Women s Intimacy, Sexuality and Relationship Issues After Cancer Sylvie Aubin, Ph.D. Segal Cancer Centre Jewish General Hospital McGill University
Objectives Acknowledge changes in intimacy and sexuality experienced by women after cancer Present ways to address changes to achieve a satisfying sexual life 2
Treatments Impacting Intimacy And Surgical treatments Prophylactic mastectomy Prophylactic oophorectomy Hormonal treatments Prophylactic oophorectomy Sexuality Hormonal treatments that suppress or lower estrogen (oral, injection) Radiation therapy (external, internal) Chemotherapy Transplant (bone marrow, stem cell) 3
What May Happen Sexually Sexual desire Loss or absence Sexual arousal Decreased or loss of lubrication Decreased sensation in vulva, clitoris, breasts and nipples Difficulties feeling sexually aroused or excited Orgasm Decreased clitoral response Not as consistent, intense or pleasurable Sexual pain Sharp, localized pain or burning sensation 4
Treatments Impacting Intimacy And Sexuality 5 Hormonal treatments Menopause (full/partial), most traumatic if sudden Loss menses Decrease/loss of sexual desire, feeling asexual Feeling sexually numb, not able to get sexually turned on or aroused Compromised fertility Vagina: internal structure (shortening, tightening, thinning, loss of Rugae) Low/absent lubrication
Treatments Impacting Intimacy And Sexuality Hormonal treatments Hot flashes, night sweats Decrease in energy level Sleep deprivation/insomnia Weight gain. And it just won t come off Increased emotional lability/sensitivity Alternating emotions of sadness, anxiety, worry Increased irritability/short fusedness, anger or frustration 6
Treatments Impacting Intimacy And Chemotherapy Decreased energy level, fatigue Irregular or loss of menses Compromised fertility Post-infusion caution for sexual activities with penetration Decreased cognitive function, the chemo brain Increased risk of bladder, vaginal infection Sexuality 7
Treatments Impacting Intimacy And Sexuality Radiation (latent vs. immediate effects) Fatigue Scarring, burning, pain or discomfort Hormonal loss/decrease if near pituitary gland 8
Altered physical appearance Breast asymmetry Scarring, skin discoloration, texture Hair loss/thinning Weight gain Decreased self/body image Feeling sexually unattractive as a partner More self-conscious or critical Altered perception of sex Anticipatory anxiety Shame or embarrassment Other Treatment Impacts 9
Intimacy and Sexuality. What to do First things first, explore in solo: Set time aside to explore if and what changed Practice exploration of breasts, genital areas (look, vary pressure, location and speed) Practice being sexually mindful: the art of the here and now 10
Intimacy and Sexuality. What to do Be creative, bring in the sex toys: A must: a good lubricant for every sexual encounter Short acting/external (Pink, K-Y, slippery stuff, Astroglide) or long acting/internal (Replens, KY ) Vibrators vs. vasocongestive toys (Silver bullet, Eros CTD) Viagra??!! What about your favorite sexual fantasies? Sexual literature (visual or erotic fiction) 11
Intimacy and Sexuality. What to do If pain, discomfort Vaginal dilators with deep breathing To help with the intensity of your orgasms Pelvic muscle exercises (Kegels)with/out vaginal weights 12
Couple Intimacy and Sexuality. What to do Pick a good time and place, yes it s about planning Communication of fears, concerns, barriers to resuming sexual life The weekly couple block of time or date exercise Re-define your sexual encounters Start with sensual, non-goal oriented sexual encounters Aim for variety, not all encounters need to include penile penetration and lead to an orgasm for both Bring in the lub and the sex toys 13 Be proactive vs. passive: Share sexual advances Guide your partner s hand to preferred area or way of caressing
Couple Intimacy and Sexuality. What to do Sexual mindfulness: where is your mind during sex? Wanders too much on what s not or should be happening How unattractive your is to him/her How disappointed he/she must feel How long this orgasm is taking 14
Changes in Intimacy and Sexuality. What else may help Exercise. It may improve Sexual desire, orgasm intensity, body/self-image Weight gain, loss of muscle mass Sleep Cognitive function Treat depression, anxiety Medication with psychotherapy Switch SSRI (Paxil) to SNRI (Wellbutrin) Seek the help of a sex/couple therapist 15
Concluding Thoughts Get the whole story about the possible changes and what can be done about it Start by re-connecting with sex alone before you try stuff with your partner Keep the sexual communication channels open Don t give up. Set backs are part of a slow, gradual learning process 16