Breast Cancer- that thing that turned your world upside down, breast cancer survivor.  You never thought it would be you.  No family history, you eat right, you exercise, but somehow you found a lump that turned out to be cancer. And you are young! Cancer is for old people.  But no, now you embark on the road to recovery, see the oncologist, the breast surgeon, the plastic surgeon, the radiation oncologist so you can fight this disease. You get your care and it’s done. Time to get your life back.

But no one told you what was going to happen to your intimate life!

 Did you know your breast would look funny or that you would lose sensation in your chest?  Your nipples would be gone? Did they tell you what lack of estrogen does to the vagina?  Did anyone mention that sex was going to become excruciatingly painful or you would never want to do it again? No, no and no. Because, as they should be, everyone is working on making the cancer go away for good. At the end of the day, you still have to lead your life. But should you even worry about intimacy when you should feel lucky to be alive?

 The answer is YES! Intimacy matters!  Sex Matters!

 Finding your new sexy

 Sex is going to be different now.  One of the most common issues in women with breast cancer is vaginal dryness that causes painful sex.

 Vaginal dryness

 If your breast cancer is estrogen and/or progesterone receptor positive, then the treatment to prevent it from coming back is to prevent estrogen from working or to get rid of as much estrogen as possible so there isn’t any left to stimulate a breast cancer cell to grow.  Vaginal dryness is the most common side effect of low estrogen levels. Lack of estrogen changes the vagina.  When your body is making estrogen, the vaginal tissue is thick and moist and it stretches.  It has proteins like collagen and elastin that help it stretch so a baby can fit out of it or a penis can fit into it.  It also has special cells that make moisture when you get aroused or excited.  When there is estrogen around there is a lot of blood flowing to the vagina and this makes a difference in sensation, how good sex feels. When there is minimal estrogen, the vaginal tissue gets thin and dry.  It loses its collagen and elastin so it doesn’t stretch when you try to put something in it.  This can cause a lot of pain, especially on initial penetration.  Also, there isn’t as much blood flowing to the vagina so some women say there is a lack of sensation.  

 What to do about vaginal dryness

 First of all, throw away your water based lubricants.  Some of you may have already purchased a lubricant and yes this is the first step.  Put some in your hand, put it on the outside of the vagina which is called the vulva and put some on your partner’s parts, penis or otherwise.  Invest in some silicone based lube or olive oil.  (unless you are using condoms, then you have to stick with the water based).  Water based lubes pull the moisture out of the vagina and make dryness worse. Avoid any lubes with flavors or tingly sensations.  I recommend the silicone based lubes Uberlube or Wet Platinum. 

 You can also moisturize the vagina.  Just like you use hand lotion for dry skin, you can use a vaginal moisturizer for the vagina.  There are many available on the market, but my recommendation is plain and simple, coconut oil or solid vegetable oil (Crisco).  You can use as much or as little as you prefer.  There is no right or wrong way to do this.  If you use too much, you will feel greasy or messy.  If you use too little, you won’t notice any difference at all.  Put it where you feel dry on the vulva or in the vagina.

 Lubes and moisturizers do a fantastic job at decreasing friction during sex.  They don’t do much for increasing the stretchiness of the vagina or bringing more blood flow to it.  Only low dose vaginal hormones do that.  But you thought hormones were out of the question, right?  Well, there are several national organizations like the North American Menopause Society who have evaluated the medical research about this and come up with some recommendations.  If lubes, moisturizers and other nonhormonal treatments have not worked, women with breast cancer can discuss the risks and benefits of using low dose vaginal estrogens or intravaginal DHEA (a different hormone) with their providers.  Treatment should be individualized, taking into consideration quality of life, risk of the cancer coming back and how bad your symptoms are.  Yes, you can consider the use of vaginal hormones in consultation with your cancer doctor after a thorough discussion of risks and benefits.

 Quality of life matters, relationships matter, human touch and intimacy matter.  So bring it up with your doctor.  Talk about it with your partner.  Don’t just accept sex as a thing of the past.  Find the right provider who can help you.  You need honest and accurate answers. 

 Don’t just survive. . . . . THRIVE!

 Coming soon, a discussion of low libido in breast cancer patients and survivors.  Stay tuned!

 I am a Sexual Medicine Gynecologist

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click here to schedule.

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