Sexuality for Women after Breast cancer
Part Three: Maintaining Healthy Sexuality
Illness/Treatment impact on Sexuality
If you have breast cancer, or undergoing treatment, it’s important to have an understanding of how treatment (surgery, chemotherapy, radiotherapy and endocrine therapies) may affect your body.
These ‘changes’ often include induced menopause with a consequence of an impact on your sexuality.
Such awareness can be very empowering…it will help you to feel more in control and it will provide you with the information for you to check with yourself, partner, GP or health care profession, to see if you need support, further information or treatment from referral to a specialist.
Sexual problems/changes are very common following treatment for breast cancer
Much research of sexuality has shown that there may be an overall reduction in the quality of life and general wellbeing for women who experience sexual difficulties.
Treatments for breast cancer, such as chemotherapy and endocrine therapies, reduce the circulation of oestrogen in the body which is important in managing some types of breast cancer. However, this reduction of oestrogen can cause vaginal dryness, vaginal atrophy, vulvar discomfort, urinary changes such as frequency or increased risk of urinary tract infections, hair and skin changes, hot flushes and weight changes.
Having said this, it is very important to talk to your doctor or specialist breast nurse to ensure that nothing else is happening, because many medical conditions that affect the vulva may have nothing to do with the reduced circulation oestrogen.
As such, it is important to have symptoms assessed before commencing any personal or over the counter treatments.
One of the more common changes is a medical condition called Vaginal atrophy, where the vaginal mucosa and tissue becomes thinner. A physical examination and discussion with a health care profession would be ideal to look at the appropriateness of medical intervention.
Similarly, there may be ongoing pelvic pain or pain during sexual activity, (called Dyspareunia). This can occur even with the use of personal lubricants and after having experimented with different positioning during sexual activity.
In this case, a referral to a specialist physiotherapist can be beneficial for an assessment of the vaginal and pelvic floor muscles: it’s not uncommon for some women following chemotherapy and ongoing endocrine therapy, surgery to experience shortening of the vaginal wall (this is called Vaginal Stenosis).
Let’s take a minute to talk about…personal lubricants.
These can be of considerable assistance for some women who experience vaginal dryness.
Some that I recommend are Astroglyde, a water based lubricant for mild dryness, or Pjur, water and silicone based, for more lubrication during sexual activity.
The use of KY jelly (or Vaseline type products) is not usually recommend as a personal lubricant as they tend to have a quick drying time and can result in increased discomfort.
Vaginal moisturisers such as Replens can also help with vaginal dryness.
Maintaining a healthy sexual self-esteem is important for your own wellbeing.
While it can be confronting for many people to discuss sex or sexual activity with a potential stranger, such as a health care professionals, we need to put this into perspective...
...we know that one of the most common side-effects of cancer treatments is the impact on sexuality and sexual activity...
Remember that many women (and men) experience the changes in their sexuality after cancer, so it is important to know that you are not alone.
If you’re in a relationship, remember also that it’s normal to experience the ebb and flow of sexuality and sexual activity related to desire and frequency of sexual activity and intimacy.
Dr Rosie King, an Australian Sex Therapist, talks about creating a willingness to be open to meeting each other’s needs sexual or otherwise. This is important for the relationship to enhance a ‘new intimacy’ between partners.
It’s also important for partners to be aware of, and be educated in the potential consequences of issues, including cancer and cancer treatment, that may impact negatively on sexuality. This will help to redefine and create the motivation to look at new ways of enhancing emotional and physical intimacy.
Most important is to take the pressure off...
This is especially so if you are still struggling with physical side effects of treatment. Create a more playful way of communicating intimacy with your partner, such as a sensual massage, touch that is non-sexual, reconnecting over a meal, going for walks together or having a date night, with or without sex…to share time together.
If you have any questions or concerns, feel free to contact me at inSync for life. You might also like to have a chat to your health care professional, or the Specialist Breast Care Nurse in your area. See our Links page for further information.
Clinical Sexologist / Counsellor
Sexuality for Women after Breast cancer
Part Two: The Uniqueness of You
In part one of this Newsletter, I spoke about the importance of discussing sexual concerns after breast cancer, and gave an overview of some of these issues.
I want to continue this discussion in Part Two by acknowledging that if you have breast cancer and you are reading this, it is significant in that you are taking personal responsibility and accepting a unique opportunity in working towards making ‘intelligent sexual and relationship decisions’.
Remember that positive motivation and understanding, promote wise choices…
Guilt, shame and anxiety about yourself or your past will act like an anchor in your life and weigh you down, and hold you back...they may lower your self-esteem, and negatively affect your relationship and sexuality.
I have had the pleasure of working with some amazingly courageous women who are managing their loss of ‘sexualness’ in relation to their own femininity, body image and sexual partner.
