Presentation on theme: "SEXUALITY and INTIMACY for Women after Cancer"— Presentation transcript:
1SEXUALITY and INTIMACY for Women after Cancer Karen Syrjala PhDCo-Director, Survivorship ProgramDirector, Biobehavioral Sciencesa member of the
2Topics: How does cancer affect sexuality for women? What can you do about it?
3What female survivors say: “Zip, zilch, nada, gone.”“Since my treatment I have had no desire and have not been able to reach an orgasm. My partner does not know about my lack of interest, it would hurt him.”“I really would like to have the feeling of love again or orgasm. You wonder what you are doing wrong.”“Same partner, much less sex. Both of us are content, but miss being frequently and spontaneously sexually intimate. Dry vagina and yeast infections are a drag.”“My body had changed so much I felt very unattractive and not sexy at all. I thought that he would find me repulsive…”“We have a healthy sex life. My partner is patient with me!”In addition to noting the differences in what people say about their sex lives, I’ll draw your attention to the communication and relationship differences between these transplant survivors.
4Fears of survivors & partners Hurting partner or demanding too muchRejection fear:‘He/she can’t find me attractive when I look like this.’‘He/she won’t be responsive if I ask so why ask?’Suppressing own needs / over-focus on the other personTalking will make it worse
5Other Barriers and Beliefs When it’s time, I’ll / he’ll / she’ll feel like itBeing alive is enoughShe / he doesn’t want to talk about itNothing can be done so it’s cruel to bring it upIf it’s a problem, she’ll bring it upIt will take care of itself with time
6Sexual Function Quality & Quantity Women recover in sexual frequency rates by 2 years, but do not fully recover in quality.Women remain below rates for without cancer in frequency and quality.40-60 % of women are not sexually active at each time pointSyrjala et al. Blood, 2007
7After Treatment: Who has more problems? Poorer sexual function before treatmentBeing femaleOlder agePoorer physical function 1 year after treatmentLower relationship satisfaction before treatmentNot returning to sexual activity by 1 yearBecoming postmenopausal from treatment and no hormone therapy by 1 yearDepressed or anxious
8Types of sexual difficulties Sexual Interest not decreased after cancerSexual DesireFewer thoughts or fantasiesLess responsive to partner’s touch/initiationSexual ArousalDifficulty with lubrication or erectionChange in physical sensations
9Types of sexual difficulties OrgasmLonger time to climaxUnable to climaxLess intense climaxPainDecreased lubricationVaginal tissue atrophyInfection orNerve increased sensitivity to touchVaginismus – muscle spasmsVulvodynia – neuropathic sharp intense pain
10Types of sexual difficulties Body ImageSurgical scars, loss of breast or other body partsChanges in body, muscle tone, skinWeight gain or loss or shiftReceptiveness to SexualityMood changes: irritability, depression, worry‘Protecting partner’ reduces intimacy
11Issues Differ by Age / Situation YoungLack of informationRelationship changes: not in a stable relationship or with a single partnerMenopause symptoms may be more abrupt, severeDon’t have sexual patterns to know clearly what changedSingle / No partnerDating and explainingNeed safe ways to try things outIf want to be sexual later, need action nowMature“Maybe it’s just aging”Increased sensitivity of skin, other changes in responses require adaptation of partner and person
12Causes: ChemotherapyDamage to ovaries depends on age, type of drugs, and dose of drugsWomen who stop menstrual periods and then restart them are still at risk for early menopause
13Causes: Premature Ovarian Failure Permanent ovarian failure is not uncommonOvaries no longer make estrogenVagina loses blood flow / ability to stretchVulvar skin and vaginal lining become thin and fragileVagina does not deepen as much with sexual excitementPain with sexual touch or penetration, burning, spotting of blood after intercourse,Frequent urinary track or vaginal yeast infectionsLeaking urine
