma, heat & ice treatments, some massage modalities (depending on client's treatment/conditions/overall feeling), dizziness post massage. The client also may not want to fully disrobe, which is fine as well. They could also be wearing a wig or currently losing hair, so being sensitive to those as well.
What modalities CAN active breast cancer patients and/or survivors participate in safely?
Light work (pressure 0-3); Swedish massage, effleurage, energy work (Polar Therapy, Reiki, or Craniosacral therapy), scar tissue work, lymphatic work (if needed & done by a lymphatic trained therapist), myofascial work. Can do some other light techniques just making sure to make modifications and if this is the first time seeing the client, my approach is always a bit more on the cautious side. Range of motion techniques could also be used, but cautiously and modifications may need to be made depending on patient comfort and their current treatment plan.
Can massage therapy metastasis breast cancer? No it cannot metastasis breast cancer. However, precautions and modifications do need to always be taken into account to provide a safe massage for the client and not cause harm or cause lymphedema, especially if lymph nodes have been removed or tested.
If individuals have undergone a mastectomy what precautions should a massage therapist keep in mind? Lymph Node removal or testing of lymph nodes & there is always the possibility of lymphedema (which should only be treated by a massage therapist who is certificated in lymphedema), scar tissue, possible decrease in ROM for the client, pain/discomfort or increased sensitivity in the area affected, client could also be going through breast reconstruction (tissue expanders), so positioning of client is important & avoiding pressure on the chest & timing (letting the incision heal), possible swelling, light pressure is best near area affected, therapist could be in communication with clients healthcare team with consent from client. They also may need medical clearance before massage work. This could also be an area of trauma, so having an understanding of that and meeting the client where they are and working within their comfort level.
Are there things AFTER a massage that breast cancer patients/survivors must be aware of? This could be different for everyone and depends on where they are in their treatments or the type of treatment that they are receiving. Some people could have an increase in nauseousness, an increase in tenderness, feel more fatigue post massage or it could reduce fatigue. They could have an increase in relaxation and sleep better. It could also help with mood or stress. They may be on medications that have side effects, so making sure of what medications they are taking and side effects as to not exacerbate them (if possible) during the massage and should update their therapist with a change of medication or treatments.
How can massage therapists adapt positioning when patients have extremely sensitive areas? (i.e. Chest, axillary, neck, pelvis) Different positions could include: laying on their back, side or stomach based on their area of sensitivity. They could also be positioned semi-reclined (such as in a hospital setting) . If they have a picc, port, catheters or colostomy bag, you will want to position them in a way in which they are not laying on top of them and that they are not being compressed or being pulled. The therapist may need to use bolsters/pillows to support the client in their positioning. The therapist can also ask the client if there is a position in which they feel most comfortable. They also may have limited ROM, so make sure to move slowly with any ROM and always check in with the client on pressure in extremely sensitive areas (staying in that 0-3) pressure level.
How does your clinic/organization address sexual health and intimacy? I have not had experience with my clients asking me directly, so I do not have a great answer for this. I know that some clinics offer massage therapy + mental health therapy, so that clients can address both the physical and mental.
How often do your patients initiate the conversation about sexual health concerns? Is there a question on your intake form addressing sexual health? I have not had patients in the past initiate conversation about sexual health concerns and I do not have a question addressing that.
What other information should patients be aware of before going to a massage therapist? Are there certain questions to ask a massage therapist prior to treatment? I think doing research on therapists and making sure to see a therapist that does specifically treat people going through cancer and making sure that they have had extensive training in Oncology massage (A Foundational Course (24 - 36) hours of Oncology Training) and then other supplemental training. They should not be receiving lymphedema work from a therapist that has not been certified in Lymphedema and fully understands how to do that work safely. If they are seeing someone who meets these: they can ask ask about experience working with neuropathy, how they will modify their massages based off of their cancer treatment/diagnosis, etc, what to expect with their massage sessions, contraindications/precautions, how will they meet the client where they are at, the therapists experience with working with cancer patients, is the therapists aware of side effects of cancer treatments (the patients treatments specifically), what the pressure level will be, the client should be able to stop the massage at any point (as any client). I have seen clients before where I have been the first person to mention lymphedema to them and what it is. Checking in with this clientele is also very important to make sure that they are not feeling sick, or need to change position or are feeling cold or their symptoms have worsened.

