What you need to help maintain good sexual health as a survivor.
“I am not what happened to me. I am what I choose to become.”
Every woman is different. It is important that your sexual health be viewed in the overall context of your general health because changes that happen during or after cancer treatment may overlap with normal age-associated changes in sexual and reproductive health.
Changes in sexual function and reproduction, either due to surgery or other modalities of cancer treatment, have a profound effect on your emotional and mental health as well.
Sexuality and intimacy are important factors for quality of life, and discussing sexual health should become a routine part of the conversations you have with your cancer care team before, during, and especially after cancer treatment.
There should be an informed, shared decision-making process that takes into consideration the risks and possible benefits depending on the severity of symptoms and your desired quality of life.
There are products and treatments that can help address many of these issues and should be started as soon as possible with the guidance and close follow-up of your cancer care team as well as your gynecologist or family physician. Some of these options include:
Vaginal Moisturizers
These are non-prescription products meaning these are estrogen-free and available at your local pharmacy. They work to help the vaginal tissue regain its natural moisture and improve comfort during sex.
Some examples are Replens or K-Y SILK-E. These should be applied 2-3 times a week, regardless of sexual activity, and can be used along with lubricants. One of the downsides of vaginal moisturizers is that they can be messy because the vagina absorbs what it needs and excretes the rest.
You may want to wear a panty-liner. Unlike a vaginal lubricant, a vaginal moisturizer can be applied regularly and at least 2 hours prior to sex, rather than right before, as you would with a lubricant.
Natural lubricants such as emu oil or coconut oil can help reduce entrance pain during intercourse, but they should not be used if you are prone to urinary tract or yeast infections or have diabetes.
Vaginal Water-based Lubricants
Use a vaginal lubricant during sexual activity (such as K-Y Jelly, Revaree, Astroglide). They come in liquid or gel form and are applied to the vagina and vulva right before intercourse, as well as to the penis or any body part or instrument inserted into the vagina.
Lubricants are absorbed into the skin, are fast-acting, and provide temporary relief from vaginal dryness and pain during intercourse. Many lubricants available contain fragrances, glycerin, flavors, or herbal ingredients that can be irritating to some women.
Avoid Vaseline or skin lotion as lubricants. These can damage condoms and may raise the risk of yeast infection.
Pelvic Floor Physical Therapy
Pelvic floor muscles give structural support to the pelvic organs (urethra, vagina, and rectum). Consistent use of postoperative physical therapy increases pelvic blood flow and stretches and relaxes pelvic floor muscles, facilitating healing of the vagina.
It can help with urinary and fecal leakage. It can also help decrease stiffness and rigidity from scar tissue, improve vaginal narrowing, and reduce pain during sex.
This helps women with tight or tender pelvic floor muscles that can happen due to surgery for particular types of cancer or radiation treatment.
Vaginal Dilators
Post-radiotherapy to the pelvic area, scar tissue begins to form in the vagina, and the tissue becomes less elastic and dry, along with decreased blood flow to the area. Scar tissue can make vaginal exams and vaginal intercourse difficult and uncomfortable.
A vaginal dilator is a smooth plastic or rubber cylinder that looks like a large tampon and is similar to a vibrator. It is used to stretch the vagina and reduce tightness, which helps to ease intercourse. Vaginal dilators come in various widths.
The aim is to progress slowly and steadily, starting with the smallest size and then gradually increasing it. If you go too fast, you can trigger muscle spasms and vaginal pain, so take your time.
Low-dose Vaginal Estrogen
For some women, vaginal estrogens may be effective. These come in several forms, including a cream (typically used daily for 3 weeks, then 2x a week), a tablet (inserted 2x a week), and a ring that releases estrogen slowly over a 3-month period.
Most of the estrogen is absorbed locally, with only a small amount entering the bloodstream. Discuss this option with your oncology team, as some women with a history of hormone-responsive cancer are advised not to use these products.
Intravaginal Didehydroepiandrosterone (DHEA)
This may treat vaginal dryness or pain without increasing systemic estrogen levels. It may be a good option for women with estrogen-sensitive cancers, such as some types of breast cancer. The only DHEA product FDA-approved for treating sexual dysfunction symptoms is prasterone (Intrarosa).
Newer Options
External ultrasound-guided trigger point injections in combination with peripheral nerve blocks are a treatment process designed to improve blood flow to the pelvic floor muscles and nerves. This is a functional, restorative approach to post-operative rehabilitation of the pelvic floor.
Helping with Your body Image
As you get better and heal, exercise can help with energy, decrease fatigue, and improve your mood. Take time to figure out wardrobe changes and cosmetics that can make you feel good and manage side effects such as facial coloring, eyebrow loss, etc.
For women with an ostomy, using an ostomy cover or camisole as camouflage can help with concerns about others noticing the bag. Gaining back your confidence and outer beauty as a survivor takes time but is an important part of healing.
Your health care team can also help with emotions that affect your sex life
Options include talking with a sex therapist, finding help in your community, such as support groups for women who are cancer survivors, and couples counseling, which can help you and your partner deal with the emotional strain related to sexual dysfunction.
Although there is no one all-encompassing treatment strategy for sexual concerns for female cancer survivors, there are multiple modalities as well as multidisciplinary care that together can help alleviate concerns and improve quality of life for cancer patients.
Reason to hope: Here is one of several interesting apps that are helping women with their sexual health and advocacy. Rosy offers women a holistic approach to sexual health and wellness, focusing on evidence-based interventions proven to increase sexual function as well as the technology to connect you with experts in real-time. https://meetrosy.com/
