Many women find that breast cancer diagnosis and treatment seriously disrupt their sexual lives. First there are the most obvious issues—the physical changes, exhaustion, nausea and pain from treatment, self-image, empty energy reserves, and the emotional chaos from the diagnosis itself. But there are also many other issues that women and their partners may not even know they'll have to face.

Yet retaining intimacy in your relationship both during and after your breast cancer ordeal is critical to your overall recovery. And single women who want to become part of a relationship worry how breast cancer will affect their prospects, about how and when to tell those prospective lovers about their condition.

You and Your Partner

What do partners of breast cancer patients care most about? In spite of what you may imagine or fear, studies show that the answer is simply this: Their loved one is alive and feeling well. The loss or alteration of a breast is almost meaningless in contrast. "I don't care what they take from you as long as I can see your face" is a common sentiment. Most caring partners (both men and women) see their lovers as having many parts to love, and as being more than the sum of those parts.

Nobody is promising there won't be ups and downs. While you're worrying about feeling less attractive, your partner is also dealing with worry, anxiety, and maybe even guilt, wondering: "Could I have been responsible? Could I in some way have contributed to the cancer? Will I become radioactive if I touch her, if I touch her breast? Is her cancer contagious?" And (perhaps feeling guilty), "When will I be able to worry about myself for a change?"

It may be hard for you figure out your needs and concerns, let alone tell them to your partner. You don't want to make light of what your partner has already done for you, so phrase your requests as carefully and positively as possible: "You've been working so hard, doing so much—and it's made a huge difference. But what I really need right now is to be close to you and tell you what's making me nervous and anxious. I need you to listen, and maybe just hold me."

Communication's the key

Communication—talking to each other, listening to each other—is the basis of any intimate relationship. But most people haven't a clue about how to talk about something as big as cancer. So here are some tips to get you started:

Find some time. Most couples have limited time together anyway. A breast cancer diagnosis just adds more distractions. Even when you do get to talk, there are so many interruptions the conversation may go nowhere. Schedule some time in a quiet place where you know you won't be interrupted.

Start somewhere. Begin by talking about something comfortable and manageable—your vacation plans, even the weather. Once you're talking, then you can work the conversation around to your fears, concerns, how the illness has changed you, and the importance of your relationship.

Talk, talk, talk. Even if your partner isn't a good talker, that doesn't mean he or she isn't listening. You may need to do most of the talking yourself but, believe it or not, what you're saying WILL be heard and it WILL sink in. Stop along the way to get feedback. Eye contact and touch can give your words greater meaning and emphasis.

Reassure your partner. Your partner may feel that you've got enough to deal with without listening to someone else's fears and concerns. Make it clear that you WANT to hear how he or she is feeling, that you're both in this together.

Bring in a third party. If you're both having trouble communicating, a visit with a therapist can get the ball rolling.

Write it down. Sometimes it's much easier to write how you're feeling in the form of a letter or even a journal entry than to say it face to face.

Breast cancer is not good for relationships, but good relationships can be made stronger by sharing hardship. Your partner may have doubts, and miss and mourn the "old" you, just as you may be doing. But that doesn't mean he or she is p repared to trade you in. "My husband stood by while I cried and screamed, and he hugged me when I let him get close enough," said Debra. "Our marriage is better now than it ever was before."

Should you be in this relationship?

If you see yourself as damaged goods, you probably assume your partner feels as you do. But that simply isn't a given.

One consequence of feeling less than lovable is fear of being abandoned. It's true that in some cases a man sees his partner's altered body as a personal reflection of his value—and just wants out. Other partners simply come apart under stress.

Flawed marriages don't have to come apart, with or without breast cancer. Divorce rates are not higher among couples in which a woman has had breast cancer. Sometimes the shock of a cancer diagnosis pushes partners in a troubled relationship to consider the source of their problem and seek counseling.

Or YOU may be the one who responds unpredictably. One very independent woman became overwhelmed, uncertain, and very dependent when her breast cancer was diagnosed. This new "frailty" devastated her, and her marriage went through a rough spell till she finally returned to something of her old self.

Talking, telling, supporting each other

It would be nice to have a partner who understands and helps you feel better as you work to get back your old confidence, but that may just be unrealistic. He or she is probably suffering, too, and may be less able to express that suffering than you are. So each of you have all this emotion buried somewhere inside.

