by Joanne K. Rash, MPAS, PA-C, and Lori A. Seaborne, MPAS, PA-C
A cancer diagnosis may change the way you see yourself. Before cancer, your sexuality may have been an integral part of your identity. However, cancer and its treatment can cause a number of sexual issues. If you’re experiencing cancer-related sexual dysfunction, you may feel as if you’ve lost this part of your identity. If you avoid intimacy because of those issues, you may also feel a loss of normalcy. As you recover from treatment, it’s natural to want to reclaim that part of yourself. So let’s look at some of the common sexual problems female cancer survivors face and what you can do to overcome them.
How Cancer Treatment Affects Sexual Function
Surgery, chemotherapy, radiation, and hormonal treatments can all put female cancer survivors into early menopause. When this happens, your ovaries will stop producing estrogen (a woman’s main sex hormone) and your menstrual periods will stop. This decrease in estrogen can lead to vaginal dryness, itching, and irritation. You may also have hot flashes, night sweats, sleep problems, and mood changes. And if that weren’t enough, many women begin to lose interest in sex, have difficulty becoming aroused, or are unable to achieve orgasm. Some even experience pain or discomfort during sex.
Each individual cancer treatment can carry its own set of sexual side effects as well. Surgery can cause scarring, swelling, pain, and numbness. Chemotherapy may cause fatigue, vaginal dryness, decreased desire, nausea, or nerve damage. Radiation therapy can thicken or discolor the radiated skin and cause sensation changes. After pelvic radiation, you may experience vaginal tissue inflammation or vaginal shortening. Hormone therapy can cause menopausal symptoms and joint pain.
Your Emotions Can Play a Part Too
During cancer treatment, you may start to think of yourself as a “sick” person, and you may forget that you are also a sexual being. Likewise, you may begin to view your partner as your caretaker rather than your lover. Due to a variety of emotional issues, sexual intimacy may not be easy during this time. You may be exhausted and overwhelmed. You may feel unattractive because of the way cancer has changed how your body looks, feels, and responds. You may even experience grief over loss of fertility, loss of sexual body parts, or loss of sexual function.
But You Can Reclaim Your Sexuality
If intimacy and sexual touching stopped during cancer treatment, there are things you can do to invite them back into your life and reclaim your sexuality. First, focus on good communication. Acknowledge your fears and grief, and share your concerns with your partner. Tell your partner where you do, and don’t, like to be touched.
Remember that your body can give you pleasure (even when sex isn’t involved). Spend time hugging, kissing, holding hands, and laughing with your partner. Laughter is a great way to connect – it lowers stress hormones, strengthens the immune system, and eases pain. Share sensual touching, like massage. It’s important to take time to enjoy sexual touch without penetration. Focus on the fun and playfulness of being intimate, rather than only on
penetration and orgasm.
Protect Your Sexual Health
Even if you don’t have a partner, it’s important to keep your vaginal tissues healthy. The following tips can help:
- Embrace an overall healthy lifestyle. Drink plenty of water, eat lots of fruits and vegetables, and avoid sweets and processed foods. Exercise for 30 to 60 minutes a day, and get plenty of sleep. Avoid smoking, which damages the small blood vessels that are important for sexual arousal.
- Use moisturizers and lubricants. A vaginal moisturizer can help keep vaginal tissue healthy, regardless of whether you are currently having sex. It can be applied daily or several times a week. Look for ones with hyaluronic acid, aloe vera, Vitamin E, or carrageenan. After menopause, you may not get “wet” during sex. A good quality lubricant can help. Water-based lubricants are great, but they may need to be reapplied during intercourse. Silicone-based lubricants stay more slippery. Avoid glycerin, waxes, petroleum jelly (Vaseline), and oils other than Vitamin E.
- Tone your pelvic floor. It helps to have good blood flow and healthy tone in your pelvic floor muscles. Too much tone can lead to pain. Not enough tone may cause urinary incontinence and lack of arousal. Ask your doctor about things you can do to tone your pelvic floor muscles. You may even want to ask for a referral to a physical therapist who specializes in treating the pelvic floor.
- Employ vibration. Using a vibrating wand with a water-based lubricant in the vagina can help maintain flexibility of the vaginal tissues. You can do this alone or with a partner several times a week. Use a wand that is long enough to reach the top of the vagina, that has a smooth surface, and that feels comfortable to you.
- Talk to your doctor about estrogen. Some women may benefit from a low-dose estrogen cream or tablet, which can help the vagina regain moisture and ability to stretch. However, it’s important to note that supplemental estrogen may interfere with certain types of cancer treatments and that several health concerns are associated with its use. Talk to your doctor about whether estrogen is appropriate for you.
Is There Sex after Cancer?
The short answer is yes. You can remain sexually active after a cancer diagnosis. Your post-cancer sexual life may look different from the one you had before your diagnosis, and a little work may be required on your part to reclaim your sexuality. But with attention, creativity, playfulness, and patience, you can feel sexual pleasure and connect intimately with your partner again.
Joanne Rash and Lori Seaborne are physician assistants at the University of Wisconsin Hospital in Madison, WI. Joanne works in the Department of Gynecologic Oncology, and Lori is a certified sexuality counselor who specializes in breast cancer survivorship. Together, they developed the Women’s Integrative Sexual Health (WISH) program at the UW Carbone Cancer Center, where they work to address the sexual health concerns of women with cancer.
This article was published in Coping® with Cancer magazine, November/December 2015.