Cancer treatments such as surgery, chemotherapy, radiotherapy and hormone therapy can change the way a person’s body looks, works or feels. Such changes can affect self-confidence and interactions with other people, particularly where the affected parts of the body are associated with a person’s sense of masculinity or femininity, or are highly visible to others, such as the face. People may feel unhappy about their body during cancer treatment but for many these feelings resolve as they recover. However, for others the effects are longer lasting.
Some women, and most men, who are treated for breast cancer have to have the whole of the affected breast removed (mastectomy). This can result in a feeling of lop-sidedness and some women may feel their womanhood has been damaged. Wearing a prosthesis inside a bra can overcome women’s fears about their altered appearance, or reconstructive surgery may be an option for both women and men. Most women we spoke to had come to terms with losing a breast and had no long-term issues surrounding their femininity as a result, although one woman said that finding suitable clothes was a problem.
Frances is retired, and single. Ethnic Background: White British.
Well, I think they’re affecting me in an extremely positive way. I’ve never been sorry I had that reconstruction. It’s been the joy of my life ever since, which is a terrible thing to say but there you go. And I was determined to have it. I couldn’t bear the idea of facing life sort of lopsided, and I’m quite vain I suppose, I like clothes and things. I thought, “I don’t want this”. And these stupid little bags that they give you. I mean they’re not stupid, they’re a great help to some people, but they would move about, and you’d think, “Oh, I don’t want this thing”. And it wouldn’t be the right shape and, you know, and I wasn’t having that. I mean at one point they offered me one which was made of some kind of, don’t know if it’s silicon or some kind of gel, and it was it was pink! It was like a blancmange and it was sort of sitting there wobbling and... take it away! I picked it up and I threw it in the air and I caught it and I thought, “No”. So I thought, “No, the real thing is all I want”.
And one very good side effect was that he removed the tissue from my stomach and took it upstairs, as it were, and it means I’ve got a flat stomach, and he said, “You have the flattest stomach in [county].” I said, “Oh, good”. So that’s been a huge benefit, as you can imagine.
Age at interview:
Age at diagnosis:
Christine is married with two children. She is retired. Ethnic Background: White British.
I think mainly, it’s being feminine. There are no clothes, you can’t wear v-necks, too low v-necks, and you can’t wear this and you can’t wear that, because you haven’t got a boob, and either I could have had breast reconstruction but, as neither my husband or my children ever seemed to be bothered about what I looked like, I never bothered to go for it. So that was the end of that really. So I didn’t bother about that but I could have done. But even today I find the clothes a problem, and swimwear, and there’s no point in looking in fashion magazines because none of them are ever going to be any good for you, unless you’ve had reconstruction, and then there’s the scarring, because you’ve been, on my side I can see the scar underneath my arm.
Of the men we spoke to who had had a mastectomy, most said they were not bothered by the scars or the change in shape of their chest. However, others felt self-conscious and were reticent about exposing their chest in public, such as when swimming; some would have liked to be offered reconstruction. Bill had all the breast tissue removed from both sides of his chest because of cancer and had new nipples tattooed onto his chest so he looked the same as before. He felt he had been ‘reborn as a man’.
David is an office administrator. He is married and has 2 children. Ethnic Background: White.
Nobody said to me, “Oh, would you like, you know, an implant to make it level?” I mean, I’m quite lopsided, but nothing. As I say, with losing not only breast tissue but muscle as well, it’s skin and bone on one side, literally. You know, simple as.
Would you have liked that opportunity?
I would have. I mean, if I’d have known about it, but it was never mentioned. It’s been mentioned since because you start asking the questions and say you find out about cancer after everything’s gone on, and yeah, it would have been nice to have been given the opportunity yes or no, you know?
So since you’ve started asking the questions, have you then been offered it?
No. Oh, yeah, not often but, “Well, you can have one if you want”, you know, sort of matter-of-fact sort of, you know?
And would you like one?
I’m not bothered now. Maybe at the time or maybe if I were younger, I don’t take my shirt off or owt like that, you know, cos you realise what that big sun can do to you.
So I’m just very aware now. You know, so no, I’m not that bothered, no.
Do you go swimming and…
I have done swimming, yeah, but I think you’re self-conscious at first cos you think everybody’s looking at you, but… I wouldn’t be bothered, no, you know? I’d go swimming if I needed to go swimming.
Similarly, women who had treatment for gynaecological cancers could feel less of a woman as a result, but many we spoke to said that because the effect on their reproductive organs was not visible it was easier to cope with. While some said it was not a problem for them once the operation scars had faded, others said they felt different inside although the change was not outwardly apparent. After having radiotherapy for cervical cancer when she was 42 years old, one woman said she felt less of a woman because her ovaries no longer worked, even though the results were not visible. Older women sometimes mentioned that losing their reproductive organs did not have an impact on their feelings of femininity.