Occupational Therapists

Kristen Stelzer, OTD, OTR/L, CLT

GO Physical Therapy Lincoln Balance & Mobility Cancer Rehab

How can breast cancer rehab address intimacy in an outpatient setting? Provide education on energy conservation and positioning to optimize ability to complete as well as provide support for the emotional/mental aspect of intimacy. Educate on impact of aromatase inhibitors/hormone treatment on pelvic health. Screening/education and referrals to help support mental health with regards to changing self-image.
How can pelvic floor therapy assist breast cancer patients and survivors in addressing sexual health concerns? Provide education & resources on maintaining vaginal health, reducing pain and other bladder/bowel symptoms. Treating urgency and urinary incontinence. Help patients discuss with their partners what they are experiencing and ways to support overall intimacy with potentially having their partner come into the clinic.
What are some common changes to the pelvic floor for individuals with vaginas who are diagnosed with breast cancer and have undergone or completed cancer treatment? Vaginal tissue/pelvic floor musculature atrophy, thinning of tissue that may lead to pain with intercourse, urinary urgency & incontinence
How does your organization address sexual health and intimacy? We have 2 pelvic floor OTs who work with patients who are experiencing pelvic floor difficulties after breast cancer treatment as well as mental health aspects of their journey. Our PTs are also trained in screening for intimacy concerns regarding appearance/self-image after breast cancer surgery & treatment that may have resulted in loss of their breasts or damage to their appearance.
What educational resources are available in regard to intimacy? Currently we don't have any specific handouts but will provide individualized recommendations. We do refer them to Susan G Komen for resources (they have a PDF).
How can patients receive your services? (Referral, walk in) Typically they require an order/referral from their physician

Lori Buckley OTR/L, CLT – Reiki Master

Integrative Healing Therapies

How can Reiki assist breast cancer patients and survivors with addressing sexual health and wellness? Reiki / energy work is an alternative therapy that assists with releasing the negative energies that are trapped in our bodies. Our mindset as well as our muscles and organs can be negatively impacted by trapped negative emotions and energies in our bodies. By releasing the negative blocks our body is able to overcome the stress, anger, fear and anxiety that can be weighing us down and cause us to withdrawal from others. By releasing these blockages our bodies naturally feel lighter and more at peace. Reiki also promotes improved sleep as it assist the body’s natural state of relaxation. Being well rested and feeling at peace improves our ability to communicate with loved ones. That feeling makes it easier to allow others in our personal space. Having a sense of calmness also makes it easier to freely give to others. The reproductive system, which includes the secretion of fluids that provide lubrication of the vagina, can only function when the body is in a state of relaxation. When the body is caught in the fight or flight pattern it goes into survivor mode. Non-essential systems like the reproductive system shut down. Reiki promotes improved health and wellness by releasing the trapped negative energies. The body heals better when it is in a state of relaxation verses stress and tension. Three common negative emotions that breast cancer survivors may have are stress, anxiety, and anger. It is medically proven that theses stressors can produce headaches, muscles tension, depression, digestive issues, increased blood pressure and even strokes. Reiki restores peace and harmony in the mind, body and spirit for healing. Many prestigious hospitals in the US recognize Reiki as a healing form of Integrative healing.
What can a patient expect in a treatment? Reiki takes place in a peaceful environment with the patient fully clothed typically relaxing in a comfort chair or laying down. Reiki is a gentle hands off experience that focuses on the movement of energy. The Reiki energy feels warm and soothing bringing calmness and healing to the body. Patients often fall sleep. Most clients report feeling increased mental clarity, peacefulness and a sense of feeling lighter (due to the release of the negative energies weighting them down). It can also reduce pain levels.
What is Lymphatic Enhancement Technology? Lymphatic Enhancement Technology is a state of the art technology for improving the movement of lymphatic fluid by unlocking the detoxification channels of the body. It is a gentle vibrational modality that improves lymphatic movement at the tissue level. It aids in the release of interstitial toxins, accelerates local healing, and aids in the immune function. When used in conjunction with manual lymphatic drainage it allows for a deeper level of detoxification. It is a very gentle relaxing compliment to manual lymphatic drainage (MLD).
Can breast cancer patients participate? Absolutely! Breast cancer patients with and without lymphedema would benefit from LET therapy. LET along with MLD can assist with releasing the toxins associated with the side effects of medication and treatment. When patients are nauseated as a side effect from cancer treatment interventions it is they body’s way of purging what it no longer needs. It is releasing the unnecessary chemicals and the die off of the cancer cells that the effectiveness of the drug has caused. LET therapy is a gentler way to assist the body’s natural detoxification process. The increased fluid movement carries waste products, bacteria, dead cells, and large protein molecules through the kidneys, skin and bowels. LET therapy also increases the flow of the lymphatic system which produces lymphocytes (white blood cells). These cells look for and destroy invaders such as bacteria, viruses parasites fungi along with other foreign materials that may enter your body. Everyone can benefit from LET therapy for detoxing and boosting the immune system.
What can a patient expect in a treatment? LET treatment is a relaxing modality designed to stimulate the lymphatic system. The lymphatic system is part of the parasympathetic nervous system that promotes the body’s “rest and digest” functions. It calms the body down, slows the heart rate which creates a sense of relaxation, increases digestion, aids in detoxification and produces white blood cells. The increase flow of lymphatic fluid stimulates increased circulation of all body fluids which promotes a lighter feeling along with a a sense of relaxation.
How soon after a surgery or mastectomy can an individual participate in your Lymphatic Enhancement Technology? We recommend that you seek guidance from your physician for their protocol. LET therapy does not pull on the soft tissue or cause any stress on incisions. Drainage tubes, staples, or chemo ports will not be damaged or interfere with the therapy. Most surgical patients would benefit from LET therapy to decrease post surgical swelling.
How does your organization address sexual health and intimacy? This is addressed through education on the importance of stimulation of the para sympathetic nervous system so the reproductive system has the ability to engage.

