Women’s sexual recovery after cancer
Re-establishing sexual interaction takes some work, but it’s good work to do
Sexual recovery during and after a women’s cancer diagnosis and treatment is as important as ensuring adequate nutrition, sleep and a healthy frame of mind. We spoke with Sallie Foley, LMSW, AASECT, co-author of Sex Matters for Women, about sexual recovery after cancer for women who experience early menopause or menopause-like symptoms following cancer treatment.
Q: In comparing natural menopause with early menopause brought on by cancer treatment, are there differences?
Yes. Natural menopause occurs over a number of years, so symptoms that can affect someone’s sexual experience -- like vaginal dryness and thinning of vaginal tissues -- tend to develop somewhat slowly. When early menopause or related symptoms happen because of chemotherapy, radiation or removal of the ovaries, symptoms that can make intercourse uncomfortable or painful can come crashing down in a very short amount of time. Suddenly your ovaries, whether affected by chemotherapy, radiation or surgical removal, are not producing estrogen, the hormone that helps vaginal tissues retain their strength and elasticity.
Many of us find our body image suffers as we age. Most cancer treatments are very hard on the body. Chemotherapy, while lifesaving, is toxic. Surgeries can lead to disfigurement, lymphedema and even permanent disability. It may be difficult for a woman with cancer to look at and touch her own body, much less allow her partner to see and touch her body. So sexual recovery after cancer can be especially complex, involving grieving, adjustment and adaptation. But this process doesn’t mean that a woman can’t sustain intimacy, desire for sex and sexual pleasure. We often say that re-establishing sexual interaction will take some work, but it’s good work to do.
Q. What is your advice for women who find intercourse painful because of vaginal dryness or thinning tissues?
After menopause, a woman can lubricate, moisturize and stretch! Lubricants and moisturizers are available at pharmacies and online. Lubricants imitate bodily fluids and are used immediately before and/or during sexual experience. Moisturizers are products designed to be used daily to help the vaginal walls stay moist. Finally, penetration, lubricated, with fingers/penis/vibrator/dilator -- a gentle way of stretching of vagina and supporting muscles – helps retain suppleness. And stretching, is something a woman can do daily/weekly so that penetrative sex, like intercourse, isn’t painful.
Q. You mentioned how complex sexual recovery is for a woman with cancer. How can someone start feeling good about herself again and think of herself as a desirable woman?
Women are used to ‘complex.’ They have busy lives that pull them outward away from self awareness. So a woman must prioritize what she finds aesthetically pleasing -- which is actually the definition of beauty -- whenever she can. It sounds trite, but this valuing and prioritizing pleasure is how she taps into her beauty. That’s the most important thing she can do as a first step toward sexual recovery. Grieving for what is lost is absolutely appropriate. And looking for balance. Yes, doubts and deep emotions are going to happen. But be open to joy, including the joy of sexual experience.
Q. Are there some practical matters that cancer patients should know about?
Yes. For one, pelvic floor rehabilitation, including pain reduction, is often covered by insurance, but a doctor must write a prescription for this specialized physical therapy. Women don’t always know that. I also urge all women recovering their sexuality after cancer to speak frankly to their cancer doctors and nurses about resources to help. And increasingly, there are free programs and support groups at cancer centers for patients on this topic.
Sallie Foley, LMSW, AASECT, co-author of Sex Matters for Women, was a social worker for many years at the U-M Rogel Cancer Center before becoming director of the University of Michigan Center for Sexual Health. A certified sex therapist and sexuality educator, she is most recently serving as program director of the Sexual Health Certification Program of the U-M School of Social Work.