Female Sexual Health After Cancer

Susan S.

Breast Cancer Survivor

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One area of life that cancer and treatment might change is the ability to have or enjoy sex. This is sometimes referred to as female sexual dysfunction and can affect you physically and emotionally. We can help.

Talk To Your Health Care Provider

  • Before the appointment, write down questions and concerns you have about your sexual health.
  • Ask for a referral to another health care professional who specializes in this area, such as a mental health professional trained in sex therapy or a gynecologist who treats sexual and pain problems.
  • Ask about causes for problems with sexual functioning and ways to help.

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If you develop a sexual problem, talk to your health care provider as early as possible about any symptoms or concerns. Some women may feel uncomfortable discussing sexual concerns. However, your health care team can answer questions, refer you to a specialist and help you find solutions. All of your physical and emotional concerns are important, so talk to your health care team. This is especially true if you are experiencing pain during sex or feeling that your intimate relationship has become less enjoyable. Sexuality is an important part of your quality of life after cancer.

When to Start Thinking About Sex After Cancer

You may decide to wait for a while after treatment before having sex. Others may be ready right away. Here are some signs that it may be time to talk with your health care provider about sexual health after cancer treatment:

  • Loss of desire for sex.
  • Negative thoughts and feelings during sex.
  • Difficulty feeling sexual excitement and pleasure during sex.
  • Difficulty reaching climax.
  • Vaginal dryness and tightness.
  • Pain when your genital area is touched or from sexual intercourse.

New sexual problems often begin during or soon after cancer treatment. Be certain to discuss any problems and symptoms with your health care provider—especially if you begin to notice any changes in your ability to have or enjoy sex. Some problems, such as loss of vaginal size and lubrication after radiation to the pelvis, may develop months or even years after cancer treatment is done.

Physical Effects of Treatment on Sexual Functioning

There are many different causes of sexual functioning concerns in female cancer survivors. Some are physical. Others may be due to changes in how you feel about yourself, your body, or other aspects of your life after cancer.

Approximately half of survivors of breast cancer and other cancers that affect the pelvic area (such as the cervix, ovaries, uterus, bladder, colon or vagina) develop long-term sexual problems. Yet, most problems are actually caused by treatment and not the cancer itself. For example:

  • Chemotherapy can damage the ovaries, causing hormonal changes and temporary or permanent menopause in younger women.
  • Radiation to the pelvic area can also damage the ovaries, triggering sudden menopause in younger women; radiation to the vagina can irritate the delicate lining, decreasing the moisture produced with sexual excitement. Over time, scarring of the vaginal walls can make the vagina shorter and less able to expand with excitement.
  • Surgery for pelvic cancer may remove parts of a woman’s sexual organs, including areas of the vulva, part or all of the vagina, and one or both ovaries. Removing both ovaries is another treatment that leads to menopause.
  • Surgery for breast cancer may involve removing the whole breast, with or without reconstruction. Even partial mastectomy can interfere with pleasure from breast caressing if the nipple or underlying tissue was removed.
  • Medicines used to treat pain, nausea, depression or anxiety can decrease a woman’s desire for sex or make it difficult for her to reach a climax.

Talk with your health care team about the risks to sexual functioning before you begin cancer treatment. If you have already undergone treatment, talk with your health care provider about finding ways to treat symptoms or concerns now.

Emotional Effects of Treatment on Sexual Functioning

Emotional reactions to cancer diagnosis and treatment can also interfere with feeling attractive and sexual. It is common in the first year of a cancer diagnosis to have:

  • Sad or depressed feelings.
  • Concerns about changes in the way you look.
  • Stress in the relationship with your partner.
  • Difficulty with self-esteem because of feeling ill and being unable to fill all your usual roles in the family and at work.

If you had concerns or negative feelings about sex before cancer, going through treatment could increase your distress. Ask your health care provider for a referral to a licensed mental health professional who has experience working with cancer survivors.

Finding Help with Female Sexual Functioning

Sexual problems after cancer are very common. Talk with your health care provider about when it is safe to have sex. Also talk with your partner. Many partners hesitate to start sex because they don’t want to pressure you or cause you physical pain. You can prepare for your sexual experience by taking time to get in the mood, focusing on pleasure rather than on whether you will have intercourse or reach an orgasm, and using vaginal moisturizers and lubricants if you notice dryness. Here are other ways to help:

Sexual Functioning Concerns

How to Find Help

Loss of desire for sex after cancer

  • Ask a member of your health care team to check your medications for possible side effects.
  • Get medical treatment for pain during sex that will not go away or fatigue that may be affecting your energy and desire for sex.
  • If you are in menopause, see a gynecologist or an endocrinologist.
  • If there are no physical causes, see a licensed mental health professional to find out if your loss of desire could be related to feelings of depression, anxiety, low self-esteem, or relationship conflict.

Negative thoughts and feelings during sex

  • Women often find themselves distracted during sex by negative images and thoughts, for example about losing a breast or being infertile.
  • Try focusing on pleasurable feelings in your body or on a sexy thought or fantasy. If that does not help, ask for a referral to a mental health professional who can help you change negative feeling and thinking patterns

Difficulty feeling pleasure during sex

  • If you have lost feeling in an area of your body that gave sexual pleasure you may need to find new caresses that you enjoy. Communicate with your partner.
  • Ask for a referral to a sex therapist who specializes in treating cancer survivors.

