One of the subjects that seems to be rarely addressed about cancer treatments, is how chemically induced menopause can affect the sex lives of those who have had chemo.
My oncologist wanted to discuss this with me, but at the time I was trying to survive the devastating effects of chemo and did not have the energy to deal with any non crucial-at-the-time-issues.
Two of the problems women often have with chemo induced menopause are vaginal dryness and atrophy. While most women in the general population have these difficulties also, they are able to take estrogen. It is usually recommended that those who have had a diagnosis of cancer not take estrogen because it could help their cancer to resurface.
So what to do?
Check with your oncologist, she or he may recommend that you use a smaller than normal amount of estrogen cream and that it be used with a less than usual frequency. Estriol is one such cream. You could ask about using wild yam cream which is a natural progesterone or about a product called Estring. Estring is a small doughnut shaped ring that is inserted vaginally, stays in place 3 months at a time and delivers a very small amount of estrogen locally. Don't forget to check with your oncologist before using any of the above products.
Vaginal dryness and atrophy are addressed in the radiation department at my hospital because radiation to the vagina, cervix or pelvic area can quickly induce vaginal atrophy.
After breast cancer treatments are over, dryness and atrophy can occur slowly and those who are not sexually active may not even know they have a problem until they have a pap smear. It can take several years before the vagina atrophies to the point of being uncomfortably obvious.
Various lubricants can be used for dryness. AstroGlide, Replens and K-Y jelly are two common ones. Additional foreplay before sex can help also.
But why would vaginal atrophy be important for those who are not sexually active?
Those with breast cancer have a higher incidence of cervical cancer, so it's important for a gynecologist to be able to visually examine the cervix. If a person has vaginal atrophy, the gynecologist may not be able to do so.
Also, if a person decides to become sexually active in the future, they may not be able to if they have atrophied.
A vaginal dilator is recommend both to avoid atrophy and to help those who already have some atrophy. These are available in the radiation department at my hospital. If they are not available in yours, you could check with either your oncologist or gynecologist. If they don't have them, which they may not, they can get them.
The nurse in my radiation department gave me a dilator and some Surgilube lubricant. She stressed the importance of using a water based lubricant (no vaseline type stuff).
She also gave me a copy of a section of an American Cancer Society booklet which has directions as to how to use a vaginal dilator after radiation treatments. The directions can be used for after chemo treatments too. Here is the excerpt from the booklet:
Using a Vaginal Dilator
A vaginal dilator is a cylinder or tube, most often made of plastic or rubber, used to "dilate" or stretch out the vagina. Dilators also help women learn to relax the vaginal muscles. Dilators come in many forms.
Vaginal dilators are often used after radiation to the pelvis, cervix, or vagina. Using the dilator several times a week (three times is recommended) keeps your vagina from getting tight scar tissue as the irritation from radiation heals. The only real alternative to using a vaginal dilator is to have intercourse a few times a week.
Since scarring in the pelvis after radiation can develop over many years, you should follow this scheule for the rest of your life. After surgery that rebuilds the vagina with skin grafts, you may need to keep a special type of dilator or "stent" in your vagina all day or night for a while.
Your doctor may suggest a certain way to use the dilator. The usual way to go about it, however, is as follows:
1. Lubricate the dilator with a water-based gel.
2. Lie down on your bed at a time when you know you will have at least 15 minutes of privacy. Gently and slowly slip the dilator into your vagina. If your vagina feels tight, hold the dilator still while you tense and relax your vaginal muscles.
3. When your vagina feels looser, push the dilator further in. You may need to repeat the squeezing and relaxing a few times before the dilator is fully inserted. Some women also find it helpful to bear down, pushing their vaginal muscles outward as if having a bowel movement.
4. When the dilator is in as far as possible, leave it in your vagina for about 10 minutes. You can pass the time by reading, watching TV, or even talking on the phone. If the dilator slips out, gently push it more deeply into your vagina.
5. When you remove it, wash it with a mild soap and water. Be sure to rinse all the soap off so no film is left to irritate your vagina the next time you use the dilator.
A woman is often given one dilator of the size needed to fit her vagina. If she is trying to overcome pain, however, or needs to stretch out a vagina that is too small, she may use a series of dilators. She can start with one about the size of a finger and slowly go to larger models until her vagina is large enough to allow a man's penis to enter without pain.
Dilators work best when used early to prevent vaginal shrinkage. Don't wait untli you have an overly tight vagina. The dilator will not be nearly as effective. If you go for many months without a sexual relationship, it becomes very important to use your dilator to keep your vagina in shape.
Two years ago I switched to an GYN who is also an oncologist.
I was very uncomfortable during my PAP smear and I told her I sometimes leaked some urine when I coughed.
She told me that I had vaginal atrophy and that this can affect your urine control.
She assured me that all the studies have shown that a small amount of estrogen based vaginal cream does not promote the growth of breast cancer. She told me that when the walls of the vagina are thin and atrophied, a very small amount of estrogen is absorbed by the body, but once the vagina is healthy, essentially no estrogen is abosorbed by the body as it all remains in the vaginal walls.
My ONC-GYN gave me a prescription for an estriole cream and suggested I use the minimum amount twice a week.
This year when I made the appointment for my PAP smear, I still hadn't used the cream! I didn't want her to ask me why I hadn't used it so a week before my appointment I used the cream. I used it three times before I went to see her.
What a difference those three treatments made! The PAP smear was no longer uncomfortable, I also no longer had any urinary control problem and she told me my vaginal tissues were healthy.
She once again assured me that all the studies showed that using an estrogen based vaginal cream did not increase the odds of further breast cancer.
The issues of chemo induced vaginal dryness and atrophy are often not addressed. People are often embarassed and don't want to discuss it with their physicians, so the physicians don't even know there is a problem.
Don't wait until you have a difficult time with a pap smear. Abstaining from sex because of pain only speeds up the atrophying. Vaginal dilators, lubricants and estrogen creams are available.
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