Sex After Cancer? It ain't the same....

As more and more patients survive early stage cancer, we increase the number of people facing the aftermath and long term effects of treatment. For some, it's organ damage from chemo, burns from radiation, hair loss, neuropathy - so many things to manage. For young women with hormone positive breast cancer, the fallout of early menopause can be devastating and difficult to live with. 

When I started this journey, I just wanted the cancer OUT and I wanted to LIVE. Once the terror began to wear off, I continued to make decisions based on wanting to live as long as I can, and to hopefully die from not-cancer. I begged to get my ovaries removed to starve my cancer - and only then did I realize the other parts of my body that would also starve. My bones, my brain, my cardiovascular system are all at risk and/or suffering - but holy moly the changes to my lady bits are next level. 

I've blogged before about the lack of data, info, and teaching about menopause to doctors, the lack of effective treatments other than hormones, the afterthought of older women. I appreciate so much that my oncologist and gynecologist sat me down and gave me the honest truth: my body, and my sex life, would never be the same. Starving your pelvic organs of estrogen results in all kinds of horrors - incontinence, dryness, painful intercourse, UTIs - and changes your intimacy with your partner. It's really important for partners (men especially) to understand what's happening biologically, so it doesn't disintegrate your relationship emotionally. Not wanting to have sex because it's painful is different than your partner thinking you're just not interested. 

The use of hormone replacement therapy is a god send to many menopausal women, but its use in women with a history of hormone positive cancer remains controversial. Newer data suggests the risks of cancer might have been overestimated, and that topical estrogen can be used safely in this population - but it's really scary for a cancer patient to hear "We have to remove all of your hormones to fight your cancer" and at the same time "we have some hormones to help the symptoms of your cancer induced menopause". Personally I have decided the risk is too great, and I would not risk cancer recurrence by using hormones. So I'm becoming an expert in the non-hormonal things we can do. A few things I've learned about sex after menopause: 

1. Use it or lose it. This is true. Vaginal atrophy begins with estrogen deprivation, and if you don't use those muscles, they can atrophy to the point of making any penetration (sex, pelvic exams, pap smears) incredibly painful. If you don't have a partner to use it, consider vaginal dilators. 20 min/day will keep those muscles active and healthy. 

2. Dryness and Pain - this affects you inside and out, thus should be treated both ways. I adore the Foria line of products for this (www.foriawellness.com) especially the Vibrance products that are made ESPECIALLY for this population. The Everyday Vulva Moisturizer and the CBD suppositories are a game changer (and their body wash is amazing for dry skin too). I recommend the suppositories 20-30 min before intimacy. Use code TCUSHING20 for 20% off their entire line - you will not regret it!

3. Incontinence/UTIs - this hasn't been my particular issue, but I hear about it all the time. Pelvic floor physical therapy is used often to help with strengthening the muscles and increasing control. Emptying your bladder fully and often can help prevent UTIs. 

4. Libido and Orgasms - unfortunately, these suffer from a loss of hormones too. My libido tanked, and even my orgasms seemed to be diminished in intensity, frequency, and achievability. The intimacy of sex brings partners together and keeps them there - so you have to figure out a way to maintain intimacy, even if you don't feel like having sex, or it takes you twice as long to have an orgasm that's 50% less intense. 

    TALK TO YOUR PARTNER. Maybe intimacy looks like hand holding, 20 second hugs at random during the day, kissing, or oral sex. It doesn't have to be penetrative vaginal intercourse - but if that was the definition of your previous intimacy, you might need to adjust that and find new ways to be intimate with your partner. You might need to rediscover oral sex, vibrators, or scheduled intimacy like date nights, in order to overcome the declining libido. Open and honest communication is paramount to navigating these changes as a couple, or for dating after cancer. I am beyond grateful to have a partner that not only heard those conversations with my providers, but was willing to make changes and work around my limitations to continue our emotional and physical intimacy. It looks different than it did before, but it is possible to maintain closeness and sexuality after cancer with a little effort and a lot of conversations. 

To my incredible husband Brian - I can't thank you enough for supporting my decision to forgo reconstruction, to remove my ovaries, to do whatever I can to prevent cancer recurrence. Our intimacy looks different now, but we are as close as we have ever been, menopause and cancer be damned. 

There can be sex after cancer - even good sex. Don't give up if it's important to your relationship and your self esteem. It might be different, but it can still be great.