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LGBTQI+ people and cancer

 

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Body image, gender and cancer

Cancer and its treatment can change the way you look. This can affect how you feel about yourself (body image), regardless of sexual orientation, gender and sex characteristics. Even if other people can’t see the changes, they may still affect your body image.

This section discusses some common physical changes to appearance after treatment. These may also affect how you feel about sex and intimacy. The changes you experience will depend on the type of cancer and treatment you have. Some of these changes are permanent, but others may improve with time.

How you feel about changes to your body image will vary. You might find some are positive, and others might be negative. You may feel less attractive. This can affect your identity, self-confidence, self-esteem and body image, which may mean you socialise less or feel excluded from your community. In some cases, you may feel that your body now aligns more closely to your identity.

Removal of a body part

Surgery to treat some types of cancer may mean removing a part of the body that affects how you look. For some, the surgery affirms their gender. After surgery, you may choose to live with your new body shape, wear a prosthesis or have a reconstruction. Only you can decide what feels right for you.

Loss of a breast

Treatment for breast cancer may include breast conserving surgery (removing part of a breast) or a mastectomy (removing one or both breasts). Having a mastectomy is different from top surgery.

After a mastectomy, you may choose to have a reconstruction or “go flat”. Some people who go flat, decide to have the area decorated with a tattoo. This can be to cover scars or to help people feel that they are in control of their body and how they express themselves.

What you decide may depend on whether the surgery affirms your gender, and whether the changes mean your body aligns with how you feel it should be. You may feel that the treatment team assumes that you will want a reconstruction after a mastectomy. Talk to the team about your goals for treatment so they can work out the best options for you.

Loss of the gynaecological organs

If the ovaries, uterus or cervix are removed, this can affect how you experience sexual intimacy.

Loss of a testicle

Some people who have had a testicle removed, may have less confidence and feel less sexually desirable. For cisgender men, the loss of a testicle may make them feel less masculine.

Some people adjust quickly to having one testicle, while others find that it takes some time. If you are self-conscious about how your scrotum looks, you may want to consider having an artificial testicle (called a prosthesis) inserted.

Loss of the prostate

During surgery, the tubes from the testicles are sealed and the prostate and seminal vesicles are removed. This means semen is no longer ejaculated during orgasm. The pleasure from rubbing or stimulating the prostate during anal sex will also be lost.

Shortening or loss of the penis

After treatment for prostate cancer, your penis may be a bit shorter when not erect. After treatment for cancer of the penis, the penis may be removed (penectomy). If the size of your penis is affected, you might avoid intimacy for fear of rejection. Your health care team can recommend a range of methods to change how the penis looks.

Weight changes

Some cancer treatments may cause you to lose weight. This may be because you lose your appetite, or you have taste changes or trouble swallowing. If you are taking medicines such as steroids or androgen deprivation therapy (ADT), these may cause you to put on weight.

Everyone responds differently to changes in weight. Your reaction may depend on your age, and how important your appearance is to you. For some, their changed body shape may feel more affirming, but others may feel less comfortable about their body after changes to their weight.

Bowel changes

Radiation therapy can irritate the lining of the bowel and rectum. Symptoms may include passing smaller, more frequent bowel movements (faeces, also called stools or poo), needing to get to the toilet more quickly, or feeling that you can’t completely empty the bowel.

These changes may mean that you avoid going out for fear of having an accident, or you avoid sexual activity. Talk to your treatment team if you are finding it hard to cope with this side effect.

Loss of hair from the head and body

Hair loss or hair thinning is a common side effect of some cancer treatments, including chemotherapy and radiation therapy. If you experience hair loss, you may have a range of different emotions such as anger, anxiety and feeling low or depressed. Hair loss can make you feel self-conscious about your appearance and be a constant reminder that you have cancer.

For some LGBTQI+ people, head and body hair can be an important part of how they express their sexual orientation and gender. It can be a way of signalling that they have rejected gendered expectations of how they should look, or beards or long hair may help affirm their identity. Losing hair because of cancer treatment can challenge this expression of identity and self-image. For others, short hair after treatment may make them feel more visible as an LGBTQI+ person.

Everyone deals with hair loss differently. You might want to wear wigs, scarves and hats, or you might feel comfortable leaving your head bare. You may want to take control of the hair loss by shaving your head before treatment.

Gender-affirming hormone therapies

Some cancers depend on hormones to grow (e.g. oestrogen may help breast cancer to grow, testosterone may help prostate cancer to grow). If you are diagnosed with a hormone-dependent cancer and are taking gender-affirming hormones, your doctor may suggest adjusting your treatment.

You may find this difficult to do, particularly if how you look changes. This is known as gender dysphoria. If this makes you feel anxious or depressed, it may help to talk to your doctor or call QLife on 1800 184 527.

Other changes to your appearance

Scars

Surgery or radiation therapy can cause scarring. Scars usually fade over time and are harder to see. Sometimes people worry because a scar looks or feels red, tight and uncomfortable. This may make you feel self-conscious, even if others can’t see it. Ask your doctor about creams that may help the scar heal and become lighter in colour. In some cases, you may choose to have surgery to make a scar less noticeable.

Skin changes

Itchy, red and dry skin can be a side effect of some targeted therapy, immunotherapy and hormone therapy drugs. Radiation therapy can also cause skin changes. These changes can make you feel self-conscious.

Lymphoedema

If the surgeon removes lymph nodes from your armpit, groin or pelvic area, the lymph fluid may no longer drain properly, and your arm or leg may swell. This is called lymphoedema. Although lymphoedema may be permanent, the pain it causes can usually be managed. Ask a lymphoedema practitioner whether wearing a compression garment would help.

Stoma

Occasionally, surgery for bowel, anal, ovarian or bladder cancer means you need a temporary or permanent opening in the body (stoma). For a bowel stoma, a new opening in the abdomen allows bowel movements (faeces, also called stools or poo) to empty into a bag that sticks onto the skin of your abdomen.

For a bladder stoma, a new opening collects and stores urine (pee or wee). Getting used to the stoma takes time. You may feel self-conscious about having a stoma, and worry that it can be seen under clothing, but it usually isn’t noticeable.

Ways to adjust to changes in your appearance

  • Keep in mind that body image is based on a mix of emotional and physical factors, not just on a body part or physical characteristic.
  • Exercise regularly. It can help improve body image, quality of life, and reduce the risk of cancer coming back. Consider seeing an exercise professional for a tailored exercise program.
  • Wear accessories and clothes that make you feel good or highlight your favourite features.
  • Look at your “new” body in the mirror to get used to how it has changed.
  • Talk to your GP or a psychologist if you have trouble adjusting to the changes to your body.
  • Connect with people on social media who have similar experiences. They may have suggestions on how to adapt to your changing appearance.
  • Ask your doctor about reconstructive surgery, prosthetic devices and/or cosmetic solutions. These are not for everyone but may help improve self-esteem and body image.

 

LGBTQI+ People and Cancer

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Expert content reviewers:

The chief investigators on the project were Prof Jane Ussher, Prof Janette Perz, Prof Martha Hickey, Prof Suzanne Chambers, Prof Gary Dowsett, Prof Ian Davis, Prof Katherine Boydell, Prof Kerry Robinson and Dr Chloe Parton. Partner investigators were Dr Fiona McDonald and A/Prof Antoinette Anazodo. Research Associates were Dr Rosalie Power, Dr Kimberley Allison and Dr Alexandra J. Hawkey.

Page last updated:

The information on this webpage was adapted from LGBTQI+ People and Cancer (2023 edition). This webpage was last updated in December 2023. 

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