However, I know that for many or perhaps even most, this becomes a very challenging area of their life…
I encourage you to think about… and talk about... what your sexuality and intimacy needs are, for you and if you're in a relationship, for your partner and relationship... What is it that you would need to enhance your sexuality and intimacy......?
...as you do this, remember that we all have unique perceptions based on our own thoughts, memories, feelings, attitudes, values, learning and knowledge. It's all of these things and more that have helped create who we are at this very moment...
These things and our perception of ourselves and our life doesn’t make things ‘right’ or ‘wrong’… Perhaps instead, it's better to think about how 'helpful' our thoughts and perceptions are...
sometimes our perceptions will be helpful to us…and sometimes unhelpful…
However, increasing awareness of our perceptions, beliefs and thoughts of ourselves will open us up to new learning, new possibilities, new ideas…
It's this 'new learning' that will help to enhance personal self-esteem, build confidence, enhance sexual self-esteem, and overall, create a healthy approach to sexual well-being.
Questions for self-reflection:
To help with your awareness and understanding of your own sexuality, take a few minutes to write down your thoughts about the following…
In Part 3, the final part in this series, I'll go over some ways to support you to develop and maintain a healthy sexuality.
Clinical Sexologist / Counsellor
Part One: Sexual concerns
Sexuality is a very sensitive subject.
When discussing this issue, it’s important to feel as safe and comfortable as you can…be gentle with yourself.
In particular, you will need to be aware that after breast cancer, your body is different in many ways. You may feel different, and you may respond differently to touch, intimacy, and sexually.
Defining your own meaning of sexuality intimacy is really important: we all have our own ways of defining our sexuality, and you need to feel as ok as possible, to talk about the impact that treatment has had on your ‘sexual self’.
By having an awareness of your sexual story, understanding how your body functions and what affects your sexuality, can help to make you feel more comfortable to talk about what is happening for you. It’s quite common for many people to never have had a conversation about their sexuality or sexual self.
So…regardless of your sexual orientation, be curious about creating an intimate bond with yourself or another, both physically and emotionally, consider all the potential possibilities to enhance your personal and sexual confidence: this is the key to being open to address sexual concerns…the key to honouring your own sexual story and continuing your journey of personal sexual growth.
Common issues after Breast cancer…in no particular order
Discussion of Changes:
The changes to one’s sexuality and sexual function are not always discussed by medical practitioners and Specialists, and when these changes are spoken about, information is often limited, usually being related to fertility and reproductive concerns and not necessarily about sexual desire, libido or sexual intimacy.
Loss of intimacy: (physical and emotional)
… and if there has been a long time between sexual intimacy...there may be a loss of confidence and hesitancy in resuming sexual activity related to fear and anxiety about how you and your partner may feel and respond.
This is often associated with cancer treatment, and can result in painful sexual intercourse, which is called dyspareunia.
Vaginal Atrophy: (thinning of the vaginal tissue)
This can be a challenging ongoing issue to manage as it can make vaginal dryness worse, and may not be remedied with personal lubricants or vaginal moisturisers. Many women and medical practitioners are often wary about the use of topical oestrogens.
Loss and Grieving:
...of sexual activity and sexual self-esteem. This issue can be related to body image changes, menopausal symptoms and confidence.
Sexual response changes:
...such as reduced arousal, loss of libido, difficulty to reach orgasm.
including hot flushes/night sweats, disturbed sleep, poor memory and weight gain, all of which may affect sexual self- esteem, sexual functioning and general wellbeing (quality of life).
Communication about sex:
This can be difficult for couples, especially if they have never broached the subject…and this silence can often be mistaken as a lack of interest or rejection.
It’s important to say that not everyone with breast cancer will experience problems with their sexuality or sexual functioning. It is only considered a problem when it is causing distress for the woman and/or her partner and impacting negatively on their relationship. Sexual difficulties such as low libido, difficulty to orgasm are very common in our society, even for women who are otherwise healthy.
I hope that this conversation so far will help you discover more about yourself, and build on what you would like for your sexuality and intimacy, both as an individual, and if in a relationship, with your partner.
Exploring further will help to create a ‘realistic hopefulness’ – understanding of the reality of the situation, but have some hope for the future.
I believe that the more you know about yourself and how you want to be sexuality can build resilience within yourself and in your relationship. In my next newsletter, I will talk about the 'uniqueness of you', to encourage you to start examining your self-awareness about what your needs and wants are concerning your sexual well-being.
Clinical Sexologist / Counsellor
Ten Tips for Enhancing Sexual Pleasure (adapted from Joan Price)
1. Slo-o-o-w-w down. Sometimes it takes longer to warm up. If with a partner, encourage each other to enjoy slow foreplay! This warm-up phase of sex play should last for as long as you need...and remember from a previous Newsletter, that the goal of sexual contact does not have to always be sexual intercourse...you can enjoy your own company, or if with a partner, there is much else you can do…enjoy the journey!