15Causes of Painful Sex Vaginal dryness & tightness from menopause Radiation damage to vaginal tissuePain after surgery to genital or pelvic area (adhesions and scarring)
16Specific Techniques for Sexual Pain… Learn to control pelvic muscles: tense & relaxUse coital positions that minimize deep penetration and give the woman controlConsider a set of graduated vaginal dilatorsCould vaginal expansion and blood flow from sexual arousal work as well as mechanical stretching?Amielle: E: or T:
20Vaginal Moisturizers Replens takes up to 2 months to have full effect Early vaginal discharge but does have double-blind studies publishedFeminease, claims to be all-naturalMoist Again has applicator
22Local Estrogen Treatment If lubricants don’t help, consider vaginal estrogenEstring and Vagifem local vaginal hormones with very little systemic escapeOncologists and gynecologists may disagree about safety of oral or transdermal (skin patch) hormones
24Causes of Low Desire after Cancer Loss of desire is the most complex and difficult sexual problem to treatStress of illnessDepressionChronic fatigueRelationship issues exacerbated by illnessBody image changesPainful sexLack of estrogenMultiple medications
27Maybe for Those With Truly Low Hormones Fad for replacement testosteroneNo good evidence it works in women over timeSafety issues in cancer survivorsIncreases risk of breast cancerTaking DHEA from health food store or bioidentical hormones just as riskyNo correlation with woman’s own testosteroneOr with sexual desire or satisfaction in naturally postmenopausal women
28Pills to Enhance Sexual Desire No aphrodisiac yet, but drugs being testedBe careful of claims for:Pink ViagraDream CreamAvlimilL-arginine, etc.
29Major Issues Return to sex as soon as possible, but gradually. Estrogen therapy is not a magic bullet, but if an option, it’s likely to help (at least with transition).Especially if premenopausal before treatment.If an option, start of estrogen right after completing treatment.Valuable for improving long term sexual function.Unclear how long is useful and safeLower dose hormones:Vaginal creamsE-ring (vaginal ring)
30Techniques to Enhance Desire Identify activities that increase sexual desire:Intimate talks, cuddling, romancePhysical sports or danceUse erotic stories, videos, fantasiesTalk to your partner about what has changed in your responses, how to please youGet counseling for relationship conflict or depressionChange meds that could be interferingTreat any sexual pain or vaginal dryness
31COMMUNICATION… SET ASIDE TIME: Talk and listen! Listen, try to remain open to the discussion. Keep the words non-blaming and ‘I’ focused.Chances are both partners are interested in improved intimacy and sexuality.Sensitive subject takes sensitivity, timing, neutral setting. (Not when tired or in bed trying sex.)Agree on a time, decide if prefer a neutral professional to assist.
32GO BACK TO ‘DATING’ Start with a plan for intimate time, not sex Avoid the performance focus on sexRemember the fun of “petting”Try sex in the shower or tubGet in the mood with dancingPractice all by yourselfTry a “mini-vacation”Candles, low lights, music, start with intimacy, not sex
33Reaching Orgasm More Easily Goal is to promote arousalDo not make orgasm a goal that creates performance anxietyUse fantasy and eroticaTry self-stimulation techniquesConsider a vibrator
34Conclusions Nearly all of us feel vulnerable about our sexuality. But sex is an important part of living fully.Sexual problems are ‘normal’ after treatment.Use it! Help it happen. Don’t wait until you feel like it – you may not at first.Plan time for intimacy.Communicate with your partner!
35Seek Help for Sexual Problems You need to bring up the topic with your doctorDoctors may have their own barriers to addressing sexual problems. Find one who can help you.Insurance may not cover all of the costsBoth partners need to understand the range of treatments available and agree on one
36SOLUTIONS IN FINDING HELP Written materials:ACS Sexuality and Cancer BookletsSexuality and Fertility after Cancer, Leslie Schover, 1997See an endocrinologistSee a sexuality specialist - GYNTalk to sexual counselor with your partner