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Putting Dr G on the spot

Sunday, 16 July 2017 | MYT 5:34 PM

Nipple stimulation and sex

Dear Dr. G,

My name is Joshua and my wife and I have been married for the last five years. Last month, my wife noticed a small lump in her left breast. We went to the doctor straight away and the biopsy sadly showed that she had breast cancer. Thankfully, the cancer was detected in its early stages and the doctors are confident that it can be treated successfully. The surgeon went through the various surgical options and advised my wife to remove the lump instead of the whole breast, and this is something that my wife is very pleased with and mentioned that she is happy that the nipple can be preserved. However, I am of the opinion that we have to be as radical as possible and remove the entire breast - including the nipple - to prevent the cancer from coming back.

We discussed the issues, and I was very surprised that my wife mentioned that she enjoyed stimulation of the nipples during sex. I am so sorry to put Dr. G on the spot on women's sexual health. But, can you tell me what role the nipples play in sexual stimulation? Can this be more important than intercourse? Have I been doing everything wrong in the bedroom all this while?

Finally, is it really safe for my wife to preserve the nipples for this cancer treatment?

Thanks in advance

Joshua

Human breasts - especially the nipples - are highly sensitive with erogenous zones for both men and women. The tactile stimulation often has a heightened level of sensitivity and stimulation that can generate sexual arousal and excitement.

Nipple stimulation is a common, but less talked about mode of human sexual practice either by itself or as part of sexual experience with a partner and engorged nipples are typically prominent indicator of female sexual arousal.

The male and female breast and areola developed similarly in the fetus. Hence both have the same number of nerve endings. At puberty, the male breasts remain rudimentary but female breasts develop further into adulthood. The influence of estrogen and progesterone determine the degree of enlargement of both breasts, and also cause them to be more sensitive than male breasts. The number of nerve endings of the breast are similar irrespective of their size, however many reports actually demonstrate that smaller breasts are more sensitive, while larger breasts require more effort to achieve stimulation.

Physiologically, the tactile stimulation of a woman's nipples promotes the production of oxytocin and prolactin in the brain. These hormones normally prepare women for breast feeding, however they are also well recognised to cause relaxation and a feeling of bonding and trust in women. Prolactin is also believed to induce post-coital sexual gratification.

A 2006 survey highlighted that sexual arousal in 82% of young women and 52% of young men can be attributed directly to tactile stimulation of the nipples. Only seven percent of participants were put off by nipple action, with a decrease in sexual arousal. In fact, some women can achieve orgasm as the result of nipple stimulation alone. This is believed to be due to the area of the sensory cortex in a woman's brain associated with female genitalia when aroused by stimulating the nipples. This was confirmed by a 2011 study that demonstrated the same connection.

As for the options for treating breast cancer, the difference between lumpectomy and mastectomy for the treatment of breast cancer essentially lies in the amount of breast tissues removed to eradicate the cancer, and this is dependent on the type and extent of the cancer detected. Mastectomy is the total removal of the whole breast. This can also have several variations, depending on what is preserved and nipple-sparing mastectomy may also be an option considered when the sexual needs of patients are taken into account.

In conclusion, it would seem sensible to make radical choices when a family is facing the horror of cancer - but it is also important to remember that life must be lived after the storm is over.

When put on the spot for preservation of the nipple related to sex life after cancer, Dr. G's advice for Joshua is to trust the gut instinct of your wife, as she knows her own body the best! On that note, good luck with the treatment!