Dealing with sexual problems

Getting used to changes in your body

Just as you learned to enjoy it when you first started having sex, you can re-learn how to feel pleasure after cancer treatment. Use this as a chance to look at your sex life in a new way.

The areas of your genitals most sensitive to touch may be a little different after treatment. Or maybe touch that felt good before cancer treatment hurts now. You might find your favorite position for sex has changed. If your vagina has been changed by surgery, you will need time to get used to the new feelings you have during sex.

Vaginal dryness

Lubricants: Cancer treatments often make the vagina dry. You may need extra lubricants to make sex easier. Choose a plain, clear, water-based gel, with

• No perfumes or scents
• No colors
• No spermicide (Don’t get birth control gels.)
• No flavors
• No herbs

Lubricants can often be found near the birth control or feminine products in drug stores or grocery stores. Common brands include K-Y® Jelly and Astroglide®. Some of the newer lubricants contain herbs (such as aloe or lavender), which can irritate or cause allergic reactions. Also, warming gels can burn some women. Be sure to read the labels and talk with a nurse, doctor, or pharmacist if you have questions.

Before sex, put some lubricant around and inside the opening of your vagina. Then spread some of it on your partner’s penis or fingers. This helps get the lubricant inside your vagina. Many couples treat this as a part of foreplay. If sex lasts more than a few minutes, you may need to stop a moment to add more lubricant.

Petroleum jelly (Vaseline®), skin lotions, and other oil-based lubricants are not good choices. They may raise the risk of yeast infection. And if latex condoms are used, oil-based lubricants can cause them to break. Watch out for gels, condoms, or foams that contain nonoxynol-9 (N-9). N-9 is a birth control agent that kills sperm, but it can irritate the vagina.

Vaginal moisturizers: Replens® and K-Y Liquibeads® can be used 2 or 3 times a week to help keep your vagina moist. The effects of these products last longer than those of lubricants, and you can buy them at most drugstores. Lubrin® and Astroglide Silken Secret® are other moisturizers that are said to last longer than usual lubricants. But you may still need some extra lubricant during sex.

Vaginal hormones: Some women do well with hormones that come in gel, cream, ring, or tablet form. They can help with dryness and thin vaginal linings. Most of these hormones are put into the vagina, though some can be applied to the vaginal lips (vulva). Only a tiny bit of hormone enters the bloodstream. These hormones must be prescribed by a doctor.

Loss of desire

People often lose interest in sex during cancer treatment, at least for a time. Worry, depression, nausea, pain, or tiredness can cause loss of desire.

Cancer treatments that change hormone balance also can lower sexual desire. Relationship problems can cause one partner or both to lose interest. And any feelings or thoughts that keep a woman from getting excited can cut off the desire for sex. For example, some people who have cancer are afraid that a partner might be turned off by changes in their bodies or by the very word “cancer.” All these problems can affect desire.

If you have less desire for sex for whatever reason, talk with your doctor. Sometimes small doses of androgens can help.

Loss of a body part

Women who lose a part of their body to cancer sometimes miss the pleasure they felt from having that area stroked during sex. Get your partner’s help to find new places to replace the pleasure you used to feel. Women often are embarrassed to look at or touch their own private parts. But getting to know your own genitals can sometimes help restore your sexual pleasure after cancer treatment.

Many women have never looked at their genitals, and may not know for sure which parts are where. Take a few minutes with a hand mirror. Find the outer lips, inner lips, clitoris, urethra (urinary) opening, entrance to the vagina, and anus. Lightly touch each part, touching the anus last to avoid spreading germs to the urethra. Find out which areas are most sensitive to touch.

Has your cancer treatment changed the look of your outer genitals in any way? If so, take time to get used to the changes. Check to see if any areas are sore or tender. Share what you learn about yourself with your partner. Work together to have sex that pleases you both.

Reaching orgasm after cancer treatment

Almost all women who could reach orgasm before cancer treatment can do so after treatment. Most will have orgasms just as easily as before. But for some it may take practice to re-learn. Many books and videos for women contain detailed steps on how to reach orgasm.

