NEW YORKSexual problems are common after cancer treatment,
Sarah Auchincloss, MD, said at a Cancer Care Inc. teleconference on
Intimacy, Sexuality, and Love.
Dr. Auchincloss, a consultant in psychiatry at Memorial
Sloan-Kettering Cancer Center, pointed out that cancer and cancer
treatment affect the same areas that determine sexual
responsethe body, the mind, and the relationshipand
the goal is to get things better in all three areas, she
said. Sex gets better when the whole person gets better.
Shutting Down Emotionally
The factors that affect sexual desire develop over the course of
cancer treatment, she said. Sexual desire may diminish or disappear
during diagnosis and treatment as the woman becomes preoccupied with
meeting the challenges of treatment and handling her emotions.
Shutting down emotionally is a common response and an adaptive one,
Dr. Auchincloss said. Even so, during treatment, many women will
still maintain the ideal of themselves as sexual beings.
Recovering emotionally and sexually after cancer treatment can take a
year or two, first to become familiar with the issues, and then to
work on them. In the months after treatment, a woman begins the
work of coming to terms with what she has been through, Dr.
Auchincloss said. She must first work to restore her strength and
The woman watches for her hair to grow back and her energy to
return, she said. She touches her skin over a breast
reconstruction to see if sensation is returning. She may feel hot
flashes or vaginal dryness and wonder what a future with a different
hormonal infrastructure will feel like. Shes trying to rebuild
a sense of her body as okay, not good yet or sexy, just okay.
Intercourse may be painful, and if it is, the first rule, Dr.
Auchincloss said, is to stop and do something else. There are
almost always things you can do to continue a sexual situation while
avoiding activities that cause discomfort.
If the women keeps having painful sex, she may soon lose her sexual
desire completely, a problem that is harder to treat than
dyspareunia, she said. Common causes of dyspareunia after cancer
include atrophy of the vaginal mucosa due to chemotherapy or
radiation, scarring after radiation to the pelvis, or narrowing or
shortening of the vagina after surgery.
Give yourself lots of time for foreplay, Dr. Auchincloss
advised. This is really helpful for women learning how to fully
develop a sexual response.
A medical examination to determine any physical causes, which
includes a check of the vulva and vagina, is the first step in
treating sexual problems.
An oncologist may agree to local applications of estrogen if the
patient has been cancer free and the cancer was not hormone-receptor
positive. Otherwise, a vaginal moisturizer used three times weekly
regardless of sexual activity, together with a vaginal lubricant
before sex, will be very helpful, Dr. Auchincloss said. Vaginal
dilators are useful for women who have received pelvic radiation or
surgery to maintain vaginal openness.
Working on psychological and relationship issues are just as
likely to improve sexual desire and response, Dr. Auchincloss
said. Feeling that your body and your partner are okay goes a
long way. The goal is to move toward feeling reunited with ones
body, to see oneself as less perfect, perhaps, but more vital.
Exercise, nutrition, yoga, and massage can reduce tension and enable
the individual to regain a sense of appreciation for the whole self.
Playing with ones appearance after treatment, she
suggested, such as getting a new hair-do, make-up, and clothes,
can help reflect a womans inner changes, changes that can
dovetail with the desire to reimagine oneself as desirable once again.
Counseling and attendance at functions sponsored by cancer support
organizations can also help reduce the feeling of being different or damaged.
Previous levels of sexual functioning are the best predictors of
post-treatment functioning, Dr. Auchincloss said. The 1 to 2 years
following cancer treatment can be the most difficult for couples,
particularly those with relationships of relatively short duration,
and here, too, counseling or support may be useful.
Anger and tension often develop in relationships during this period,
she said. Learning ways to weather these difficulties and ease
tension will not only improve the relationship but also improve
Other measures to enhance sexual activity, Dr. Auchincloss said,
include avoiding stressful topics during intimate moments; taking an
unhurried pace; doing things that promote relaxation such as bathing,
showering, or massaging; exploring through touch; and emphasizing
comfort and not performance.
Single, divorced, and widowed women will have special issues
regarding their future relationships, Dr. Auchincloss said. A
cultural background that places a special value on fertility may
present particular difficulties to some women who may require
The good news, she said, is that alone or with a partner, the
woman treated for cancer may find her way to a life better lived,
lived more fully in deeper appreciation and with stronger connections
in every way.