It is well-documented that a large proportion of emotional problems associated with mastectomy is due to the fact that the loss of the breast may have a negative impact on body image. However, counseling the patient and her partner in advance about what to anticipate after treatment for breast cancer no doubt provides the most service to the woman as a preventative measure. Where sexual function is affected, therapeutic couseling may be of benefit. In some cases the woman's loss of sexual function is related to her fear of rejection by her partner. In many cases, the woman may feel deformed or mutilated, resulting in low self-esteem and inability to function sexually. The sexual function problems associated with breast cancer in general, in mastectomy in particular, relate to the psychological and physiological effects of the disease and the treatment of the disease on the patient and the psychological effect on her partner. Sexual rehabilitative couseling significantly increases the number of women who resume sexual activity alter cancer treatment. These are concerns to be dealt with by the treating physician before, during, and after the radiation therapy. Occasionally, the partner may fear actually contracting cancer or being affected by radiation. Sometimes return to sexual activity is slowed by the sexual partner's fear that sex may actually injure the woman. Sexual activity should be encouraged once the patient has passed the point of risk for post-radiation bleeding. Daily vaginal dilation by the patient will help prevent contracted scarring in the long term.

In order to minimize some of these adverse effects, the patient may use vaginal dilators after the risk of hemorrhage has passed. The mucosa becomes atrophic, losing its elasticity, with decreases in length and width. In addition to the negative factor of the cancer being extensive and requiring this radical procedure, the treatment will leave the patient with one or two stomas on her abdominal wall. It may produce significant changes to the vagina. Radiation therapy is often used in treatment of cervical, endometrial, and vaginal cancer.

Vaginal estrogen therapy, adequate medication for nausea and temporary utilization of wigs or head coverings may improve the patient's self-image and sexual function. All of these may affect sexual function by causing a decrease in sexual desire.

Chemotherapy may cause hair loss, disruption of bowel function, decrease in energy and atrophic changes of the vagina. A given couple's age, previous sexual frequency, sexual attitudes, and each partner's level of enjoyment of past sexual activity will determine that couple's most acceptable options. No one decision is best for all couples. In the absence of major vaginal reconstruction, the options include no sexual activity, direct penile-clitoral contact, use of a vibrator, masturbation, manual stimulation of the partner's genitals, and oral stimulation of the partner's genitals. These may occasionally smell of urine or flatus, thus contributing to a feeling of decreased sexuality and loss of self-esteem.