Female Sexual Dysfunction: Suggestions

Loss of desire for sex after cancer

• Have a member of your health care team check your medications for possible side effects.

• Get treatment for pain that won't go away or fatigue that may be affecting your energy for sex.

• If you are in menopause, see a gynecologist or an endocrinologist for a blood test to check if your testosterone is low. Women need some testosterone for good sexual function. However, if you had breast cancer, using replacement testosterone may not be safe for you. You can discuss other options with your health care team.

• If there aren't physical causes, see a mental health professional to find out if it's related to feelings of depression, anxiety or low self-esteem.

Difficulty feeling pleasure during sex

• A member of your health care team may be able to recommend a mental health professional who may be able to help you. Problems with feeling turned on often are related to how you feel about yourself and to your desire to have sex.

Vaginal dryness and tightness, making sexual activity uncomfortable or painful

• Visit a gynecologist who specializes in women's problems with menopause or pain.

• Ask a member of your health care team, especially your gynecologist, for advice on muscle relaxation, local forms of estrogen or over-the-counter lubricants.

Orgasm problems (difficult or impossible to reach an orgasm, orgasm feels weak)

• Ask your health care team to look at your medications. Antidepressants or anti-anxiety medicines may make it more difficult for you to have an orgasm.

• The nerves that help a woman feel pleasure around the clitoris and in the vagina are rarely damaged by cancer treatment. This means the cancer or its treatment probably won't physically prevent you from having an orgasm. But you might want to address other issues like changes in your desire or pleasure.

• Try not to pressure yourself to have an orgasm. Sometimes this makes it hard for you to relax. Give yourself time.

Treatment Options for Some Sexual Dysfunction

Pros

Cons

Pills for women

Increases vaginal lubrication without estrogen hormones.

Studies of PDE-5 inhibitors in women do not show a lot of change in female sexual dysfunction.

• Water-based lubricants last longer and work better than old-style gels.

• Can be purchased at most drugstores or over the Internet.

• If you are going to have intercourse, spread lubricant around vaginal entrance and head of penis, to avoid friction and pain at entry.

• The lubrication may wear off and need to be re-applied during intercourse.

• For women with severe vaginal dryness and tightness, it may not be effective enough to avoid pain.

• Using lubricants cannot compensate for pain with deep thrusting.

• This gel keeps the vaginal lining moist all the time.

• Needs to be used regularly (three times a week) at bedtime for up to two months to show its full effect.

• Some women may not need water-based lubricants for sex if they use Replens.

• Expensive and not covered by insurance (around $20/month).

• May cause messy vaginal discharge the first couple of weeks of regular use.

• Some women prefer these products to vaginal estrogen cream.

• The Estring is like the ring of a diaphragm without the cup, and releases a small dose of hormone over three months.

• The Vagifem suppository is used a couple of times a week.

• Both produce such a low dose of estrogen that it helps ease vaginal dryness, but very little hormone gets into the bloodstream, so they are safer than pills, patches or creams.

Some oncologists still worry about breast cancer survivors using these products.

Self-help guides describe positions that may avoid pain during deep thrusting for women whose vaginas are shortened or narrowed.

Requires good communication between partners and being open to trying something new sexually.

Self-help guides explain how to become aware of the muscles that surround the vaginal entrance, how to tense and relax them at will, and how to use the relaxation to avoid pain during penetration with intercourse.

Can help minimize pain, but may not relieve pain if severe scarring exists.

Lotions may act as lubricants.

• No studies have shown lotions to help with sexual dysfunction.

• Some include menthol which makes the skin tingle.

• Herbal remedies may interfere with a woman's other medicines, and may have unknown dangers.

This small pump is supposed to draw blood into the clitoris, increasing sexual arousal.

• No scientific evidence that it works.

• Expensive and not covered by insurance.

• May help women because it gives sensation similar to a vibrator.