2. Kiss and kiss. Kiss sweetly, tightly and lightly, passionately and hungrily, quickly and sloppily, or slowly and contentedly. Play, have fun, enjoy all kinds of kisses – this will help you bond with and warm up to your partner, while you both enjoy the moment.
3. Appreciate, decorate, and celebrate your own and if in a relationship, your partner's body. Use your imagination, again…have fun…! Use Jewellery, lingerie, feathers, fringe, silk, velvet, massage oil, candlelight, whatever is safe, looks good, feels good.
4. Do fun & sexy things long before you hit the sheets. Dance, prepare and enjoy a sensuous meal, hold hands while walking if in a relationship, enjoy non-sexual touch and massages. Visit lingerie or adult shops. Allow yourself to have lots of sexy thoughts, and if with a partner, leave sexy notes in each others' pockets, and each other little gifts. Singles can buy themselves a special gift, something that brings you pleasure or enjoyment.
5. Do sexy things to get yourself in the mood. Wear those special clothes that make you feel good! Work out, walk, swim. Dance. Fantasize. Read a sexy story, or maybe write out all the sexy things you want to do together. Think sexy – be sexy! For women…and perhaps men…consider spending some time humming with your vibrator (if you have one) or time for just self-pleasuring.
6. Loving during high energy times. Midnight sex may work for some, while a sex date with yourself or another in the morning or afternoon is a delight for others. (Why do you think they call it "afternoon delight"?).
7. Explore sex toys and other erotic helpers. For those who wish to experiment, or or perhaps those who need extra help, consider the many different variety of sex toys – they are easy to find, fun to try.
8. Use a silky lubricant if necessary. Sometimes the use of a lubricant is an essential ingredient to sexual play. This is especially so for women who are not so young, and don't have the natural moisture of youth. There are many different lubricants that feel great and bring back the joy of friction. When the partner applies it, it becomes an erotic part of sex play.
9. Enjoy quality 'warm' time. This is a time of enjoying the warmth, contentment and peace. It isn't just for couples, but if you're in a relationship, it can help build closeness, emotional intimacy, and bonding: snuggle before, during, and after your sexual play. Holding each other, feeling the warmth and texture of each others' skin, can be a sweet and sexy part of making love. As a single, just allow yourself to bask in your own warmth and the peace of being.
10. Laugh a lot. Play silly games, invent special words, playfully tease yourself or another intimate partner, and rediscover your ‘inner adult child’. Laughter is relaxing, promotes peace and bonding...it's joyful, ageless - and sexy.
What a Sexologist does…
As you might imagine, when I tell people I’m a Clinical Sexologist, I get so many different responses!
Clinical Sexology is a relatively new profession that addresses sexual concerns of individuals and couples. Sexologists are highly skilled and proficient in applying knowledge and practice from a combination of areas such as psychology, counselling, physiology and medicine.
Perhaps a primary key to the success of Clinical Sexology is that it allows the Sexologist to provide personal counselling together with the application of practical methods of addressing sexual issues. This is perhaps one of the major differences between a Clinical Sexologist and a Psychologist: While usually highly trained in psychological intervention, most Psychologists are unlikely to have any training in the practical application of various methods of overcoming sexual issues.
As a Clinical Sexologist and Counsellor, one of my main objectives is to create a comfortable environment that allows individuals and couples to discuss their sexual wellbeing and to encourage them to talk about any sexual changes they might be experiencing. These changes may be of concern to them as an individual or impacting on their relationship in a negative way.
Research suggests that overall quality of life and general well-being are often lower for those who experience sexual difficulties.
Clinical Sexologists work with their clients to provide an assessment of their sexual concerns and provide counselling, and practical and informational resources.
My aim in doing this is to support those I’m working with to feel empowered by looking at new or different possibilities to enhance their sexual self-esteem, overall self-confidence and intimacy with self, relationship and others.
Sexual concerns/changes are very common following certain surgeries, pregnancy and/or certain treatments for medical conditions. Such issues may include physical changes such as, vaginal dryness, painful intercourse for women or erectile difficulties for men, and/or low sexual self-esteem and changes to emotional intimacy.
Sexual difficulties such as low libido, difficulty to orgasm are very common, even for men or women who are otherwise healthy.
While it is normal within relationships to experience the highs and lows of sexuality and sexual activity related to desire and frequency of sexual activity and intimacy, this can be further affected by illnesses or certain medical treatments.
As a Clinical Sexologist I can support you by:
Feel free to email me if you have any questions, or use the contact page to make an appointment.
Helena is a Clinical Sexologist with extensive experience...talking about sex! and supporting others to manage their sexual concerns.