Kaitlin Van Saders OTR/L CSOT

Functional Harmony OT

What does CSOT stand for? Certified Sexuality Occupational Therapist is someone who utilizes their domain and field of practice to work within the scope of sexuality and intimacy for individuals seeking help in that area. We have gone through a certification process that allows for diversity, inclusion, and cultural humility to understand the differences individuals may face when targeting certain questions within this area of practice.
At what stage in an individual's survivorship or treatments can a CSOT address intimacy and sexual health? There is no set standard of time or staging for an individual to receive CSOT. Typically if an individual is starting to question or wonder about sexuality or intimacy, it would be a great time to seek a therapist out. If an individual has recently received a diagnosis and questions are coming to mind, reaching out to a CSOT is a great idea to start building on education, modifications, adaptations to bridge the transition to their new role.
Are the sessions in person or via zoom? Sessions are done virtually to allow for being in the comfort of your own home.
Do I need a partner or caregiver present to participate in the sessions? Partners are not necessary for therapy sessions unless it would benefit the person receiving therapy (for instance, modifications or adaptations the individual may require assistance with)
How often do individuals meet with a CSOT? CSOT is recommended weekly initially with a taper off method of every other week followed by monthly appointments. The goal is to educate the individual in being independent sexual beings and to not require therapy for long term!
What if an individual becomes overwhelmed and wants to withdraw from the session? If an individual becomes overwhelmed and wants to withdraw that is their right, however a therapist may want to visit the triggers that are causing the heavy emotions and assist in stress management to aid in the overall wellbeing of the client.
Are there tests or assessments given during the treatment sessions? Personal inventory, an about me, and a questionnaire is given to the client prior to meeting so the therapist can help understand the clients level of comfort discussing the subject matter as well as find anything that may be helpful in assisting the client’s achievements and goals.
How can individuals find CSOTs? Individuals can access the “CSOT Directory” through The Institute for Sex and Occupational Therapy by visiting: https://www.sexintimacyot.com/csot-directory
Personally, how has your experience as a CSOT benefited your journey through cancer treatment? I became certified prior to my cancer diagnosis and ever believing I would have a cancer diagnosis at 37 years old. Having stage III cancer and having my rectum removed and a surgically placed ostomy bag was beyond humbling. As a sexual being I was able to use my knowledge to adapt and modify my time by myself and with my husband to create intimate moments that allowed us to connect for emotional and physical bonding during this difficult time. I am so thankful for my knowledge in this subject to be able to still maintain my independence within sexuality as well as utilize my husband to also be able to share his perspective as well.
What advice do you have for breast cancer patients on the importance of addressing intimacy concerns throughout the cancer journey? Advice I would give is that you are not alone. You are worthy of touch, intimacy, and sexuality within your comfort level and it is all so beautiful. Touch is therapeutic and to be able to share that individually or with a partner can aid in lower levels of stress and increase meaning throughout your day. Cancer treatment is a large variable and there are so many ways to feel honored and loved, make sure to utilize your CSOT because they are there for you

