The night before her bilateral mastectomy, Melissa Berry washed her breasts with Hibiclens antiseptic soap and said goodbye to them.

“I remember thinking, these are the breasts that I had in a training bra, and was so excited [that they] were developing. And I remember getting to second base at sleepaway camp with them. I nursed my babies with them. I put my wedding gown on [them],” she tells Well+Good.

After years of vigilance following genetic testing that revealed a BRCA mutation (which can increase the risk of breast and ovarian cancer), including breast checks every six months and an oophorectomy at age 39 to surgically remove her ovaries, Berry, the founder of Cancer Fashionista and co-host of the newly launched podcast series Empowered Intimacy: Getting Your Sexy Back After Breast Cancer, was diagnosed with stage 1 triple-negative breast cancer.

Today, Berry is cancer-free, but she says she’s struggled with sex and intimacy since her diagnosis with the illness, which she calls “deeply defeminizing.”

Why breast cancer can feel defeminizing

Breast cancer can shift a person’s relationship with their body and sexuality. These changes can sometimes be most intense after treatment is complete and the hectic whirr of medical appointments subsides. “One of the biggest emotional and mental effects is figuring out who you are after this traumatizing experience,” says Minerva Guerrero, PhD, LMHC, a mental health counselor and founder of Mind Matters Mental Health Counseling, PLLC, in Westchester County, New York, who specializes in treating women struggling with significant life changes.

There are a few factors that can make navigating breast cancer—from diagnosis, to treatment, to lingering side effects—lead to a disconnect with your femininity and self-esteem:

Breasts are a symbol of femininity

For some people, breasts are emblematic of femininity, a source of pleasure and attraction, as well as a means to nurture babies. “This disease does a lot to an individual, and their femininity is affected,” says Melissa D. Fana, MD, a fellowship-trained breast surgical oncologist at NYU Langone Health.

Essentially, how you feel about your breasts can change. For example, some people associate breasts with giving them cancer, Dr. Fana says.

For her part, Berry says: “Once I knew what the course of treatment was, and that I was going to be okay, I thought to myself, How am I going to look?” She was concerned her breasts wouldn’t look the same. “I just wanted to look like Melissa,” she recalls.

Treatment can change your appearance (beyond your breasts)

“Cancer in general, but particularly breast cancer, can affect the way our bodies look,” Guerrero says. Chemotherapy, for example, can cause side effects like weight changes and hair loss. Berry notes that she lost the hair on her head as well as her brows and lashes during chemo.

Breast appearance can change, too, even without a mastectomy or lumpectomy. Specifically, radiation therapy can lead to a loss of elasticity in the skin, Dr. Fana says. Breasts can also shift in size or feel firmer following radiation, per the Susan G. Komen Foundation. All these changes in appearance can have “a huge effect on our confidence and our sexuality,” Guerrero says.

A change to sex and intimacy

It’s not only that your breasts (and other body parts) can look different. They can feel different, too, which may leave you feeling less eager for intimacy.

Radiation can lead to breast soreness or irritated skin, per the National Breast Cancer Foundation. A mastectomy or lumpectomy can cause a lack of sensation, whether or not you’ve had breast reconstruction or flat closure surgery, says Dr. Fana. Scar tissue from these surgeries can also cause chronic pain, she adds.

Cancer treatments can also cause libido-lowering side effects—like entering menopause early or abruptly, vaginal dryness, and other changes to the vagina and vulva—leading to discomfort or pain during sex, per BreastCancer.org.

Even if it’s not painful, sexual intimacy may feel physically or emotionally different. It can be jarring to lose sensation in your breasts, especially if you got reconstruction, because your breasts look the same as they did before cancer, but lack the pleasurable feeling that previously came with touch.

“After you’ve had breast reconstruction, maybe you don’t want to be touched because you feel like you’re going to break in half,” Berry says. This can also lead to conflict in romantic and sexual partnerships.

“I don’t want anyone to feel alone. No relationship should suffer because of breast cancer.” —Melissa Berry

Reconnecting with femininity and sex after breast cancer

From the start of her journey, Berry’s been intent on staying connected to her femininity. In fact, her podcast is all about “getting your sexy back after breast cancer,” she says. “I don’t want anyone to ever feel alone. No relationship should suffer because of breast cancer,” she adds.

Dr. Fana finds that support after treatment can be neglected, often because healthcare providers aren’t comfortable sharing a key truth: “One day, you will be yourself again. You will have gone through breast cancer, and you will survive…But you might not feel like you again, and you might need other things to allow yourself to be who you are, to be comfortable with intimacy, to not have pain, to feel like it’s okay to engage in intercourse.”

Here are some strategies Berry—along with Dr. Fana and Guerrero—recommend to become more comfortable with sex after breast cancer:

1. Find supportive healthcare providers

Open up to your healthcare team if you’re having symptoms like low libido, hot flashes, vaginal dryness, or pain. “It’s really the most important thing to have an open line of communication with your medical team and not be afraid or ashamed to say, ‘Hey, I know I’m in the middle of treatment, and I know we’re saving my life, but intercourse hurts. What can I do?’ Or ‘I have no libido. What can I do?'” Berry says.

Dr. Fana says you don’t have to accept this as your normal. Doctors can help, but you’ll have to speak up. Your doctors are likely more focused on metrics like survival and limiting recurrence than on your quality of life.