If you enjoy being touched but still have trouble reaching orgasm, you may need to try something new to push yourself toward more excitement. Here are a few ideas that might help a woman reach orgasm.

• Have a sexual fantasy during sex. A fantasy can be a memory of a past experience or a daydream that excites you. Strongly sexual thoughts can distract you from fears.
• Use a hand-held vibrator to give extra stimulation during your lovemaking. Hold it yourself or ask your partner to caress your genitals with it. You can steer your partner to the areas that respond best and away from those that are tender or sore.
• Change the position of your legs during sex. Some women reach orgasm more easily with legs open and thigh muscles tense. Others prefer to press their thighs together.
• Tighten and relax your vaginal muscles in rhythm during sex or while your clitoris is being stroked. This helps you focus on what you’re feeling. Tighten your vaginal muscles as you breathe in, and let them relax as you breathe out.
• Ask your partner to gently touch your breasts and genital area. Try new things with your partner to find the type of touch that most excites you.

If a sexual problem has not cleared up after you have worked on it for weeks or months, think about asking your doctor for professional help.

Pain during sex

Pain during sex is one of the most common problems for women. This can be pain in a non-sexual part of the body or pain in the genitals. Even if your pain is not near the genitals, it can keep you from feeling pleasure during sex.

Non-genital pain: If you are having pain in areas other than your pelvis or genitals, these tips could help lessen it during sex.

• Plan sex for the time of day when you feel the least pain. If you are using pain medicine, take it an hour before sex so it will have time to work. Try to find doses of medicine that relieve pain without making you too sleepy.
• Find a position for touching or sex that puts as little pressure as possible on the areas that hurt. If it helps, support the sore area with pillows. If a certain motion hurts, choose a position that avoids it. You can guide your partner on what you would like.
• Focus on your feelings of pleasure and excitement. With this focus, sometimes the pain fades into the background.

Genital pain: Another side effect of some cancer treatments is pain in the genitals. Sex may cause pain in the vagina or in the tender areas around it. Some women’s vaginas are shorter and narrower after surgery or radiation. If you don’t have enough moisture in the vagina, sex can be dry and painful. This can lead to burning, soreness, and urinary tract infections.

If you have genital pain during sex:

• Always tell your doctor about the pain. A number of common problems can cause pain on the vulva or deep in the vagina. Treatments can often help.
• Make sure you feel very aroused before your partner enters. Your vagina expands to its fullest only when you are very excited. It also gets wetter. As women go through menopause, it may take a longer time and more touching to get fully aroused.
• Spread a large amount of water-based lubricating gel around and in your vagina before sex. You can also use lubrication suppositories (pellets) that melt during foreplay. Use vaginal moisturizers regularly, whether or not you have sex.
• Let your partner know if any types of touching hurts. Show your partner ways to touch you or positions that aren’t painful. Usually, light touching around the clitoris and the entrance to the vagina won’t hurt, especially if the area is well lubricated.
• Try a position that lets you control the movement. That way, if deep thrusting hurts, you can make the thrusts less deep. You can also control the speed.

One position that often works well is for you to kneel over your partner with your legs on either side of your partner’s body. Either sit up, or lean forward and support yourself with your arms. From this position your partner can easily stroke your breasts or clitoris to add pleasure.

Another good position is for partners to lie on their sides, either with your partner behind you, like spoons, or face to face.

Use Kegel exercises to learn to relax the vaginal muscles: Once a woman has felt pain during sex, she may tense up during sex. Without her knowing it, the muscles just inside the vagina may tighten. This makes sex even more painful. Sometimes the muscles are clenched so tightly that her partner cannot even enter her vagina.

You can learn to relax your vaginal muscles during sex. Exercises that teach control of the vaginal muscles are called Kegels.

The first step is to find your vaginal muscles. The muscles around the vagina are the same ones that you use to stop the flow of urine. The next time you pass urine, stop the flow for a few seconds. Notice how you do this. When you relax your muscles, the urine flows again.

