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But not all breast cancer patients know this going in.

I still hear horror stories about women who have mastectomies then turn to their doctors in puzzlement when their skin and/or nipples remain numb.

“A lot of times, I hear that they haven’t tried for a very long time because neither one of them wants to bring it up,” she said.

This year alone, an estimated 1.7 million people will be newly diagnosed with cancer and, according to one study, half of those with pelvic cancers and a quarter of those with everything else will have something go haywire in bed, some more than others. We’re going to live for years — maybe even decades — after treatment. Key parts of our sexual anatomy — our sexual selves — may be broken or missing and that’s tough to talk about and deal with.

“It depends on the diagnosis and type of treatment,” said Dr. Most patients wait for their doctors to bring up the whole sex thing but doctors are often too uncomfortable — or too pressed for time — to do so.

“Certainly young adult survivors will live the vast majority of their lives with these consequences.

That’s a long time to live with sexual dysfunction.

It’s inexcusable to not be addressing the needs of these people.” But the inexcusable happens. (Remember, cancer touches young and old alike.) What’s their experience?

In a recent blog post on the website I Had Cancer, one patient, writing anonymously, said when she brought up lack of libido with her doctors and nurses, they just gave her “a blank stare, like this was another thing I just had to accept.” Any topic that smacks of sex does seem to be almost taboo for many doctors, maybe because they don’t know what to say. A quick survey on the private Facebook group Beyond the Pink Moon prompted a slew of anecdotes from breast and ovarian cancer patients. Gary Lyman, a breast cancer oncologist with Fred Hutch’s treatment arm Seattle Cancer Care Alliance, said despite the discomfort it causes doctors and patients, discussing the effect of cancer and treatment on patients’ sex lives is extremely important.But for whatever reason, most of us talk about the mechanics of sex about as readily as we talk about the mechanics of other normal, healthy functions like, say, pooping. Luckily, I’d reached out to other patients so I had an inkling of what was to come.I knew that even a nipple-sparing mastectomy would eliminate two key players on the team, leaving my chest a dead zone — no nerves, no feeling, nothing.Sex was the furthest thing from my mind when a breast cancer surgeon told me I needed a double mastectomy five years ago. No matter what kind of cancer you have, the surgery and treatment you go through will have a profound effect on all aspects of your life, including your sex life.From changes in body image to erectile dysfunction to excised bits and pieces, things just don’t quite work the same for many after a cancer diagnosis.Anti-hormone treatments, the bane of breast and prostate cancer patients, put a kibosh on intimacy in about 17 different ways — even cuddling is out when hot flashes make people feel like they’re going to spontaneously combust. Men may struggle with impotence, women may lose their natural lubrication and most everybody’s joy button is off, thanks to the physiological, emotional and/or psychological changes wrought by diagnosis and treatment.