OncoSex

“First we save lives and only then do we worry about the sex life”, seriously?

Women with breast cancer only start thinking about their sex life once they end treatment and are no longer afraid of an imminent death. During treatment physicians focus on saving lives, leaving the topic of sex for later. Rightly so. However, it is important to bring up the sexual side effects when still in treatment to prevent their often irreversible consequences.

Sexual dysfunction related to breast cancer is associated with:

• the cancer diagnosis itself
  • stress, and fear of deteriorating health and of death,
• surgical treatments
• full or partial mastectomy and full or partial axillary lymph node dissection
• upper limb lymphoedema
• chemotherapy
  • hair loss
  • vaginal dryness
  • cognitive impairment
  • bouts of depression
  • chronic fatigue
• adjuvant therapy
  • more severe menopausal symptoms
  • premature menopause

When sex hurts

Dyspareunia is the persistent and recurrent genital pain occurring before, during, or after intercourse. It may be superficial or deep. Superficial dyspareunia is pain and redness at the entrance of the vagina, a tension on the pelvic floor, intercourse difficulties, and frequent bleeding. Deep dyspareunia is a pain occurring in deep penetration in the cervix or lower abdomen.

In breast cancer patients dyspareunia may be caused by:

• chemotherapy
• adjuvant therapy
• preventive oophorectomy (ovary removal)
• loss of libido
• vaginal dryness
• bouts of depression
• menopause

How to cope?

• Pharmacotherapy
  • Medication should be prescribed and dosed by a physician familiar with the patient’s health history
• Pelvic muscle rehabilitation
• Prevention of vaginal dryness
• Adequate treatment of mood disorders
• Sex therapy to increase libido

Vaginal dryness

It is often one of the side effects of chemo and radiotherapy. It also affects women shortly before and during menopause. It is caused by an oestrogen deficiency, a significant libido loss and reduced vaginal lubrication. The dryness is also accompanied by atrophic changes of the vaginal mucous membranes. The vagina becomes prone to to microtrauma, which in turn promotes favour fungal and bacterial infections. That is how the vicious circle of sexual dysfunction starts. Sometimes the dryness is responsible for recurrent vaginal infections. Once lubrication is increased, the infections and painful intercourse often stop. What is more is that the libido also increases, since sex is no longer associated with pain.

Lubricants

There are many water, glycerine or silicone-based lubricants available in pharmacies. The water-based ones may feel sticky, while those with glycerine may feel greasy. The best advice is to try both and then choose the one that suits you better.  However, these types of products have a short-term effect. Therefore, you should use them directly before the intercourse. Alternatively, pharmacies also offer over-the-counter hyaluronic acid globules that work a little longer. You should use them every second or third day.

Prescription drugs

You may also talk to your gynaecologist to get a prescription for a discomfort relieving drug, that would strengthen your mucous membrane.

Aesthetic medicine laser therapies

Until now, the use of laser therapies in patients after breast cancer has been controversial. They have not been approved by the Food and Drug Administration. However, they are becoming increasingly popular as they improves the vaginal hydration and blood circulation. They also remodel the vaginal mucosa, increasing the elasticity of its walls and turn the symptoms of mild stress urinary incontinence milder. Usually a series of at least two or three treatments is necessary, however it is sometimes possible to get satisfactory results after just one treatment.