Q&A

On Cancer: Strategies for Women to Cope with Sexual and Vaginal Health Concerns Related to Cancer

By Andrea Peirce, BA, Writer/Editor  |  Friday, June 14, 2013
Clinical psychologist and certified sexual therapist Jeanne Carter Clinical psychologist and certified sexual therapist Jeanne Carter

Many women who undergo cancer treatment experience changes in their sexual and vaginal health, such as problems with vaginal dryness and discomfort and pain with intercourse.

In an interview, clinical psychologist and certified sexual therapist Jeanne Carter, head of Memorial Sloan Kettering's Female Sexual Medicine and Women's Health Program, indicates that while such difficulties are common, effective solutions are often available.

What are common sexual and vaginal health concerns of women undergoing treatment for cancer?

Any cancer treatment that damages the ovaries, such as chemotherapy or radiation to the pelvic area, can sometimes trigger menopause in women. This treatment-associated menopause is often more intensified and prolonged than in naturally occurring menopause.

Symptoms can include extreme vaginal dryness and discomfort, lack of lubrication, and associated pain with intercourse and gynecologic exams. Not surprisingly, these physical effects, especially when combined with the emotional issues surrounding a cancer diagnosis, can lead to arousal difficulties and loss of libido or interest in sexual activity.

These concerns go beyond sexual health, though. Vaginal health is important for all women, even if they are unsure about future sexual activity. Vaginal dryness can make gynecologic examinations painful, and essential health surveillance can be jeopardized if a woman avoids her medical visits.

The good news is that we have some simple solutions that can help.

What is the sexual and vaginal health treatment that you provide most frequently?

For many women, the key to relieving vaginal dryness, pain, and discomfort is to find a way to restore vaginal moisture, lubrication, and a natural pH to the vagina and vulva. Often, once that's accomplished, things get better overall, both physically and emotionally.

Unfortunately, there is a lot of confusion about the difference between vaginal lubricants and moisturizers. Vaginal lubricants are liquids or gels applied inside the vaginal entrance and around the clitoris and labia minora during sexual activity to prevent irritation and painful tears in vaginal tissue.

Vaginal moisturizers are nonhormonal products (usually gels or creams) designed to be applied several times a week to maintain overall vaginal health and comfort. To adequately address their symptoms, cancer patients and survivors may need to use moisturizers as many as three to five times a week, which is more frequent than what may be recommended on the product container.

What should women expect during a visit with you?

Some women come with a partner and others don't – it's a personal choice. Women meet with a nurse practitioner and me at the first visit. We ask about your medical history, adjustment issues you may be dealing with, and your concerns about your sexual or vaginal health.

The nurse practitioner conducts a vaginal exam, and we then develop a treatment plan, tailored specifically to your needs. Our goal is to provide a safe and comfortable environment where women feel free to be open and honest with us.

Are there other treatment options that you commonly recommend?

Yes. We also provide literature on ways to heighten awareness of pelvic muscles and increase muscle control through pelvic floor muscle exercises – also known as Kegel exercises. These exercises can improve issues with pain or problems with intercourse, as well as promote circulation that enhances sexual arousal.

For women experiencing vaginal discomfort following pelvic radiation, hormone deprivation, or vaginal reconstruction, we often suggest using vaginal dilators – which are cylinders of different sizes – because they can be helpful in stretching the tissue, increasing vaginal comfort, and gaining awareness and control over pelvic muscles.

Given the strong link that has been identified between relaxation and arousal(1), we also discuss the role of the mind-body connection, offering suggestions to expand the sexual repertoire and enhance sensuality for those currently in a relationship or thinking about having one in the future.

We also work closely with specialists in other parts of Memorial Sloan Kettering, such as with general gynecologists for hormone-related issues, and rehabilitation specialists for incontinence or pelvic floor dysfunction problems.

What do you say to women who are afraid or hesitant to bring up sexual health issues with their doctor?

For many women, it can be challenging to raise this topic. But it’s very important. You might start a conversation by saying something like: “I have heard that many women have vaginal dryness after treatment. Do you have any information or suggestions to help with this?” or “I have some questions about sexual and vaginal health after my treatment. Can you suggest someone I might speak to about this?”

But we also recognize that this should be a two-way conversation between you and your doctor, and we are searching for ways to increase dialogue on the topic. For example, we have tested the use of checklists with questions about sexual or vaginal health for doctors to review with their patients.

This year, we aim to pilot a program at Memorial Sloan Kettering that involves women completing an online screening survey prior to appointments with the Gynecology Service. We hope that this will enhance discussions about potential sexual or vaginal health issues so that strategies and solutions can be offered more easily.

