I founded The Women’s Sexual Health Foundation in 2003 to bridge the gap due to the lack of information in the area of women’s sexual health disorders that existed for women and healthcare providers and educators.
I was diagnosed with breast cancer in 2007. It was not until I was given Judy Kneece’s book Your Breast Cancer Treatment Handbook at the time of my diagnosis and came to the chapter on Sexuality After Breast Cancer did it strike me that cancer would impact my entire being, including possibly sexual function. When I first heard the words “you have breast cancer”, concerns about body image and intimacy were not at the top of my list. Saving my life was.
For many, cancer is a chronic disease. As with any chronic disease there can be an impact to one’s quality of life. But when I came across the sexuality section in Judy’s book, I realized that not only would I loose a breast, there were so many ramifications to the surgery and the treatments to follow.
I was fortunate because I knew Judy and instantly e-mailed her for wisdom. Also I had access to the world’s experts in sexual health. Many are on The Women’s Sexual Health Foundation’s Advisory Board. However, I am acutely aware that not all women have this type of access and that is why I felt compelled to write this article.
Reclaiming Intimacy
Life does change after cancer, but that does not mean women cannot reclaim many aspects of the quality of the life they had before cancer. One area that is often not discussed with cancer survivors is that of sexual function and intimacy. A survivor may wonder if surgery or radiation or various cancer medications may impact the intimacy she once had. These are important questions and she has every right to have them addressed by her physician.
One out of three women will have cancer in her lifetime. Cancer and cancer treatment such as chemotherapy, radiation, surgery and hormonal therapy can impact a woman’s ability to enjoy sex. Plus, many of the procedures are very intrusive and after being poked and prodded over several months, the last thing that may be on a woman’s mind is any form of intimacy. Research shows that approximately 90 percent of those who have had cancer will have difficulty with sexual function. You are not alone if you have intimacy difficulties since your cancer diagnosis and treatment. So if you have a concern, you should raise it with your healthcare team. If your doctor cannot help you, then ask for a referral to someone who can. More and more healthcare professionals are developing the expertise to help women with sexual function and intimacy difficulties.
Why Does Cancer Cause Sexual Difficulties
There may be various reasons why sex may not be enjoyable after cancer. There can be emotional and physical reasons. Cancer is stressful for many to manage from a financial, relationship, family and employment perspective. Day to day life for many women is filled with plenty of stress, but when the diagnosis of cancer and its treatments are added to this mix, the stress can be overwhelming. This stress can interfere with one even considering having an intimate relationship.
Certain surgical procedures such as a mastectomy or colostomy may make a woman feel unattractive and create body image concerns. A mastectomy will also create a complete loss of sensation in the chest area from a sexual function perspective. Typically the nipple is removed which may impact sexual desire.
Surgery, radiation, chemotherapy, and hormonal therapy can affect a woman’s sexual enjoyment.
Also, other medications that are used to treat anxiety, pain or depression may interfere with sexual function.
Cancer Treatments That May Cause Sexual Difficulties
Chemotherapy may damage the ovaries causing menopause or hormonal changes. Vaginal dryness, decreased desire, and possibly diminished arousal and orgasm.
Hormone therapy may cause vaginal dryness.
Radiation to the vagina, cervix, or uterus can lead to painful intercourse and loss of sensation in the genital area which may make arousal difficult. Some women complain of difficulty achieving an orgasm or orgasms are less intense.
Surgery- ovarian, uterine, vaginal, vulvar could cause body image difficulties, vaginal dryness, loss of sensation in the genital area which may make arousal difficult. Some women complain of difficulty achieving an orgasm or they are less intense.
Surgery-Mastectomy also may lead to body image difficulties and loss of sexual or erotic sensation in the breast area.
Medications given for pain, depression and anxiety may decrease desire for sex or interfere with arousal or having an orgasm.
Solutions for sexual difficulties
There is wonderful news because there are treatment options available. So do not hesitate discussing with your healthcare team your concerns. It is possible for you and your partner to have an intimate relationship.
Therapy
For the woman who can no longer have sexual intercourse you may grieve deeply for this loss. A psychologist, counselor or sex therapist can help you and your partner through this loss and perhaps help you find other ways to become intimate and regain the closeness and pleasure of one another. A trained professional with expertise in this area should provide this therapy. For sex therapy, you may want to find an AASECT certified therapist at www.AASECT.org. It is important for you and your partner to keep communication open if changes in your sexual function are causing you distress.
Loss of desire
Ask your doctor if any of the medications that you are on may be causing decreased desire. This includes chemotherapy, hormone therapies, and antidepressants.
Pain can cause loss of desire. This may be due to dryness and over the counter lubricants or vaginal estrogens could help. Also a pelvic floor physical therapist consult should be considered.
Lack of energy can cause a decreased interest in sex. Talk to your partner about having sex when your energy level is up, perhaps in the morning.
Ask you physician 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 appropriate.
If all physical causes for low desire have been eliminated, then ask to see a counselor. Your loss of desire may be related to depression, anxiety or body image concerns.
Decreased arousal
A decreased ability to become aroused may be due to medications or how one feels about their body. If this has to do with body image concerns, a consult with a mental health provider could be helpful. If it is due to medications, ask your doctor if she/he could switch your medication to one that does not have this side effect.
Vaginal Dryness, Tightness, and Pain
See a gynecologist who has expertise in pelvic and vaginal pain. Talk to this provider about lubricants and vaginal estrogens. You may want to ask for a referral to a physical therapist with expertise in pelvic floor problems. Also, if you have had gynecological surgery and radiation therapy, a pelvic floor physical therapist with expertise in rehabilitation post pelvic surgery and radiation should be considered.
Difficulty reaching orgasm
Medications may cause this, so ask your doctor if the medications you are on or have been on could be causing this difficulty. Antidepressants or anti-anxiety medications can make reaching orgasm more difficult. Some women complain that chemotherapy impacted their ability to have an orgasm. Other women will express that after having their uterus removed their orgasms are less intense.
Conclusion
What is most important is that you continue to seek help. If your doctor cannot assist you, then do not hesitate to ask for a referral or speak with other women in cancer support groups who may know of a doctor or therapist who has helped them.
Lisa Martinez, RN, JD, founded The Women's Sexual Health Foundation. The Foundation's mission is to act as an educational resource for the public and healthcare professionals on sexual health matters, to support women and their loved ones, and to advocate for research in the area of sexual health. Implements the strategic plan, and manages the Foundation's corporate and fiscal affairs, along with the website at www.TWSHF.org. Directed the incorporation of the Foundation. Lectures and writes on the topic of women's sexual health national and internationally.