Getting Warmer: Women Can Revive Sexual Function After Cancer

Started by anonymous, March 02, 2016
3 replies for this topic
anonymous

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Posted on
March 02, 2016
 

The advent of cancer affects multiple domains of a patient’s life. An area that tends to be under-recognized by oncologists, and accordingly unaddressed, involves the detrimental effects of the disease on the patient’s sexual functioning.

After diagnosis and during treatment, fatigue and other side effects caused by therapy, as well as depression — engrafted on pre-existing and ongoing work and family roles — often serve to decrease or negate sexual desire.

Cancer can be detrimental to female sexual functioning when organs such as the breast, cervix, uterus and vulva undergo surgery or radiotherapy. As an example, placing radiation cylinders into the vagina may cause the organ to shorten and narrow. Use of dilators and exercises prescribed by the radiation oncologist can help address this issue.

Physical changes such as hair loss from chemotherapy or the placement of an ostomy can impair sexual desire by causing perceived loss of attractiveness.

Another problematic issue is that chemotherapy given to pre-menopausal women to prevent recurrence of breast cancer may induce premature menopause, causing estrogen withdrawal symptoms such as hot flashes and vaginal dryness. In addition, localized estrogen receptor (ER)-positive breast cancer may be prevented from spreading by inducing a low-estrogen state. Many post-menopausal women are given the drugs anastrozole and letrozole, which can cause vaginal dryness and resultant pain with intercourse. Premenopausal women are now also being given specific types of hormonal therapy that induce premature menopause, resulting in similar symptoms.

Although many patients are reluctant to bring these issues up with their oncologists, they should understand that their doctors are comfortable discussing sexual function and can provide help. By the same token, oncologists must remember to ask their patients about sexual health and, ideally, be able to refer them to appropriate specialists as needed.

Medical Solutions

A significant decrease in hair loss from certain types of chemotherapy is possible with cold cap technology, and one system (DigniCap) has been approved by the FDA.

With regard to vaginal dryness in women with a history of ER-positive cancer, any medication, whether oral or topical, containing estrogen could increase the risk of recurrence. That’s why non-estrogenic lubricants such as Replens, RepHresh and Good Clean Love Almost Naked are the mainstay of therapy.

Of note, a drug called Osphena (ospemiphene) is marketed as a “non-estrogen” pill for the alleviation of painful intercourse. However, this drug has some estrogenic effects, and its safety in women with a history of ER-positive cancer has not been established.

For patients with significant vaginal dryness/atrophy, a laser system called Monalisa Touch, pioneered in Italy, has just become available in the U.S. The laser treatments increase vaginal hydration and lubrication by stimulating cells to produce collagen. This therapy is not widely available and not yet insurance-approved.

Finally, a drug called Addyi (flibanserin) has been approved for the treatment of Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women. HSDD is characterized by an acquired reduction in sexual desire that causes distress and difficulty with relationships that is not accounted for by other conditions. This drug has not been studied specifically in cancer survivors, and thus its benefit and safety in this population have not been established.

Once identified, patients with sexual issues should be referred to health care professionals who can work with oncologists to optimize the patient’s sexual functioning. These can include gynecologists, psychologists, psychiatrists and sex therapists.

Up Close and Personal

The goals of sex therapy are to improve sexual functioning and intimacy and address associated psychological issues. In order to fully help, sex therapists work with patients individually and also together with their partners, first to ascertain the vitality of the sexual relationship prior to the diagnosis of cancer, and then to renegotiate sexuality and intimacy. Both partners have to be open and honest, communicating their comfort and desire to engage in sexual activity. For example, partners commonly disclose their fears and anxieties relating to hurting the patient, or their feelings of guilt about wanting to increase sexual intimacy.

Cognitive behavioral therapy can be useful for women suffering from anxiety, depression and the low self-esteem that can stem from hair loss, involuntary weight loss and altered anatomy/physiology of sexual organs due to cancer or its treatment. For example, after breast reconstruction, a change in sensitivity of the breast can lead to feelings of frustration, anger and guilt, in that the client does not feel the same sensation as she did in the past. A sex therapist can teach the client to alter those reactions by adjusting to and accepting her body changes. Another tactic is to work on changing the partner’s perception of the sexual playing field, for example by asking the patient to discuss fantasies with her partner or to try on a wig with lingerie or a costume.

