I am about to have a double mastectomy, having been told I’m a carrier for the BRCA 1 gene fault. I’m really worried about the effect it will have on my marriage. My husband is very reassuring, but I’m worried he might not fancy me anymore. I’m also anxious that I won’t feel attractive after the operation.

What you have chosen to do is very brave indeed. You are about to undergo major surgery which will result in the loss of something fundamental both to your self-image and to your identity as a woman. It’s natural that you are worried about how you will look and feel afterwards, and how it will effect your relationship with your husband.

It’s impossible to predict exactly how you will feel after the operation, or how your husband will feel (save that he will be relieved that it’s now far less likely he’ll lose you prematurely). While it’s true that your body will not be the same, that doesn’t mean that it won’t look attractive, or that you won’t learn to accept it and enjoy it again. The more prepared you both are — in terms of knowledge and risks, as well as emotionally and psychologically — the better.

I’m sure you already know all the medical facts, but for the benefit of readers who don’t, BRCA 1 and BRCA 2 are tumour suppressor genes, which help repair damaged DNA in cells, protecting against cancer. If there’s a fault in these genes, as in your case, the DNA damage may not be properly repaired, leading to a higher risk of several cancers, including breast, ovarian, prostate, pancreatic and skin.

There are three specific BRCA gene faults (two in BRCA 1 and one in BRCA 2) that are seen more commonly in the Ashkenazi Jewish population. Approximately one in 40 Ashkenazi Jews has a mutation, compared to one in 800 for the general population. According to a study in medical journal, The Oncologist, Ashkenazi women with a BRCA 1 mutation are 31 times more likely to get early onset breast cancer (defined as aged under 42) than women in the general population, and have an 80% to 90% chance of getting breast cancer during the course of their lifetimes. Some scientists now believe all Ashkenazi women should be routinely screened. Having a bilateral mastectomy, as you are, reduces the risk of breast cancer by up to 95%.

Have you spoken to your doctors about the possibility about breast reconstruction, either at the same time as your mastectomy, or at a later date? Is this something you want? And have you discussed it with your husband? What’s most important is that you talk to each other about your feelings, and that you go through this whole process together. Yes, you’re the one actually having the surgery, but he will be dealing with its effects too, and you’ll need each other’s support to cope. Not communicating about this is actually more likely to destroy the intimacy between you than the changes to your body. Remember, the attraction you have for one other is about far more than physical appearance, especially if you have been together for several years. And enjoying sex is as much about feeling confident and comfortable in yourself as it is about the physical.

Women who have had mastectomies say it does take time to get used to the way their bodies look and feel afterward. Experts believe that the sooner you confront any physical changes, the better. And the more you look, the quicker you’ll get used to your new self. Even if it’s hard, let your husband see, as soon as you feel able, so he doesn’t feel shut out. This will make it more likely that your sex life will stay on track.

Breast Cancer Care  has a booklet which might be helpful for you to read called Your body, intimacy and sex. If you’d like to talk, call the helpline on 0808 800 6000. The charity also has a "Someone like Me" phone service, which will put you in touch with a woman who has been in the same situation as you. Call on 0345 077 1893 or see the website. You can also access the charity’s online forum Genes and Breast Cancer where you can talk to other women who’ve been through the same experience.

For specific Jewish support, contact Chai Cancer Care . If necessary, they can refer you to a psycho-sexual counsellor, or help with physiotherapy after surgery, Call the helpline on 0808 808 4567.

Do you agree with Hilary? What advice would you give? We’re keen to hear what readers think and may post some responses online.

Contact Hilary with comments or with your problems via email at agony@thejc.com, anonymously or not. Or write to her at 28 St Albans Lane, London NW11 7QF