Your mental health is also important. “I always joke when people say, ‘How did you get through this?’ [The answer is] Xanax,” Berry says. “I also really couldn’t have gotten through this without really great talk therapy,” she adds. She encourages people to lean on medication and talk therapy without fear and shame, if doctors suggest it.

“Even though you’re navigating a very scary disease, you should still be able to live your life as you’re going through it the best that you can,” Berry says.

2. Get reacquainted with your body

“I had to re-acclimate and get to know my body all over again, from head to toe,” Berry says. “Honestly, there were times where I felt like a shell of myself, and I even questioned, Do I still feel like a woman?” Berry recalls.

“I’m a real girl’s girl. I always loved doing my hair, my makeup, [and] wearing beautiful clothing,” she adds. Breast cancer meant overhauling her wardrobe, and dealing with beauty issues beyond a pimple or fine lines. But she still wanted to hang on to as much of her old self as she could.

Guerrero recommends “learning your new body.” That may mean changing how you dress, playing around with wigs, trying out new bras and tops, and figuring out what looks and feels good to you, she says.

“I needed to completely get to know my body again in a completely different way, and I think it starts with accepting it and loving it,” Berry says.

3. Take baby steps to intimacy

“You don’t need to jump straight into the pool of intimacy after going through such life-changing and life-saving treatment,” Berry says. Give yourself grace and time to take it slow, she adds.

Consider masturbation as an early step toward intimacy, Berry suggests. This can especially help if you have a loss of libido and “you need to figure out what feels good for you again,” she says.

And if you’re dealing with symptoms like vaginal dryness, and over-the-counter solutions (like lube) don’t help, reach out to your doctor. What works for some people may not work for those going through breast cancer. Berry had had friends recommend using coconut oil as lubricant. But she said “using coconut oil when you have that kind of discomfort is like taking a baby aspirin when you have a migraine,’” she recalls.

Your OB/GYN, or others on your medical team, can prescribe things like medicated suppositories (to relieve pain) or vaginal dilators, which can help with vaginal dryness or discomfort with penetration.

4. Remember, intimacy is more than sex

“Sexuality is not just sex,” Guerrero says. That is, there are other ways you can tap into your femininity and sexuality beyond having sex, she says.

“Intimacy comes in many shapes and forms,” Berry says. “It can mean holding hands, snuggling on the couch, or playing a board game.” Finding ways to connect with romantic partners can help boost your self-esteem.

5. Have open conversations with your partner (or future partners)

If you’ve been with someone for awhile, it can be tough to find new ways to be intimate. Especially if you’ve used the same foreplay moves for years…even decades.

Guerrero also says after treatment, there can be pressure to show up for partners sexually and resume familiar sexual habits. “In general, whenever there’s pressure to have sex, well, there goes the fun,” she says.

The reality is: Sex may be different after treatment. Things that felt good before may not feel good now. Your best bet is to talk about it. Having open, honest communication allows your partner to understand what’s changed, Guerrero says.

But it’s not always an easy step to take—there can be fear, shame, guilt, and discomfort about voicing how sex has changed. Plus, after breast cancer, you may wonder, “Is my partner going to think I’m still beautiful?” Berry says.

“Having the openness or courage and the trust in your relationship to share” is important, Guerrero says. “You want to enjoy the best sex life that you can with your partner, and you want your partner to enjoy their sex life with you.”

6. Look for products that help

Your care team can share products and solutions to help you manage physical symptoms. But there are other products, too, that may help you feel more beautiful and attractive.

Berry founded Cancer Fashionista for this reason. She provides information on things like how to apply false lashes when yours fall out and how to know your bra size after a mastectomy. “I see myself as the bridge between life-saving cancer treatment and quality of life,” she says.

She recommends finding a mastectomy bra that doesn’t give off medical vibes, like the ones made by AnaOno. “Something I also recommend when you’re in the middle of going through breast reconstruction and you want to feel beautiful: Put on a sheer sexy camisole,” Berry says.

And, if you’re in the middle of breast reconstruction or are unsure if you want to reconstruct your nipples, try rub-on temporary nipple tattoos, Berry suggests.

Life after breast cancer needs more attention

A lot of attention goes to preventing breast cancer and treating it early, especially during Breast Cancer Awareness Month in October. But the conversation tends to stop there.

Dr. Fana says the healthcare system shouldn’t just track cancer recurrences, but also patients’ quality of life and their personal satisfaction, she says. “Do we have a measure of how they are doing [at] being them, the mother, the wife, the girlfriend, just them at their core? Are they okay?” she says. Patients’ emotions, mental health, sexuality, and physical health should all be addressed, she adds.

“Once you’ve had cancer, there are some parts of your identity that may shift,” Guerrero says. When you get a cancer diagnosis, it’s terrifying—but there’s a roadmap to your next steps, she says. “Once treatment ends, there’s no roadmap. And now you have to figure it out. Now you need to figure out how to integrate this life experience into the other parts of your life and the other roles that you have besides cancer patient and cancer survivor,” she says.

This can be scary, she says, but also empowering. It may take time, and the adjustment period can be challenging, Guerrero says, but people tend to figure out how to face this new moment and regain their femininity and the type of intimacy they desire in time.

“Breast cancer is hard enough,” Berry says. “You should be able to keep the joy in your life with your partner, or even just with yourself, to be able to have the joy of feeling beautiful and sexy. That’s something that you should never have to give up.”