Ginny could not understand her husband's silence. "What's the matter with you? Why don't you talk to me about what's happening? I have CANCER! I could die! Say SOMETHING! " Ginny felt as though she was yelling at a stone wall.

Breast cancer has become so common that most men have someone close in their life who has suffered the disease. There's no way to predict how any man will respond, but there is no doubt that many men are supportive and prepared to continue the relationship.

Women may find it easier to talk to one another, and lesbian partners may be particularly sensitive and supportive. It is also true, however, that a woman may feel especially vulnerable and personally threatened if her partner has breast cancer, knowing this disease is one that can affect her as well.

Single Women: Finding Your Way

Linda Dackman was 34 when she had a mastectomy. She had no way to find help as a single woman looking for a relationship, wanting to know when and how to tell about her mastectomy and her disease. She wrote the book Up Front: Sex and the Post-Mastectomy Woman, a personal account of how she coped with these problems (unfortunately out of print, but worth tracking down in a library or a used-book store).

Each time she met someone new, Linda had to struggle with when and how to tell, and then how to behave in intimate situations. In the beginning, she would blurt out her history almost immediately, frightening herself and her date. Gradually she got to a point where she was able to wait till the third or fourth meeting, and discuss it without upsetting herself or her companion. And she learned to protect herself during the initial phase of a sexual encounter, by wearing a silky cover-up, gradually working up to full exposure.

Renee told Burt about her cancer history on their first date, including the fact that it was unlikely she could have children. They were married ten months later. "I worked through my fears with him—and they disappeared from my head when we had sex. Sexy lingerie helped me feel confident and attractive," she says.

Don't allow breast cancer to define who you are. You don't have to wear a sign that says "I've had breast cancer," and you don't have to bring it up until you are ready and feel you have some stake in a relationship. Here are some suggestions on how to ease into the dating world again after your diagnosis and treatment:

Find a friend. The first rule in dating after breast cancer is to make sure your partner cares about you as a friend before you reveal too much.

Practice. If you find it difficult telling a potential partner about your cancer, practice talking about it in front of a mirror or to a trusted friend well ahead of time.

Be honest. When you're ready, it's to let a potential partner know what to expect. So in addition to revealing your diagnosis, you should say very clearly and simply what was done, how you're doing now, and how you feel. You have not been diagnosed with a rare disorder. Most people know somebody close to them who has been affected by breast cancer.

Put yourself in a potential partner's place. How would you feel if a man revealed that he had prostate cancer? Would you still want him as a potential dating partner? Would you be willing to cope with a problem in your sex life together?

Dump a person who can't cope with the knowledge of your breast cancer. You deserve better.

Making the connection

Finding a suitable and available companion is always a challenge, but there are enough success stories to keep up hope, to take action and make things happen. You've got to do what any woman out to meet Mr./Ms. Right does, and take your chance, just like anyone else, that you'll be lucky.

There ARE quality single people out there looking for relationships. They may not fit your ideal fantasy, but maybe it's time to set realistic standards and look for what really counts, like character and responsibility.

According to Sex in America, most couples are introduced to each other by family members, friends, co-workers, classmates, or neighbors. So look to the people you know—and tell them you'd really appreciate an introduction to a quality person, a serious date. Don't be shy. Your social network has resources for you to tap, but you've got to let your friends know what you're looking for and talk up your hopes. Keep up your connections and your expectations. You never know which blind date may be The One.

When Debbie, a 35-year-old divorced single mom of a four-year-old son, was diagnosed with breast cancer, she decided to call her old college boyfriend for support. He had never married and was still carrying a torch for her. They got together the very next weekend and fell in love all over again; his family also embraced her. He stayed by her side through chemotherapy, hair loss, early menopause, a 25-pound weight gain, the return of her period (a terrific day, as they desperately want children together), and much more. They eventually married and made a life together.

Strengthening connections

This is a tough time, and you've had to do a lot of soul-searching with this disease. Maybe the same soul-searching can help you learn how to handle relationships better. Maybe you tend to go after the wrong partner, or send the wrong message. If you've had problems with relationships before breast cancer, those problems are not going to go away. This may be the time in your life for you to look into yourself more closely, perhaps with the help of a therapist.