Sexuality and Cancer

Sexuality is frequently impacted by both a cancer diagnosis and treatment: 90% of women have some sexual problems after breast cancer treatment. In 50% of women the problems are chronic.  Painful intercourse and vaginal dryness are the most common complaints.  Often women do not bring these complaints to their doctors’ attention – and many doctors don’t ask about sexual concerns.

After a cancer treatment your body image may change.  I recall one patient saying to me “Its hard to feel like a goddess when…”  (and she went on to describe the changes surgery had wrought on her body.)  Sometimes people feel as if their body has betrayed them.  Women, even after a long relationship, may feel shy in front of their partner – or their partner may feel nervous about hurting them.  At times, the way a person views sexuality can change; after fighting to survive cancer, sex may seem less important.

Physical changes

  • Mastectomy can lead to loss of pleasure from breast stimulation
  • Vaginal dryness and painful intercourse may occur
  • Decreased libido can be due to hormonal changes or as a side effect of medications
Vaginal Dryness:

Dryness can be managed with moisturizers, lubricants, or in non-hormonal cancers, estrogen.  Only estrogen requires a prescription.  Do look products up on the Environmental Working Group’s skindeep website to assess for environmental toxins.

Moisturizers (to be used regularly) – are available over the counter. it is worth experiment with several to find one that works well for you. A few examples are the following:

  • Replens – 2 studies in breast cancer survivors found it as effective as conjugated estrogen (skin deep 2)
  • K-Y liquibeads (skin deep 1)and K-Y Silk-E (skin deep 3)
  • Vitamin E capsules can be pricked with a pin and the oil applied

Lubricants (used during intercourse) – available over the counter

  • Pre-Seed – isoosmotic – best tolerated (no skin deep review)
  • Femglide – hypo-osmotic –
  • K-Y Yours+Mine
  • YES (plant derived from flax extract, guar, locust bean, xantham gum) (skin deep 0)
  • Maxilube
  • And many more.

Hormonal Treatment

This is the most effective treatment for vaginal dryness or atrophy.  It can be delivered intravaginally with very little absorption into the body; hormone therapy can also be taken by mouth or applied to the skin.  It requires a prescription:

  • Estring (bio-identical ring that gradually emits 17 beta estradiol)
  • Vagifem (bioidentical tablet of 17 beta estradiol)
  • Estriol (from compounding pharmacy)
  • Hormone therapy (if no contraindication)
  • DHEA suppositories

Reduced sexual desire:

Check labs for: thyroid, B6 and B12, rbc Magnesium, early am Testosterone

Consider whether this could be a side effect of a medication you are taking.  SSRI antidepressants (Prozac, Zoloft, Paxil) and anti-estrogens (Arimidex, Femara, Aromasin, Tamoxifen) frequently impact sexual desire.

Sex therapy

  • Cognitive behavioral approaches – help shift negative thoughts
  • Sensate focus exercises

Testosterone therapy can be beneficial for some women.  It requires a prescription that will need to be filled at a compounding pharmacy.

Other medications:

  • Wellbutrin may be of benefit in some women
  • Viagra was studied and found to be helpful in premenopausal women who had  SSRI related sexual dysfunction especially difficulty with orgasm.

Botanical products and supplements

  • Ginkgo biloba
    • increases blood flow
    • may help SSRI related sexual dysfunction
    • 160 mg-240 mg of a standardized extract
    • best products have EGb 761
  • L-arginine
    • Increases blood flow
    • Required for production of nitrous oxide
    • 500 mg two or three time a day
  • Damiana leaf
    • Stimulates sexual desire,
    • May have progestin-like activity
    • Use the tincture 2-3 ml twice a day
  • Ginseng
    • Increases blood flow
    • Phytoestrogenic activity (leading to a concern in breast cancer)
  • Zestra  (borage seed oil, evening primrose oil, angelica extract, coleus extract, vitamins C and E)

 Other options:

  • Acupuncture
  • Yoga, tantra

Good companies for variety of products: