SurvivorNet spoke to experts from Memorial Sloan Kettering Cancer Center about sex and sexuality during and after cancer treatment.
Published Aug 19, 2021
While many women experience sexual side effects both during and after treatment for a variety of cancers, many won’t bring up the topic with their doctors. This may be because they feel embarrassed, uncomfortable, or because there’s simply so much going on during treatment, that women forget to think about sexual health.
Still, it’s important for patients to understand that a healthy sex life is possible after facing cancer — though it may look a little different. SurvivorNet sat down with Memorial Sloan Kettering clinical health psychologist and sexual health therapist Dr. Jeanne Carter and gynecological nurse practitioner Ashley Arkema to get the low down on sex after cancer — from how to address body image issues to which products to use to improve any discomfort.
Dr. Carter explained that many women who experience sexual issues feel ashamed because they don’t understand how common these problems are.
“Patients actually feel like it’s just them, that no one else is having these issues,” Dr. Carter said. “So, I think it’s important for healthcare providers to raise the topic so it can normalize their experience, as well as give them an avenue to get information and support.”
While the healthcare field is making progress when it comes to sexual side effects, Dr. Carter said that there’s still work that needs to be done. For the time being, it’s important for women to know that there are many different options and many different solutions available for physical as well as emotional issues.
Since some cancer treatments cause menopause or menopause-like symptoms, the sexual side effects can lead to both emotional and physical pain.
Discomfort during sex or sexual activity is enough to turn anybody off. Dr. Carter stressed the importance of using both lubricants and moisturizers.
“A lot of times people feel like lubricants are the solution, and they are part of the solution, but they are not the entire solution,” she said. “When you don’t have estrogen, you usually are not having moisture in the vagina, as well as on the vulva.”
It’s important to make sure the vulva, or the external part of a woman’s genitals, is well-moisturized as well, Dr. Carter said. There are options for both non-hormonal moisturizers and low-dose estrogen moisturizers. Dr. Carter gave examples of a few non-hormonal products that work well for many women:
Dr. Carter added that women dealing with cancer side effects will often need to moisturize more often.
“We find that women need to moisturize more in the cancer setting, like 3 to 5 times per week, whereas the product instructions will tell you to only use it 2 to 3 times a week and only in the vagina.”
Dealing with emotional issues that may arise because of cancer treatment is just as important as dealing with the physical ones when it comes to sexuality, Dr. Carter said.
“Sexuality is physical and emotional and they’re completely enmeshed, so you can’t really treat this without addressing both of those issues,” she said. “I think women going through a cancer experience are just really trying to make sense of what their body is going through.”
Whether you are mourning the loss of a body part, like breasts after a mastectomy, or trying to find the confidence to date again after treatment, there is support and guidance available.
“I just encourage people to explore on their own some,” Arkema said. “Sometimes people say that they have a lack of interest, but a lot of times the lack of interest is directly correlated to the pain.
“If sex over time is painful over and over again, then you start to develop a negative association with it. So, I usually try to encourage people to explore on their own or limit activity to external stimulation until they feel like they’re able to tolerate penetrative sex.”
From trying new things in the bedroom to seeking the guidance of a therapist or peers in a support group, there should be options for women seeking all different types of support. Both Dr. Carter and Arkema stressed that help is available for women dealing with any sort of sexual side effects, but the solutions will take some time and take some getting used to.
“A lot of these changes [to the body] happen very quickly and I think people are ready at different times to be ready to address it,” Dr. Carter said. “So, we always start with the physical stuff, because I think it actually slows women down to really treat these symptoms and connect with their body in a positive way because they’re healing and nurturing.
“There’s a lot to be said about that. Taking time and effort to actually pay attention to these areas and to touch these areas and to try to heal these areas I think wakes up something for women that there’s a part of their body that maybe they weren’t paying attention to.”
Dr. Jeanne Carter and nurse practitioner Ashley Arkema were recently featured in an episode of Memorial Sloan Kettering’s Cancer Straight Talk podcast. Check it out here