A boutique at Smilow Cancer Hospital at Yale-New Haven stocks wigs for chemo patients — and vibrators, dilators in various sizes for women whose vaginas may have narrowed after cancer treatment, and lubricants.
An estimated 85 to 90 percent of the 6 million female cancer survivors in the country have problems with sex. But often they’re too modest to talk about it with their doctors, or think they should be grateful they’re alive and not push for more. They give up on sex, especially if they’re middle-aged or older. Men treated for prostate cancer also typically experiences sexual problems as long as three years after treatment.
Don’t live with physical symptoms unnecessarily. Your doctors can help. For example, a woman might get a prescription for ospemifene (Osphena), an FDA-approved non-estrogen oral pill for women who experience pain during sex during or after menopause. Women shouldn’t automatically rule out estrogen, either. “There are women, including some cancer survivors, who can take it to very good effect,” says Mary Jane Minkin, MD, a Yale menopause specialist who co-founded a clinic to help cancer survivors with their sex lives. The estrogen gel Divigel treats vaginal dryness and hot flashes.
For men, the most common problem is achieving and maintaining an erection, but they may have weaker climaxes or sex drive, or find that they urinate while climaxing. Medication, penile implants, devices that can help produce erection, and therapy can all help.
Women who have had hysterectomies, chemotherapy, or radiation often report pain during sex, less interest, and trouble climaxing. Some women have found help taking sildenafil citrate (Viagra), which is most often used by men to increase blood flow to the penis. You might also talk to your doctor about the “pink pill,” or flibanserin (Addyi), to boost desire. Flibanserin failed trials as anti-depressant before it was approved to enhance lust; it doesn’t target blood flow but acts on the brain.
Patients who enjoyed sex before cancer are more likely to find pleasure afterwards. “I use the piano joke," says Minkin. "'After the accident, can I play the piano again?’ The answer is: ‘Well, did you play the piano before?’”
Consider counselling if you are struggling with self-esteem or troubles in your marriage after a change in your sex life post-cancer. Some men are impotent after prostate surgery and women may lose sensation in a breast. You may need to learn to find pleasure in different ways. A counsellor can help you grieve the loss and move on.
We associate sex issues with cancer of the reproductive organs or breasts, but other kinds of cancer affect sexual wellbeing, too. A review of the research found evidence that survivors of colorectal, colon, head and neck, bladder, lymphatic, and lung cancers may lose interest in sex, and struggle with their body image and sexual self-esteem. These issues may go on for years, even when the cancer crisis appears to be in the past.
A major illness tests your relationship with your partner. After a period away from work, you may be working fewer hours and earning less money, or no longer working.
Perhaps your partner became a devoted caregiver, but you both feel less sexy. A man may stop trying to seduce a woman who has experienced sex as painful; she may misinterpret this reaction and feel less desirable. Both men and women can become over-protective, which often makes their partners feel less in control and more unhappy. Some focus so much on caregiving that they stop expressing their own thoughts and needs. Others pretend that the cancer had no effects.
Communicate! (Yes, you’ve heard that before.) You don’t need to let cancer leave a shadow.
RELATED TOPIC: How Psychology Can Fight Cancer
October 16, 2015
Janet O’Dell, RN