How to improve sexual health in menopause, with a history of cancer

Problems with sex are the third most common issue reported by cancer survivors, after fatigue and loss of physical fitness. It is also a subject that isn’t talked about often enough –  it can feel like you are on your own. You’re not. You have changed, so sex has changed. Our sexual function sits on […]

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Problems with sex are the third most common issue reported by cancer survivors, after fatigue and loss of physical fitness. It is also a subject that isn’t talked about often enough –  it can feel like you are on your own. You’re not.

You have changed, so sex has changed.

Our sexual function sits on four “pillars”.

  • Sexual function (the body parts that control our sexual response and function)
  • Sexual body (all the other body functions that support sexuality: smell, touch, taste, vision, mobility etc)
  • Sexual identity (how we see ourselves sexually)
  • Sexual relationship (who we have sex with)

Anything that changes one of these pillars will change how sex works for us.  Cancer has an effect on all four.

Changes in your body

Whether by inducing menopause, intensifying your existing menopausal symptoms, through surgery, chemotherapy, radiotherapy or medication: cancer can leave your body working differently, and feeling very unfamiliar.

Women often look to HRT to manage menopausal symptoms, but this is not always an option especially with a hormone-receptor-positive cancer. Other medications can improve sleep and hot flushes: but take care to ask about sexual impacts.  Some of them (anti-depressants, gabapentin, oxybutynin) can further reduce lubrication, libido or delay climax.

It is crucial to appreciate the impacts of cancer-induced menopause (and any local surgery or radiotherapy) on the vagina, vulva and bladder. The loss of hormones and blood supply can make tissues more delicate. You may lose lubrication, sensation and find you are less able to cope with penetrative sex as hormone levels fall. There is a lot you can do to help.

We suggest:

  • Washing, moisturising and massaging with a good emollient
  • Use of a skin safe lube for any penetration (we like “double glide” by Yes, with oil and water based lubes used in combination)
  • Local vaginal and vulval oestrogens are usually safe for almost everyone in low doses.  They can be a game-changer for how sexual touch feels. It’s worth discussing these with your oncologist or GP.

Changes in your mind

You are unlikely to feel the same as you did before your diagnosis. Cancer can be the catalyst for a great deal of change, and most of it won’t have been easy.  You may not have quite worked out how you feel about this yet, either.

Whenever our identities are forced to shift, our sexual identity will also change. It can take time (and deliberate attention) to work out how you feel about sex now, what place intimacy has in your life and in your relationship. It may feel like a priority, or the last thing on your list.

There can also be trauma – from diagnosis, surgery, or other aspects of your treatment – that needs addressing. Trauma generally results from situations where we feel unsafe or helpful. Unprocessed trauma can manifest itself with feeling emotional blocks or sudden triggers: you may notice you are transported to a previous moment, or that you feel suddenly overwhelmed with feelings or unable to find your words.

A potentially life-threatening diagnosis disrupts our sense of safety. This can be compounded by losing agency over our bodies for a period too: submitting ourselves to treatment that can be distressing or painful. Our bodies can feel very unfamiliar.

To cope with things, we sometimes develop techniques such as thinking ourselves away from whatever situation we are in. This is called dissociation. It can become a reflex, making it hard to give our focus to our bodies in situations that need this – such as when we are intimate.

We may also have experienced pain when we have tried to return to intimacy – and this sets up anxiety about subsequent attempts. Anxiety makes arousal even less likely – and this can set up a vicious cycle.

The priority is helping you to feel that your body is a safe place again, and somewhere you can expect to feel pleasure. How can you do this?

If you feel you have unprocessed trauma, then it can help to find someone to work through this with. Body based methods that can help enormously. Mindfulness and breath-based activities like yoga have also been shown to help with re-connecting with your body and calming anxiety and trauma responses.

When it comes to sex, it can help a lot to explore things on your own first. What touch feels good now? What feels uncomfortable? What sparks your interest? What turns you off?

Context and expectations have a lot of influence, too. Think about what you may need in order to feel relaxed and comfortable, and in the right space emotionally for sexuality. What helps you to achieve this? Very often, to have any space to notice our need for intimacy, we often need to ensure that we are meeting most of our non-sexual needs first. This means rest, exercise, safety and having our emotional needs met.

Changes in your relationship

A relationship is the space between us and another. When one of us changes, we force a shift in the other as they adjust around us.

Change doesn’t mean for the worst. Many couples feel closer than ever after facing illness: but the adult:adult dynamic of the relationship may have altered for a period into being patient/carer. Sexual currency – the anticipatory, flirty chat between lovers – may have been lost for a period. It can feel very hard to rediscover the habits that create the space our sexual relationship exists in.

It can help simply to talk about the issue. In many couples, the conversation can feel hard to start – but when one partner is afraid of some aspect of intimacy, avoiding this can mean that very quickly all touch is lost for fear of it being seen as a “green light” for sex. This is when communication can make a huge difference.

Use “I” statements, as these are less likely to provoke a defensive response. Explain how things are for you. Talk about what you fear. What you miss.

Look for the shared ground.  What did intimacy mean to one or both of you? What do you want more of? How can you find that? Sometimes it helps to agree what you don’t want to do for a while, in order to signal that other forms of intimacy are still welcome. Keep touching – especially non-intimate touch, as this helps build connection and permission for non verbal expression between you.

Getting back to sex can take time, so in the meantime agree to widen what counts as quality intimacy: sex is a buffet, not a three course meal.

Here are our three top tips for sex after cancer

  1. Communicate, communicate, communicate. Don’t let this become the elephant in the room. Talk about what you miss, what you fear, what you want back.
  2. Prioritise vulval and vaginal care. Treat your vulva like your favourite cashmere jumper. Moisturise and massage regularly. Ask about low dose oestrogens – they can really help.
  3. Remember sex is a buffet, not a three course meal. Don’t let fear of one aspect of sexual connection stop all connection. Agree what is ok right now, and what is not. Keep touching and connecting in non-sexual ways. Widen what counts as intimacy.
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A note on our language

Throughout this website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and PMS/PME or PMDD, and we warmly welcome everyone who needs this support in our clinic.

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