For women, breast cancer remains a common and dreaded experience. It is normal for a diagnosis of breast cancer to evoke grief, anger, and intense fear. Most women, however, face this crisis and master it without developing major psychiatric disorders or severe sexual dysfunction. The options of breast conservation and reconstruction give women a new sense of control over their treatment and are quite successful in helping women feel comfortable with their bodies again. The effectiveness of breast conservation and reconstruction in preventing or ameliorating sexual problems after breast cancer diagnosis is less clear, however. Any impact these options have on sexuality is subtle and may relate more to a woman's feelings of being desirable than to how often she has sex, her lovemaking practices, or how much she enjoys sex. We need more information on how chemotherapy and hormonal therapy affect women's sex lives. As clinicians, we should pay more attention to our patients' complaints of vaginal pain, dryness, and overall loss of sexual desire during systemic treatment. Practical advice on lovemaking techniques and a clinician's open attitude towards discussing sexual issues can prevent a great deal of anxiety and sadness as women with breast cancer search for ways to keep their sex lives satisfying.