Breast Cancer Awareness: Sexual Health, Part I

Sex. It’s a topic women aren’t always comfortable discussing with their oncologists or primary care doctors – and frankly, in the midst of treatments, not often the first priority when survival is top of mind.

“Women have trouble when they are not prepared for the physical symptoms resulting from treatment and don’t have clear expectations of how that may impact their sex lives,” says Jeanne Carter, Ph.D., head of the Female Sexual Medicine and Women’s Health Program at Memorial Sloan-Kettering Cancer Center. “We know that chemotherapy – depending on the treatment regime and the patient’s age – can impact the ovaries and put a woman into premature menopause.”

Endocrine therapies such as aromatase inhibitors cause hormonal deprivation, resulting in vaginal dryness, pain and discomfort. “This obviously can have a negative effect on interest in sexual activity and the ability to become aroused,” says Carter. The good news, she says, is that simple strategies can provide great relief for many women during treatment and into survivorship.

Moisturizing for Health, Comfort

Many cancer therapies result in changes to the tissues of the vagina: atrophy, less elasticity and moisture, and the inability to produce lubrication. “Lubrication is important for touch and penetration, and to avoid tearing during intercourse,” explains Carter. Most women and even doctors, she says, don’t understand the importance of using moisturizers. “They are not for sexual activity. They help to improve the health of tissues and allow them the capacity to move.” Clinical care and outcomes at the Female Sexual Medicine Program have shown that moisturizing – internally and externally – can help to improve sexual response by increasing comfort and pleasure.

“Moisturizers help with gynecological exams, intercourse, and overall comfort.” But, Carter warns, consistency and frequency (beyond the manufacturer’s instructions) must be maintained. “What we have learned is that internal vaginal moisturizers should be applied three to five times a week, in addition to moisturizing externally, to adequately address the symptoms women are experiencing after cancer treatment.”

Carter recommends over-the-counter, non-hormonal internal moisturizers to be inserted into the vagina at bedtime: Replens cream, K-Y Brand Liquidbeads, Carlson Key-E (vitamin E vaginal suppository), Hyalo GYN^® and vitamin E capsules (poke a hole in the capsule prior to vaginal insertion). External moisturizers recommended for the vulva, introitus [opening of vagina] and clitoral area – all prone to atrophy as well – include: vitamin E oil, coconut oil and Replens cream.

“These are simple resources you can use throughout your life – just like putting lotion on your skin,” says Carter. “It only takes a few minutes and can make such a difference.”

Strengthening of the Pelvic Floor

Standard Kegel exercises can also reduce vaginal pain in breast cancer patients. “We teach women how to have awareness and control over muscles that could be working against them and contribute to pain,” says Carter. “Increased pelvic-floor strength and tone can improve circulation, which in turn can enhance arousal.”

The key is to do the Kegel exercises in a challenging way, says Carter. “To build up muscle strength and tone – which is what research shows is beneficial – you need to continually challenge those muscles.” Her study participants began slowly: holding a contraction for three seconds then relaxing three seconds, for ten repetitions. The goal is to achieve muscle fatigue then stop. “Eventually a woman may increase to 12 or 15 repetitions.” Then she may lessen repetitions but increase the length of the contractions. Scroll to the Kegel Exercises section of the American Cancer Society’s “Preventing Pain During Sex” guide for specific instruction.

Says Carter of talking about sexual concerns, “The onus is for both the patient and the provider. The doctor needs to ask if you’re having difficulties, but you need to say, ‘I have some questions; do you have information or anyone I can speak with?’”

Recommended Reading:

• American Cancer Society’s Guide: “Sexuality for the Woman with Cancer”
• Sexuality and Fertility After Cancer by Leslie Schover
• LiveStrong – a reputable source for general articles about women’s sexuality. Search terms: female sexuality, sex and breast cancer, female sexual health.
• Google or Amazon, using the key search terms above, as well as cancer and sexuality; sexuality and breast cancer.

Visit us later this month to learn more about body image issues after breast cancer and their impact on sexuality.