28. Role models of every age and sex.
Without estrogen, the vagina atrophies: It becomes shorter, narrower, dryer and has less elasticity, plus the walls of the vagina can tear easily, and sex can be extremely painful. The vagina may also be more prone to infections. A lack of estrogen can also contribute to a waning libido as can stress, having a baby and some medications. If you have vaginal problems or a low sex drive, you should first see your gynecologist to make sure nothing else is going on.
Last week I took Dr Susan Love to lunch, and we talked about estrogen and women who've had breast cancer. She was quick to point out that research on decreasing vaginal dryness has only been done on women who've not had breast cancer. Those studies found that estrogen creams appear to have a higher absorption than the low-dose Estring or Vagifem. If you've had breast cancer and your doctor approves you for estrogen, talk to him or her about prescribing Estring or Vagifem. Also, be aware that bioidentical hormones are still hormones, so don’t let anyone tell you they’re safer or better for you because they’re not.If you can’t or don’t want to take hormones, Andrea Bradford, Ph.D. psychologist and instructor of Gynecologic Oncology at MD Anderson suggests using a combination of techniques. For starters, use a vaginal moisturizer several times a week and a lubricant each time you have sex. Check the labels on non hormonal over-the-counter products and avoid those with alcohol, propylene glycol and parabens. For some women, personal lubricants that are oil or silicon-based can cause more friction and therefore more pain, and lubricants with glycerin are known to promote yeast infections, so water-based products are preferable. My favorites are Replens Single-Use Disposable Applicators and Wet Naturals Barely Bare. This particular Replens and Barely Bare may be harder to find, but you can purchase them at the RETAIL THERAPY store on BreastCancerSisterhood.com. You may also want to read my blog, Breast Cancer, Vaginal Dryness and Sex for more information about lubricants and exactly where and how to apply them.
Changes in self-image due to breast cancer and the natural aging process make some women less comfortable with their bodies. One of the biggest factors in a post menopausal woman’s sex life is her relationship with her partner and whether she’s comfortable talking explicitly about what works and what doesn’t work to get her aroused. Most women require more than hugging and kissing. They need direct stimulation to the genitals and more than they needed before menopause. Perhaps we should rename “foreplay” to “men-o-pause.” Men, oh pause here, longer!
Libido and/or lack of libido was a major topic of conversation at the recent Life Beyond Cancer Foundation’s Retreat in Austin, Texas. Many of the women there were angry at their oncologists for not telling them about the side effects breast cancer treatment might have on their sex life. While we know a diagnosis of breast cancer may result in the loss of our breasts, few of us know we may also lose our sexuality. As one of the women at the Retreat asked, “Why didn’t my oncologist warn me that after cancer treatment, I would no longer have any desire for sex? I do it for my husband, and I know he wants more sex, but since menopause, it’s painful, and I’m just not interested anymore. Why didn’t my oncologist tell me that?”<PREVIEWEND>
Many oncologists tell their estrogen positive breast cancer patients that cancer treatment may push them into premature menopause--hot flashes, night sweats and weight gain--but they fail to tell us menopause may cause our vaginal tissues to become dry and paper thin. As a result, our vaginal opening may atrophy and become smaller, and our tissues become less pliable which results in painful penetration by our sex partner. What’s worse, we feel guilty that we’re not interested and don’t want sex like we used to, and we worry our partners may look elsewhere to satisfy their needs. Could menopausal libidos and painful sex be a contributing factor as to why some men have historically taken up with younger and juicier women?
If we deconstruct the word “menopause,” we get “men-o-pause,” which implies we’ve reached a point in life where we’ve pushed men, and perhaps sex, to the sidelines. Our mothers’ generation suffered through menopause and any resulting lack of sexual desire in silence, but we are not our mothers. We’re not prepared to go through the rest of our lives as female eunuchs. We’re not only conscious of the effect our lack of libido may have on our sex partner, but we miss our sexuality. We’re not afraid to say that we like sex; we like pleasing our partners, and we like having orgasms. Sex feels good, and it’s fun! What a dirty trick that just at the time when our children have left the nest, and we have more time and money to travel and enjoy our partner, mother nature saddles us with men-o-pause.
For years men have made it clear they want to remain sexually active until the day they die. Whats more, their sexuality is often more important than whether they survive their cancers or not, as exemplified by one of James’ ski buddies, who was diagnosed with prostrate cancer and chose not to receive any treatment. In other words, he chose his sexual health and a shorter survival as opposed to living longer with the very real possibility of sexual impotency and/or incontinence.
Trust me, I’m more than OK with the fact that men can sire children ad nauseum while my days of having babies are behind me, but I’m not OK with the fact that I don’t have a good sexual libido/self-moisturizing alternative except for hormone replacement therapy. Before James died, I decided to look into solving this problem. I spent countless months talking to gynecologists, oncologists, researching alternatives to estrogen and meeting with prominent chemists around the country. Just when I caught a glimmer of hope, a way to moisturize my dry and withered vaginal tissues, the Food and Drug Administration (FDA) stepped in and crushed my bubble.
Because the FDA defines a personal internal moisturizer as “intended to affect the structure or function of the body,” such a product must go through the FDA. Unless I was willing to spend years and years and millions and millions of dollars taking my product through clinical trials, it would never be anything more than a fantasy... and not one of the sexual ilk. If I didn't go through the FDA, no reputable laboratory in the country would develop and/or manufacture such a product and if I somehow found one, here or abroad, the FDA could slap us with an injunction, shut us down and sue us for all the tea and orgasms in China.
So for now, we must make do with less than perfect herbal and over-the-counter remedies while we take a page from our male counterparts and raise our voices until we have a safer solution than hormone replacement to our problem.
PS: You didn’t really think I was going to leave it at that, did you? Next week, we’ll talk about some practical things you can do to help the situation.
PPS: To all of you who emailed and called, asking about Goldie, I thank you for your kind wishes and prayers. I’m over the moon to report she seems to have gotten rid of the incredible, mind-boggling amount of lace she consumed, but it wasn't easy. We'll leave it at that. From now on, I’m going to put her in the bathroom when I leave the house and take away all the towels and bathmats and soap. Goldie girl will only get a bare tile floor and a stainless steel bowl full of water until I feel like I can trust her again, but then again, hello! She's a dog! That's what they do... Oy vey!
FRIDAY: I’m preparing the Barefoot Contessa, Ina Garten’s, recipe for Boeuf Bourguignon. For the first time in almost a year, my tiny house is alive with the smells of chopped garlic and yellow onions, simmering in bacon fat. I know... Not exactly the beginnings of a meal designed to lessen my risk of recurrence, but it gets better, or worse, depending on your point of view. I still need to add a bottle of Cabernet, half a cup of Cognac and two pounds of red meat.<PREVIEWEND> Because this inspired dish rises to the ‘Heaven on Earth’ category the second day, I’ve invited my friend Rob for dinner tomorrow. Rob and I’ve been buddies since college. It was Rob and his friends, I affectionately call them ‘the River Oaks Boys,’ who inspired me to learn to cook well. Give any of the River Oaks Boys a bag of random ingredients, and they’ll deliver you a gourmet treat.
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