I'm lucky that with this sort of surgery that people can't see it, if you have surgery on the face or something, hugely difficult for people for different reasons really. But you do feel so different even though nobody can see it, which of course has its own problems, as I said before, you know you look fine, but may not necessarily feel that way inside.
The loss of a testicle was a big thing for about a week and a half maybe. I mean at first there was this great sense of loss and particularly because your pubic hair is shaved, you've got this scar, you've got surgical dressings. I remember the scrotum just kind of hanging there and I did feel a definite sense of loss. Again I would say that really lasted for, you know, no more than 10 days or so because the, the surgical site quit causing me any problem within 2 or 3 days, and then very quickly I was moving onto chemotherapy and I had other things to worry about.
Before you go on, can you just expand a little bit about your sense of loss, was it - I don't want to put words into your mouth - in a sense of your masculinity or part of your body or…?
Well both. I mean there's this common expression, at least in North America, where you talk all the time about balls, you know, "That really took balls", or, "He's really got balls", and all of a sudden you don't have balls, you've got ball, and so there is a kind of threat at least to masculinity. It was important to me to realise very quickly that sexual function wasn't impaired at all and really that the funny thing is that once I got used to having one testicle, which was really, again, very quick, it all of a sudden seemed incredibly clunky to have two. I mean the idea of, "Well don't they bump into each other?" And they do bump into each other, and all of a sudden having one just seemed like a very natural and even sort of preferred way to go through life.
Reconstruction using a prosthetic testicle is possible either at the same time or in a separate operation later. Those who had been offered later reconstruction declined it because they did not want a second operation and possible complications from it. One said he would have had a prosthesis if it had been offered at the same time as the orchidectomy.
It was never discussed, I was never offered a prosthesis. I've been offered one recently, I recently, in June of this year, had another check-up and I was offered one, 6 years later and I'm not in the least bit interested, not in the least bit. For one, I wouldn't want to go through that operation again, because it's the same operation to put a false testicle in as it was to remove the first one. So you'd be off work for 2 weeks, apart from anything else, and the pain would be just the same and I wouldn't achieve anything from it. If I walk down the street now with the next guy, nobody knows whether I've got one, two or none, so it doesn't make any odds to me. It doesn't stop you sexually, you still produce sperm at that point, so it doesn't make any difference.
Others did have the procedure done; one man said it had been a very straightforward operation and he was very happy with the cosmetic result. Another had doubts about whether it had been the right decision.
I was given the option of whether I wanted a prosthetic implant, basically a plastic ball.
What did you decide about that?
I had one in the end, I wasn't sure. I think there are a number of things that went through my mind. One I suppose is pure vanity, and I was lucky that I was in a long-term relationship, I'd already had a vasectomy, so children wasn't really an issue, so I was also very fortunate there. And I'm not quite sure why I did, and I'm not quite sure that my choice would be the same again.
Were there any pros and cons given to you?
There were quite a few. Basically the con side is you're introducing a foreign body into my own body, so there was much higher chances of infection and post-operative problems, slightly more complicated. There had been cases earlier on of problems with artificial testicles and, sort of, in the cold they shattered, and this sort of thing. But I was promised that the new ones did not have that kind of problem and I was actually given one to see and feel and whatever.
What was it made of?
I'm not sure exactly, it's a fairly hard plastic. Whether it's true plastic or silicone or whatever, it feels like a fairly hard plastic, slightly harder than a normal testicle, which is one of the reasons why I say I'd think about it twice, because I actually had problems with almost bruising because it hung slightly differently than the natural testicle, they were actually, almost bruising effect until everything got used to the new arrangement. So there were times when I wished I hadn't had it.
Did they put it in at the same time as they removed the…?
It was all done exactly the same time. They said, it's actually quite a straight forward procedure to put in; you know, they've already made all the incisions and so forth, and he said there was really no point in having a second set of surgery to implant. So he would recommend either having it at the same time or not at all. I don't know whether that's the standard recommendation but that was definitely his quite definite recommendation. He also said that it's quite straight forward to remove them again afterwards, it can be an almost out-patient exercise to remove an artificial testicle. And I haven't had that, I kept my artificial testicle.
What about sense of masculinity, do you think it affects guys' sense of masculinity at all or temporarily?
I think it does to a degree. Initially, especially early on. As I said, I had a prosthesis and I think that had something to do with why I decided I would have it. Part of it I think was automatic, I'm losing a testicle, I want one back. And as I said early on, with the surgery it was so rushed between diagnosis and surgery that I'm not sure I was making a 100% rational decisions all the time. So thinking back I'm really not sure why I decided to have the prosthesis. I think part of it is vanity, part of it is the self-image, part of it is sort of masculinity and sexuality.
Cancer of the penis is rare and tends to occur in older men. It is usually treated by surgery, and the extent of surgery depends on the size and position of the tumour. Reconstructive surgery may be possible. Les had a small area of his penis removed and was worried that it might not work properly afterwards, but his worries were short-lived.
