By Diana Bitner, MD
Daily life can be difficult to navigate after a cancer diagnosis, and women who survive cancer have unique challenges when it comes to their sexual health. If you have gone through cancer treatments, you probably know what I’m talking about. This article will address sexual health for cancer survivors, including the product and device “must-haves,” to help you navigate these challenges. We will also discuss your sex drive and body image, and cover the options for what’s next after cancer treatments.
Why I Care About Cancer Survivors
I often like to start with why I care about the topic/issue I write about in each article. This one is no exception. I care because so many women have come into my office feeling sad and scared after going through cancer treatments for various types of cancer. I have seen women break down as they talk about the effects of cancer on their relationships, and their ability to be intimate and have comfortable sex with their partner after cancer. I have had many women cry in my office, raw about feeling broken, old, or damaged because of the effects of cancer treatments. They also tell me they feel guilty because, on the one hand, they are so grateful to be alive and happy that their treatment was successful; but, on the other hand, they are now trying to cope with a life they didn’t expect.
I’m happy I have been able to support women in these situations by offering understanding and effective solutions. I have watched them walk out of my office with a sense of hope and feeling whole again, ready to reconnect with themselves and their partner. I’m excited to be a part of their solution!
You Are Not Alone
For many women (and men as well), sex helps them feel connected and close to their partner. Unfortunately, many cancer treatments push women into early menopause or cause issues with their sexual health. Many cancer survivors’ reality is negative body image, low libido, painful intercourse, and decreased confidence. But, a cancer diagnosis (and subsequent treatment) doesn’t have to define you or keep you from the intimate life you deserve.
Sometimes it helps just to know you are not alone. Studies have shown that as many as 85% to 90% of breast and gynecologic cancer survivors report long-term concerns regarding physical intimacy. That’s a large percentage, but it doesn’t have to be this way. There is hope and there are options. You CAN have a fulfilling and pain-free intimate life after cancer. Intimacy doesn’t have to mean intercourse—just being held can be intimate and can be enough for you. But, you have to be open and honest with your partner, and be able to bring up the topic of intimacy without fear or shame. Sometimes simply having a phrase or an opening line can be helpful in getting the conversation started. Some women tell me they’re afraid to hold their partner’s hand because he will think they are wanting to initiate sex, but sometimes just holding hands is really all they want. It’s okay to tell your partner that’s all you’re looking for!
Low Sexual Desire
Some women don’t have much of a sex drive or describe themselves as “never really being that sexual.” Of course, that’s okay! However, when there is a problem or some type of sexual dysfunction that is causing you distress, it’s time to figure out what’s really going on. You may be suffering from Hypoactive Sexual Desire Disorder, which is a true medical condition where a “switch” in the brain gets turned off. If your lack of sexual desire is causing issues in your relationships, make an appointment with your healthcare provider to get some much-needed answers. If you feel like your provider isn’t able to answer your questions, it might be time to find someone who is specially trained in menopause or sexual health. Check out menopause.org, aasect.org, or isswsh.org to find a professional near you.
A very common reason for low desire among my patients who have had cancer and survived treatment (or are still undergoing treatment) is painful intercourse. But, there are also many other reasons why you might be avoiding sex. At true. Women’s Health, we use a tool called the “Sex Puzzle Cards” to help you determine why you are having low sexual desire. I invented this tool to help women be able to have a conversation about sex—without blame—with their partner. I love being able to go through these cards with my patients in the office, and then they take them home to share with their partner.
The cards are divided into three categories of problems—or reasons—for low sexual desire: physical, psychological, or interpersonal. On the front of each card is the reason why you might be experiencing a low sexual desire, and on the back of each card are the possible causes and the various options to fix the issue. Here’s a look at three of the cards (one from each category) that I often use when I discuss this topic with my patients:
- Painful Sex (physical category)—This may be caused by painful skin on the outside of the vagina (Lichen Sclerosis), painful skin on the inside of the vagina (dryness), or pain from tight pelvic floor or endometriosis. The good news is some therapies can help all three of these causes! Options for treatment include pelvic floor physical therapy, vaginal valium (such as Diazepam®), steroid creams, dilators (such as the Milli Dilator), vaginal moisturizers and lubricants, estrogen therapy, the Ohnut®, and MonaLisa Touch laser therapy.
- Poor Self Image (psychological category)—Your poor self-image might be caused by unwanted weight gain or loss, surgical scars, body dysmorphism (a psychological issue where you can’t stop thinking about your perceived flaws), or feeling unattractive. Treatments include cognitive behavior therapy, having open discussions with your partner, self-care, exercise, and yoga.
- Insufficient Intimacy (interpersonal category)—This might be caused by a lack of emotional connection with your partner, not sharing leisure time with each other, or not respecting each other’s needs and desires. Your partner might even be afraid of causing you pain or worried that your cancer might reoccur. It’s hard to be intimate with all of that worry going on! Solutions to bring back the intimacy include reconnecting with each other, spending time together doing something you both enjoy, or attending couples therapy.
Good sexual health and intimacy are possible and critical to a healthy relationship. At true. Women’s Health, we want to help you reach your goals, especially if you are suffering from intimacy issues resulting from a cancer diagnosis or cancer treatments. We are fortunate to have Susanne Pettigrew, a Nurse Practitioner who has specialized training in cancer-related to risk assessment, cancer survivorship, and menopause. Susanne is also trained in sexual health and has started several programs about cancer survivorship. At true., we are fortunate to have such highly-qualified providers who can answer your questions and help you overcome your sexual health challenges after cancer treatments. If you need help navigating these challenges, please visit us here at true. Women’s Health. We are here for you!