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.