The couple can also partake in sensate focus activities. This entails the partners exploring each other’s bodies to find erotic and sensual areas. The human body has an abundant nerve supply. Finding alternate areas of pleasure can reestablish intimacy. 

–Mark Hoffman, M.D., is an attending physician at Northwell Health System’s Monter Cancer Center and associate professor of medicine at Hofstra Medical School. His daughter, Rachel Hoffman, L.M.S.W., is a Ph.D. candidate in human sexuality at Widener University, cofounder of sexpertise.org and a therapist at the Long Island institute of Sex Therapy.

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bonniesherbals

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Posted on
March 02, 2016
I'm an herbalist and health consultant and for many years have had clients complaining about vaginal dryness who were upset that they couldn't find a product that was organic, had no hormones or chemicals and that worked. I found an amazing one, that I now market as it worked so well I want to share with you a testimonial that I received the other day Sexy after Cancer Haus of Volta on Feb 28, 2016 I was fortunate enough to find Sex Butter before I ever really experienced pain related to my cancer treatment. Post hysterectomy I started to experience intense pain and discomfort, luckily I had been to a dinner party where sexual pain was discussed. I already had a jar and applied it 3x a day until the pain subsided. I still use it several times a week as a balm and as an after sex recuperation. I also work with ladies going through breast cancer treatment whom I've gifted sex butter to and they feel miraculously better. Sex is possible again! Where before Sex Butter intercourse was excruciatingly painful. After Sex Butter it's pleasurable and a they feel normal again in that dept. So much about cancer is finding that "new normal" sexuality and sex is often not addressed. But a healthy sex life is just as important as any other aspect of life. Thank you Bonnie! Sex Butter is a game-changer! If anyone has any questions on this they can go to http://bonniesherbals.com/pages/no-more-vaginal-pain-and-dryness or email me directly bonniesherbals@gmail.com Not only is enjoying your sexual life after cancer important to many, but I will say that at least 50% of my clients want nothing to do with sex, they just want to feel good, they want to stop the pain. To your health, Bonnie
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rhondalea

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Posted on
March 22, 2016
I've used Replens, which was awful, and RepHresh, which was nearly as bad. I read the ingredients of Almost Naked etc., and I'm not a fan of aloe for the purpose. As for the Sex Butter, I'm sure it's fine for some, but the odor of chocolate mint from my vulva is not my cup of tea. I suspect we all have very specific needs and preferences. I use Luvena, which was created by GSK, and is now owned by Laclede. They had a problem a couple of years ago--a labeling issue which brought down the full wrath of the FDA upon them: http://www.medicaldaily.com/fda-looks-stop-sale-luvena-prebiotic-vaginal-products-there-are-bigger-fish-fry-290970 So anyway, right around the same time, my gynecologist gave me a sample because I was out of options. I'd also just had a bad PAP. Six months of consistent use, and my PAP was fine. Eighteen months after that, my new gynecologist examined me, and expressed disbelief that I was postmenopausal. (I'm 57, and 4 years out from ACTH--trust me, I'm postmenopausal.) Luvena has made me normal, as in pre-cancer normal. Recommended use is every 3 days, but I use it now every 4 or 5. It's not for everyone. Some women complain of a burning sensation, although most who continued to use it had no more problems after a month or two. I think the bottom line is that we all just have to try different products until we hit on the one that works for each of us individually.
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Tracy

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Posted on
March 22, 2016
My name is Tracy and I am 49 yrs old. I was diagnosed with stage IV nsclc in 2013. I had chemo and lost my hair, lost my teeth, gained 100 lbs and I have felt horrible about myself. My husband and I started dating in 2008 and he was with me when I lost my dad to the same cancer that I have. When we found out that I had cancer, we got married. We had a wonderful sex life until this ugly disease got in our way. I don't initiate any closeness because I don't feel sexy anymore and he doesn't initiate closeness because he just says that he is dealing with his own issues. He says he still thinks I am sexy, pretty, he loves me etc. I don't know if he is afraid to get close to me because he is afraid he will lose me. I try to put myself in his shoes and I know I would be probably more attracted to him because of wanting to spend as much close time together as possible but, I can also see myself backing off to avoid the pain that comes with losing someone you love. I am 3 yrs in remission and I think that it is time for us to address this issue head on. Does anyone have any advice on how to approach and handle this subject. Praying for all of us. Love and light to you all.

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