“Doctor, your chemo and hormone treatment saved my life, but I’m dead down there!”*

Does this sound familiar to you? One of the most common issues experienced by patients who have completed their chemotherapy for early stage breast cancer is related to sexuality. These include

• Lack of desire (libido)
• Vaginal symptoms with intercourse: pain, bleeding
• Inability to climax

Treatment of breast cancer often includes chemotherapy that causes menopause and that may be further complicated by medicines that reduce estrogen levels. Estrogen is necessary for the normal functioning of a woman’s genital tract including the vagina AND the lower part of the urinary tube (“urethra”) thru which the urine passes. The lack of estrogen makes the tissues very thin and susceptible to being torn (like a “skinned knee”) and this may cause pain and bleeding with intercourse, and make women more susceptible to urine infections.

To properly address these issues, we need

• FIRST: To check the health of the genital tract.
  • A gynecologist will check on the condition of the genital tract, that is: the outside (“exterior” or “perineum”) tissues, the vagina, the cervix, the uterus, the ovaries, and the examination of the other pelvic tissues.
  • If there is a specific problem, often correcting that may allow normal sexuality
  • However, most of the time, this is a complex issue which includes both BODY and MIND.
• SECOND: A psychologist or sexual therapist can review the mental or psychological aspects of sexuality
  • I am always reminded of a quote from (I think) Goethe. He was a charismatic and engaging man, but was apparently not very attractive. He was apparently quoted as saying, “Give me 5 minutes with a woman and she will forget my face!”
  • And another quote from a wise person whose name escapes me: “The most important sexual organ is…THE MIND!”
  • The issue of “desire” is really an issue for “behavior modification.” At the Breast Cancer Symposium in September 2010, Dr Michael L Krychman talked about “mindfulness therapy” to address this.

Dr Krychman has written a very informative book, pictured above, that I highly recommend. You can read extending excerpts from it online by clicking on Dr Krychman’s name. The title of this blog was a quote from one of his patients!

Next blog, we’ll summarize some of his recommendations about vaginal moisturizers.

  Dr Holmes