Barry is a White male and is trained as an approved electrician. He is not currently married.
But I’d always had one thought or one hope that to stop the cancer from going inside my body I could’ve, and they cut my penis off, and if cutting my penis off could stop the cancer from going inside my body then well, it’s like there’s no comparison really, is there? If you want to live then you cut it off. And by this time I’d had, like, ten years to come to terms with it. I knew I was going to lose and, like, I was, like, in my sixties so…… but I never ever really sat down and thought, ‘Oh I’m going to lose my penis, what am I going to do?’ It never, I think I thought about that more when I was fifty-one than I did do in my sixties, but I can’t really say to you that I thought, I worked myself up into a state, ‘oh I’m going to lose my penis,’ the only saving grace for me was that I had cancer but it was outside my body. So to stop me having cancer inside my body, if they cut my penis off…….. looking at it like……. if you cut something off that’s not inside your body then it’ll never get inside your body. So, I mean, like, since I’ve lost my penis, I mean, like, about five years has gone down the line, I’m sat here talking to you, I haven’t liked what’s happened to me – nobody likes what happens to you because as a bloke your penis to me, the only reason you’re a man is because you’ve got a penis. So if you haven’t got a penis, in some senses you’re not a man. That’s how I look at it. But I’d plenty of time from me first contracting cancer on my penis to, like, when my, like, ten years had elapsed, so I’d plenty of time when it came back, as it did do, I was glad for them, in a sense, to take it off me because I knew it was going to stop the cancer from, like, getting inside my body. So if you want to live, it goes doesn’t it? I’m not happy about it but I’m still here talking to you now, and I go and see the specialist in June, next month, to see what he’s got to say, but all the signs are that everything’s hunky dunky and rosy, so I, well you can’t say no more about that, I’m alive aren’t I, so that’s it.
Surgical scars, rather than losing a part of their body, were a source of distress for some people, but their feelings changed as scars faded over time. Having had a partial circumcision and radiotherapy for penile cancer, a man said, “I look OK but it can be frightening if I take my clothes off”. Julie was glad that her chemotherapy central lines had been inserted into her groin rather than her chest as the scars in her groin were only visible to her and her husband.
David is a retired mechanical engineer. He is married, and has two daughters. Ethnic Background: White British
It’s only, first time I was aware someone noticed we were in Sicily, went for a week, Sicily, and I was down by the swimming pool and I was just, typically Italian, Sicilian, you have a job to get in anywhere. I don’t like that. I’d rather go where it’s, I’m on my own but laying by the pool there, and after about half an hour a guy said to me, “Fancy sewing been done on you”. I said, “Yeah”. He said, “Was it bad news?” I said, “Well, it was at the time”. It turned out he was a fisherman from Yarmouth sewing nets. He said, interesting guy, he said, “Fancy stitch work done there”. And he was a great person, great character, but that was the only time I became aware of people saying, aware that I’ve had cancer, and after that people don’t take any notice.
But I did, when I first, first holiday I had after I was cured, or been operated on, got rid of the bags and pipes and things, I wasn’t allowed to fly. [My wife] said, “Right, we’ll go on a cruise”. So we had to catch a train to Southampton and of course, I couldn’t carry the suitcase. Oh, it was a disaster, getting luggage in, you need a lot of luggage when you go on a cruise.
But I was aware when I was by the pool on the ship people were looking, because the scars were still red. I was aware, I wasn’t so much self-conscious but I noticed someone looking one day. and I found out later on that she was actually a nursing sister and she’d obviously said to someone, and they of course, they all look, but other than that, never been aware.
Not conscious at all. I don’t think about it.
Other unwelcome body changes caused by cancer treatment that people mentioned included the menopause (see also ‘Hormone changes’) and weight gain. Sandra said she feels fat and sweaty and has been robbed of her femininity. Another woman said her weight gain was probably due to several factors and she hoped it would sort itself out in time. Pauline said that she also lost some teeth; tooth decay or loose teeth can be a side effect of certain drugs or radiotherapy to the jaw. Radiotherapy or hormone therapy can also affect hair growth, and some people said that no longer having hair on certain parts of their body was an advantage of their cancer treatment. Claire also liked the softness of her skin after radiotherapy.
Having an understanding spouse or partner was very helpful in enabling people to overcome their feelings about unwelcome body changes after cancer treatment. Some women who had surgery for breast or ovarian cancer said that their husband still loved them the same as before and made them feel no less womanly as a result of their loss. A man who had to have both testicles removed said he had felt emasculated at first but that he had overcome his feelings thanks to having a caring partner. A man who had to wear an ileostomy bag after colorectal cancer surgery felt unclean and believed that his stoma must be off putting for his wife, but that she hadn’t allowed it to affect their sex life (see ‘Sexual functioning and intimate relationships’). Women who felt tired and lacked energy due to chronic leukaemia often said that they made more of an effort to dress up and look good to overcome how they were feeling.