Vaginal dryness and tightness, making sexual activity uncomfortable or painful

  • Talk with a gynecologist who has expertise in menopause and problems with pain during intercourse.
  • Ask your gynecologist, for advice on using over-the-counter vaginal moisturizers for before and during sexual activity. You also may benefit from learning to control the muscles around the vaginal entrance. Some women can benefit from low-dose vaginal estrogen in a cream, tablet or ring form. Such hormones can help the vagina regain moisture and ability to stretch with less getting into the general blood circulation.

Difficulty reaching orgasm

  • Ask your health care team to check your medications. Antidepressants or anti-anxiety medicines may make it more difficult for you to have an orgasm.
  • Give yourself time. Try not to pressure yourself to have an orgasm. Try to have a goal of enjoying sex and getting as much pleasure as possible. The nerves that help a woman feel pleasure around the clitoris and in the vagina are rarely damaged by cancer treatment. Cancer or its treatment rarely will physically prevent you from having an orgasm.

Treatment Options for Women with Sexual Concerns

Loss of desire for sex is often a complex problem that needs both counseling and some medical help. There is no magic pill that can restore desire, but communication with your partner, patience, and experimenting with touch can often help. But there are some treatment options for sexual functioning concerns. Talk with your health care provider about these common methods:

Treatments for sexual functioning concerns

Pros

Cons

Vaginal moisturizers (such as Replens®, Hyalo-D®, or Luvena®)

  • Vaginal moisturizers are designed to keep the vaginal lining moist all the time. Some include prebiotic ingredients to help grow healthy bacteria and keep the vagina at a good pH.
  • Need to be used regularly at bedtime 2 to 3 times a week
  • May replace the need for lubricants during sex, although women may benefit from an extra lubricant for lovemaking even if they are using a moisturizer.
  • Can be costly and is not covered by insurance.
  • May be messy. Some women may need to use a mini-pad, but the discharge decreases after a couple of weeks.

Water- or silicone-based vaginal lubricants

  • Water-based lubricants last longer and work better than old-style gels. Silicone-based lubricants last even longer but are more expensive and may stain sheets or clothing.
  • Can be purchased at most drugstores or over the Internet. Look for brands that do not contain perfumes or chemicals such as parabens or gycerine, and that try to keep the vagina at the same pH as is normal before menopause (4.5).
  • May wear off and need to be re-applied during sexual caressing or intercourse.
  • May not be effective enough to prevent pain if there is severe vaginal dryness.

Low-dose vaginal estrogen replacement (such as Estring, Vagifem)

  • The Estring releases a small dose of hormone over three months.
  • The Vagifem suppository is used a couple of times a week.
  • Both Estring and Vagifem produce a low dose of estrogen. This is considered to be helpful treating vaginal dryness with very little hormone released into the bloodstream. Generally thought to be safer than pills, patches, or creams.
  • Some oncologists still worry about breast cancer survivors using these products.
  • A small study found that some women using suppositories still had levels of estrogen in their blood high enough to interfere with the benefits of aromatase inhibitors.

Find comfortable positions for intercourse

  • Certain positions may help avoid pain during sex.
  • Requires good communication between partners.

Learn to relax muscles around the vaginal entrance

  • Learn methods of relaxation to avoid pain during intercourse. Try “Kegel” exercises.
  • Women can use silicone vaginal dilators to practice muscle control, starting with a smaller size and going up to larger ones. Always use a water-based lubricant on the dilator and be gentle inserting the dilator.
  • Can help minimize pain, but may not relieve pain if tissue scarring is present in the vagina.

Herbal pills or genital lotions

  • Lotions may act as lubricants.
  • Herbal remedies may interfere with other medicines or may have unknown dangers.
  • No scientifically valid studies have identified lotions to help with sexual dysfunction.
  • Some lotions may irritate skin or tissues. Lotions containing L-arginine may trigger episodes of genital herpes if a woman has a history of infection with this virus.

See Female Sexual Problems in Medline Plus for more information about the causes and treatments of female sexual problems. See Your Sexual Health by the American Congress of Obstetricians for more information about the causes and treatments of female sexual problems.

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Works Cited

American Cancer Society. “Sexuality and Cancer: For the Woman with Cancer and Her Partner.” Atlanta: American Cancer Society, 2001 (99-rev. 07/01-50M-no.4657-HCP). Downloadable version: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinWomen/SexualityfortheWoman/index

Andersen, Barbara L. “Surviving cancer: The Importance of Sexual Self-Concept.” Medical and Pediatric Oncology33 (1999): 15-23. Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. Journal of Sexual Medicine 8 (2010):549-59.

Derzko C, Elliott S, Lam W. Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy. Current Oncology14 (Supplement 1).( 2007): :S20-40

Ganz, Patricia, Julia A. Rowland, Katherine Desmond, et al. “Life after breast cancer: Understanding women’s health-related quality of life and sexual functioning.” Journal of Clinical Oncology 16 (1998): 501-14.

Grumann, Mareile, Robert Robertson, Neville F. Hacker, and Greta Sommer. “Sexual Functioning in Patients following Radical Hysterectomy for Stage IB Cancer of the Cervix.” International Journal of Gynecologic Cancer 11 (2001): 372-80.

Jensen Pernille T., Mogens Groenvold, Marianne C. Klee, et al. “Longitudinal Study of Sexual Function and Vaginal Changes after Radiotherapy for Cervical Cancer.” International Journal of Radiation Oncology, Biology, and Physics 56 (2003): 937-49.

Schover LR. Androgen therapy for loss of desire in women: is the benefit worth the breast cancer risk? Fertility and Sterility 90 (2008): 129-40.

Stovall DW. Aprela, a single tablet formulation of bazedoxifene and conjugated equine estrogens (Premarin) for the potential treatment of menopausal symptoms. Current Opinion on Investigative Drugs 11 ( 2010):464-471.

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