When a woman is diagnosed with breast cancer, chances are that lust is not the first thing on her list of things to worry about. But it's up there because while treatment can save her life, it can also seriously threaten her sexuality. A mastectomy or lumpectomy often damages a woman's image of her body. Add to that the hair loss, fatigue, and low libido that accompany radiation and chemotherapy, and you got anything but a recipe for romance.

Just ask Lisa Collins, a pretty 34-year-old who contracted breast cancer in 2002. Collins can sum up her post-diagnosis sex life with her husband in one word: nonexistent. The couple never slept together again. "I didn't feel attractive anymore," she remembers. "I had no hair. I just looked drawn."

      Collins left her husband the following Valentine's day. "Looking back, I think maybe he didn't know how to handle the whole situation," she says. She'll never know for sure, since they never talked about sex while she was undergoing treatment.

      They would have, if Collins had been under the care of Lilly Shockney. Shockney, a breast cancer survivor, oncology nurse, and administrative director of the Johns Hopkins Avon Foundation Breast Center, does what most doctors don't: she counsels women and their partners about their sex lives during and after treatment, largely to address the woman's fears about how her partner now sees her.

      Shockney says that most of the time, people are not turned off by their wives or girlfriends after breast surgery. "We make these assumptions that if the man is silent, he's thinking negative things," she says. "And that may not be the case at all. He may be afraid to show emotion because he doesn't want to cry." He may also fear that sex will hurt her.

      To create a dialogue, Shockney asks the woman, in front of her partner, how she feels about sex. She often privately cautions the husband about the expression on his face the first time he sees his wife's breasts after surgery. She gives a couple practical advice on the ups and downs of treatment. When radiation creates fatigue, she prescribes "quickies." If vaginal dryness becomes a problem, she recommends buying a bottle of Astroglide®. And for those rare instances when a woman's fears about the relationship are realized, well, she has an answer for that, too: "I tell the patient, ‘Thank heavens you got breast cancer to get that stupid man out of your life.' "

      For most couples, Shockney says sex after the disease improves because of the closeness created by communication during treatment. Many couples also learn that sex isn't always about intercourse, that lovemaking can happen just lying in bed and holding hands.

      Even Collins found that there is sex after breast cancer. She started to date someone right after she finished radiation, when she was still bald. And when that relationship didn't work out, she found someone else. So far things seem to be going well, including the sex. "I think it's great with the right person," she says.