Does a woman have to be a patient at Memorial Sloan Kettering to take advantage of these services?

Yes. Our services are available to all females receiving care at Memorial Sloan Kettering. Many of the women who seek help are undergoing treatment or are survivors of breast cancer or a gynecologic cancer such as ovarian, cervical, or uterine cancer. An increasing number are also coming to us following surgery or radiation treatment for colorectal cancer. We also see women who come to us through other areas of the hospital, such as the Integrative Medicine Service.

We still have more to do to meet the needs of our own patients before we open up our program to women outside of Memorial Sloan Kettering. Meanwhile, by focusing on clinical trials(2) and research, and offering practical advice through patient education materials on such topics as sexual health and intimacy and sexual activity during cancer treatment, our program can help women no matter where they live.

Comments

I notice that you do not mention the use of hormones such as in vagifem. I had estrogen positive breast cancer, 5 yr survivor but am prescribed vagifem by my gyn and ocologist. I have been told to only insert approx 2 inches so less systemic. I would like to know your feelings on this.

Annette, we are unable to answer personal medical questions on our blog. If you'd like to make an appointment to speak with a doctor at Memorial Sloan-Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

As a general question, do you recommend vagifem for survivors of estrogen positive breast cancer?

Hi Annette, we sent your question to one of our physicians, Jeanne Carter, and she responded:

"Vagifem is wonderful but it is up to the discretion of their oncologist."

Hope this is helpful, and thank you for your comment.

I am very glad to see this issue being addressed. I must say I was really taken back by the way vaginal health/dilators discussion was almost nonexistent at my first follow up visit with my Gyno at Sloan. The only question asked was "Are you using the dilators?" I said yes and the reply was "Keep using them." Nothing else said or asked. Forget asking questions regarding sex!
There should absolutely be an in depth discussion. We are told how important the issue of vaginal health is yet no support or education is offered.
If the doctors are too busy or uncomfortable with the subject than we should be given an opportunity to see someone who will take this on. This should be part of the care and automatically scheduled for the patient.

I think MSK is phenomenal. It surpassed my every expectation. This is the one area where I feel it is letting it's patients down. My internet searching tells me MSK is far from being alone with this problem. Women all over the world are complaining. I hope MSK is successful in breaking the barriers to this much needed interaction.

Mary, thank you for your comment.

We are sorry that this aspect of your care was not adequately addressed. We passed on your concern to Jeanne Carter, head of Female Sexual Medicine and Women's Health Programs at Memorial Sloan-Kettering, who added "We are trying to improve awareness of this issue with blog articles such as this and are working with medical professionals inside and outside of Memorial Sloan-Kettering to identify this topic as an important part of clinical care follow up discussion. We appreciate your honesty and feedback, it is an important reminder to us all to be better at addressing these areas."

You can learn more about Memorial Sloan-Kettering’s Female Sexual Medicine and Women’s Health Program at this link:

http://www.mskcc.org/cancer-care/counseling-support/female-sexual-medicine-women-health

You can also contact us directly at 646-888-5076

I personally am vs. hormonal products, despite the fact my gynecologist is for it, despite my radiation and chemotherapy for anal cancer in 2008. Cancer of all types is genetically on both sides of my family. One of my medical consultants pointed out that although hormones produce results (I have seen research photos of before and after), she says it makes "abnormal tissue."
I have pleasurable sex now - no more pain and burning at the introitus or anywhere as before. All it took was regular dilation with a silicone dilator for fifty strokes regularly and before any intercourse, one vitamin E 400mg capsule before intercourse (no infection from clogged pores ever occurs), and organic coconut oil from any health food store.

The oil is refrigerated and chunks are broken off - one small one is inserted vaginally. Other hardened oil is used to lubricate the dilator.
This is inexpensive. If it is carcinogenic or harmful, there is no research (yet1) to suggest it is.
I was a sex health educator in the 1970s, have done sex therapy with individuals and couples, and had a very hard time with pain after menopause - which was nothing compared to the burning and pain after intense radiation and severe burns from radiation for anal cancer in 2008.
I can hardly believe my progress and good fortune that I now have intercourse with absolutely no pain or burning, as if I were again age 40. I am 71 years old.

Judy

Judy

I am currently researching ovarian cancer in order to complete a school project at Wilmington University in Delaware. I just wanted to thank you for the wealth of information at this website. The video's are great; short, concise and informative. I've learned so much about this cancer.

Kathleen, thank you so much for your comment. We're glad you find our information useful!

What do you think of the vaginal moisturizer Luvena? http://www.luvenacare.com/

Emily, thank you for your comment. We passed your question on to Dr. Carter and she responded:

Luvena is a great product, but I believe it works better as a lubricant than a moisturizer.

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