Sex matters to a greater or lesser degree to us all. It is unusual when worries about intimacy are at the very top of someone's list immediately after a cancer diagnosis, but it is not unheard of. I remember meeting a woman in her mid 70s who had just been diagnosed with breast cancer. Her oncologist had recommended endocrine/anti-estrogen therapy, and she was very distressed by the possible implications for her sex life. She explained that, mostly due to some other medical problems, her life had shrunk, and sex was her remaining primary pleasure. As you can guess, her doctor referred her immediately to me; he was completely taken aback and had no idea how to continue the conversation.
The impact of a cancer diagnosis and treatment on sexuality varies among individuals and certainly among kinds of treatment. Anyone deals with the psychological impact of having a potentially life-threatening illness. Most cancer patients also have to deal with some physical changes, from surgery or radiation or chemotherapy, and maybe ongoing physical and emotional malaise. It is hard to feel sexy and desirable when you are bald and nauseaus, and it may continue to be hard in the weeks and months after treatment ends.
Trouble comes often both to libido and responsiveness. Bodies and reactions are changed by powerful treatments, and you may well have to relearn what is pleasurable. The best advice is to teach yourself and then teach your partner. As a beginning exercise, I often suggest that someone focus each day on a different sense: meaning taste or smell or feel.... On the feel day, for example, the suggestion is to pay close attention to textures and temperatures and sensations around touch. Wear a silk blouse that feels good against your skin; stroke something soft; notice what happens if you hold an ice cube or place your hand on something toasty warm. The idea is to train yourself to really notice, to bolster your physical connections.
This is a very good article from Living Beyond Breast Cancer about the use of vaginal hormones for women post breast cancer. Their concerns about estrogen are not relevant to everyone, but are potentially relevant to women with some GYN cancers, too. The whole article is larger than this particular topic and worth reading.
Here is the start and a link to read more:
Sex Matters: What About Vaginal Hormones?
By Michael Krychman, M.D.
We’ve discussed vaginal and vulvar dryness and some conservative measures that can be used to help treat symptoms, including nonhormonal vaginal moisturizers that help hydrate the tissues and vaginal lubricants that can make intercourse and sex more comfortable. The question that many women diagnosed with breast cancer often ask is, “What about vaginal hormones? Are they safe? Can we use them?” In this month’s column, we will talk about locally applied vaginal hormones that are placed in the vagina or on the vulvar skin. They come in a variety of different application methods. Locally applied vaginal hormones are different than systemic and oral hormones; this column will focus on local hormones.
Since many breast cancers contain estrogen receptors (ER) and progesterone receptors (PR), caution should be used with the use of any type of hormonal product, even if it’s locally placed in the vagina. All local estrogen products have a black box warning because they may be harmful to women who’ve had breast cancer. To make issues more confusing, there is emerging and limited data that may suggest that the local hormones that are minimally absorbed may be used in small quantities. When it comes to local hormonal products, there are NO long-term safety data or any significant safety studies in the breast cancer population, and it is important to discuss your specific cancer and condition with your healthcare professional or your oncological team to see if you may be a candidate for the use of any type of local estrogen.