by Lisania Milli, WHNP-BC, and Jeanne Carter, PhD
Female sexuality is complex and multifaceted. In the past, researchers have described the sexual response cycle using a linear model consisting of five phases, each one leading into the next: desire, arousal, plateau, orgasm, and resolution. We now realize that for many people, especially women, sexual response is not linear, but is instead circuitous, with three interactive phases: drive, desire, and motivation. Each phase contributes to sexual arousal. Sexual response is also influenced by other factors, such as tissue quality, emotional well-being, and relationships – all of which can be affected by cancer.
Body Changes and Body Image
Many female cancer survivors worry about how their bodies have changed because of cancer. These body changes can influence a woman’s perception of herself and, in turn, affect intimacy.
For example, cancer surgery may involve removal of body parts (like a woman’s breasts), scarring, and in some cases, lymphedema. If her ovaries are removed, a woman may experience decreased hormonal levels, which can lead to vaginal dryness or discomfort and can diminish sexual desire and arousal. Certain types of chemotherapy can also alter sexual function, as can radiation. Not to mention other treatment side effects, like fatigue and hair loss, which can injure a woman’s body image and sexual interest.
Treatment Strategies and Solutions
If you’re experiencing sexual problems due to cancer-related body changes or body image issues, it’s important to discuss these problems with your medical team early on. That way, you can get the information, support, and potential solutions you need to revive your sexual interest and function before these problems worsen.
Many female cancer survivors worry about how their bodies have changed because of cancer.
Most women with a decrease in hormones, including cancer survivors, can benefit from using non-hormonal vulvovaginal moisturizers and lubricants. The good news is that these are safe to use for cancer survivors, are available over the counter, and can improve vulvovaginal comfort, sexual function, and quality of life.
Vaginal moisturizers (such as Replens and Hyalo Gyn) can improve vaginal tissue quality and comfort, but they must be used consistently and at a higher frequency (about three to five times per week) by female cancer survivors than by women in natural menopause. In addition, water-based and silicone lubricants (such as K-Y Jelly, Astroglide, and Body Glide) can improve comfort with sexual activity and touch. These products mimic natural secretions to boost arousal and enhance pleasure.
Low-dose vaginal estrogens are also an option for some women experiencing vaginal dryness or discomfort. However, these require a prescription, and a discussion with your medical team is crucial to find out if they would be safe and effective for you. If you have hot flashes or night sweats, non-hormonal therapies, such as selective serotonin reuptake inhibitors (SSRIs), or complementary therapies like Relizen, may help. Certain lifestyle modifications, such as eating well, getting enough exercise, or practicing relaxation techniques, may also help ease menopausal symptoms.
For women who have vaginal stenosis (narrowing, shortening, or scarring of the vagina), dilator therapy may help. Dilator therapy is a process by which the vaginal canal and the opening of the vagina are stretched using a series of vaginal dilators that gradually increase in size. This can help decrease pain associated with intercourse, and with gynecologic exams. In addition, pelvic floor exercises can help to increase blood flow and circulation to these tissues, and may provide a more comprehensive stretch when done alongside dilator therapy. Sexual health is an important component of long-term cancer survivorship. It’s vital for women diagnosed with cancer to know about the common sexual issues faced by cancer survivors, as well as solutions to address them. Simple strategies and proper support can help women reconnect to their bodies, regain sexual function, and enhance desire, arousal, and orgasm. If cancer or its treatment has put a damper on your sexuality, let your voice be heard – don’t hesitate to bring it up with your healthcare provider. Help is available.
To reclaim your sexuality after cancer, it’s essential to learn your new body, accept your new body, and love your new body.
Common Sexual Problems Faced by Women with Cancer
Here are two examples of common sexual problems women face after cancer, and potential solutions. Keep in mind that every woman is different. What works for some, or even most, women may not work for others. And you should definitely talk to your doctor before trying any of the treatment strategies mentioned below.
Scenario #1: Maria is a 37-year-old woman diagnosed last year with breast cancer. She underwent surgery and chemotherapy and was prescribed hormone-blocking medications to reduce her risk of recurrence. At her follow-up visit with her healthcare provider, she complains of vulvar and vaginal dryness; burning, painful sex; and hot flashes. She says, “I wish I knew how these medications were going to affect my body and my sex life. Do I have any options? I can’t continue living in so much discomfort.”
SOLUTION: The first thing she should do is try non-hormonal vulvovaginal moisturizers and lubricants. Female cancer survivors who are experiencing vaginal dryness or discomfort should apply vaginal moisturizers regularly to the vagina and the vulva, just as you would moisturize your face and hands, and should use water-based or silicone lubricants liberally during sexual activity. For some women, vaginal moisturizers and lubricants may not be enough to sufficiently treat their symptoms. In that case, vaginal estrogen therapy may be an option for treating vulvovaginal atrophy.
Scenario #2: Ellen is a 75-year-old woman diagnosed with endometrial cancer. She underwent surgery and radiation therapy. Although she was in menopause before treatment for her cancer, she is having even greater vulvar and vaginal discomfort after treatment. She says to her doctor, “I already went through menopause. Why am I feeling extra dry down there, and why is it so uncomfortable to be touched? Even my underwear hurts me.”
SOLUTION: As is the case for both Maria and Ellen, vulvar and vaginal dryness because of cancer treatment can affect many survivors’ vulvovaginal health and sexual function, regardless of age. It’s important to note that cancer treatment and hormone depletion can still affect women who are already in menopause, or women who received hormone replacement during menopause but discontinued it when they were diagnosed with cancer.
Dr. Jeanne Carter (left) is head of the Female Sexual Medicine and Women’s Health Program, which is part of the Gynecology Service in the department of Surgery, at Memorial Sloan Kettering Cancer Center in New York, NY. She is also an American Association of Sexuality Educators, Counselors, & Therapists certified Diplomate of Sex Therapy and a member of the Gynecologic Oncology Group.
Lisania Milli (right) is Nurse Practitioner for the Female Sexual Medicine and Women’s Health Program at Sloan Kettering. Prior to her nursing career, she worked as a sexuality educator.
This article was published in Coping® with Cancer magazine, May/June 2017.