Now that you know how, you can practice. Tighten your muscles while you count to 3, and then release. Repeat this 10 times, once or twice a day. Other people can’t tell that you are doing Kegels, so you can practice anytime you want.

Before you try sex, agree ahead of time that if you feel any pain, your partner will stop until you relax and stretch your vaginal muscles. Start by making sure your vagina is wet and that you and your partner are both aroused. Take a few seconds to tighten your vaginal muscles. Then let them relax as much as possible before your partner enters.

If sex is painful or difficult, you or your partner can stretch your vagina with a finger. Lubricate a finger and gently slip it inside your vagina. Use the Kegel movement to tighten and release your vaginal muscles as you slowly move it deeper in. When one finger is no longer painful, try using 2 fingers, and then 3, before you try your partner’s penis. Use plenty of gel, and go slowly.

If you try these tips but are still having pain, you may need help from a gynecologist or sex therapist. Talk with your doctor about this.

If you feel discouraged or feel as if you can’t handle the changes, talk with your cancer team about seeing a mental health professional. They can help you adjust to these changes.

Grief and loss

It is normal to feel grief over what you’ve lost with cancer and its treatment. You might have to give up your old ideas of yourself and start finding new ways to cope with the changes in your life. You might also notice feeling sadness and anger, even toward those close to you. Cancer changes the way you think of your body and yourself. This can disturb your well-being, and affect how you see yourself sexually. It can also affect your ability to have relationships.

It may take time for you to even notice some of the losses and changes from cancer. It can help if you can share your grief with someone close to you. If there is no one close that you want to confide in, you might want to see a counselor. Just as it is important to take care of pain in your body, painful feelings also need to be dealt with.

Depression

Depression is feeling empty or sad most of the time. It happens to a lot of people with cancer. Staying active is a good way to reduce stress and lower your risk of depression. Talk to your doctor about the kinds of exercises that are right for you. As long as you don’t overdo it, exercise will help you feel better during and after treatment.

Side effects can also get you down. You can reduce the pain and nausea that some cancer treatments cause by learning skills to help you relax. Many relaxation methods can be learned from DVDs, CDs, or books, though training by a mental health professional may work best. Sometimes professionals may offer other methods to help improve your sleep, appetite, energy, and ability to feel pleasure. In turn, this can help your self-esteem and desire for sex.

If you notice you are sleeping poorly, feeling hopeless, not enjoying life, and have trouble thinking or other signs of depression that last more than 2 weeks, talk to your doctor. Depression can be treated with medicine and in other ways.

Keep in mind that some of the newer anti-depressants may make it harder to reach orgasm. If this becomes a problem for you, talk to your doctor about it. There are other anti-depressants that may not have that effect on you.

Anxiety about sex

Many couples believe that sex should happen on the spur of the moment, with no planning. But sometimes a cancer-related symptom or treatment side effect makes it impossible for it to happen like it did in the past. The most important thing is to bring up the topic and talk about it with your partner.

Part of the anxiety about sex might be because you want to satisfy your partner. One way to find out if you are ready to enjoy sex is to start by touching yourself and bringing yourself to orgasm. That way, you can find out if cancer treatment has changed your sexual response without feeling like you must please your partner. It can also help you find out where you might be tender or sore.

If you are OK with the idea, try stroking not just your genitals, but all of the sensitive areas of your body. Notice the different feelings. The books listed in the “To learn more” section can help you feel more relaxed about sex and touching yourself. Later you can teach your partner what you learn about your body’s sensitive zones. Even if cancer treatment has not changed your sexual responses, you may find some new ways to spice up your sex life.

Every now and then we all have sexual thoughts or feelings, but we often ignore or forget them. Your sexual thoughts can be used to improve your sex life.

Pay attention to when you have sexual thoughts. Try to notice patterns, like the time of day, where you are, people, music, activities, movies, or fantasies. When you notice patterns, you can plan things that will help you get in the mood for sex.

If these and other efforts don’t boost your sexual interest, think about asking your doctor for counseling or professional help.