Chiropractor

Dr. Luke Blackburn

DC Millard Oaks Chiropractic

How long post mastectomy surgery should someone wait to get adjusted/manipulated? 4-8 weeks to allow the incision to heal. We typically wait 6 weeks before having a patient get adjusted lying prone. There are cases where the incisions are small and the healing time is closer to 4. Also the opposite, severe incisions may take closer to the 8 week mark before we or the patient feel comfortable getting adjusted prone. However, if there is significant pain a seated adjustment can be done as soon as bleeding has stopped from the incision and the patient feels comfortable to have the adjustment.
Can chiropractic adjustments metastasize the cancer? No, chiropractic adjustments do not metastasize cancer. Studies have shown that chiropractic adjustments actually improve immune system function.
Can someone active in treatment receive chiropractic adjustments and/or traction? Yes, chiropractic adjustments and low force traction can be performed during active treatments even with a port-a-cath. Its all about patient comfort.
How does your clinic/organization address sexual health and intimacy? A chiropractic adjustment is aimed at removing stress from the nervous system which allows the body to heal itself.
What precautions and/or contraindications should be considered for chiropractic treatment during cancer treatment? Depending on the type/stage of cancer, bone density needs to be taken into consideration. If a patient has decreased bone density there are special low force techniques utilized to make safe effective adjustments. Any case with port-a-cath, incisions, scarring, or increased sensitivity, is addressed with low force techniques to make a safe and effective adjustments. These can be done with hands on or instrument assisted adjustments. Patient positioning is also taken into consideration and can be done in a variety of ways to the keep patients comfortable. Adjustments can by done seated, laying, and standing. The goal of any chiropractic adjustment is to keep the patient as comfortable as possible. Electrical stimulation/TENS unit is common in chiropractic and is NOT used on acute cancer care. The evidence on whether muscle stimulation/TENS unit stimulates cancer cells is inconclusive and avoided until proven otherwise. There are times TENS can be recommended for pain in cancer patients, but should be approved by an oncologist.
How do you treat patients with pain from cancer/radiation/chemo? What are some things you can instruct them to do at home to alleviate symptoms? I.e. tender ribs from radiation, limited range of motion from radiation burns and scarring. As mentioned above, specific lower force techniques are utilized to help treat cancer patients with pain from cancer/radiation/chemo. Electrical stim/TENS is currently not used in our office unless recommended by an oncologist. Low force decompression therapy is also utilized to help patient with pain from cancer/radiation/chemo and is tolerated favorably. Light decompression of the spine during cancer/radiation/chemo can help open the spinal column, chest, and ribs allowing for less stress and deeper breathing.
2 types of decompression utilized are:

1) Low force seated decompression, which allows a Y-axis decompression of the spine (like being lightly stretched from head to toe).

2) Roller decompression, which involves lying on the back and having 2 wheels lightly massage motion into the spinal column and ribs.

For home therapy, various stretches/exercises are given depending on the situation. Most stretches/exercises are aimed at reducing stress or providing strength in areas needed. In most cases the goal of the stretches/exercises is aimed at opening the chest which is often compressed and closed down during cancer treatment. This is common when undergoing any stressful event in life. Often times a foam roller is recommended to help mobilized the joints of the spinal column and ribs. This is great at helping open the chest and loosen the back and ribs. Breathing exercises are given to help bring patients from a sympathetic to a parasympathetic state. The body should maintain an even balance of the sympathetic and parasympathetic nervous system. Most people live primarily in a sympathetic state which keeps the body under stress. A parasympathetic state is when the body is relaxed and able to heal the best. The goal of breathing exercises is to help keep the body in a parasympathetic state so it is best able to heal. Wim Hof breathing is a great technique to shift the body to a parasympathetic state and is highly recommended. 2:1 breathing is another breathing exercise given and although less intense than Wim Hof, can help relax the body and get to a parasympathetic state.

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