Hi! I am Barbara Musser, founder of Sexy After Cancer. My passion is helping women with breast cancer to know that they are beautiful, feminine, desirable and sexy, and that they can absolutely have a fabulous intimate and sexual life after cancer treatments.
The Best and Worst Things to Say and Do When it Comes to Intimacy and Sexuality
Communication is the most important element to opening doors to intimacy and sexuality. It’s a slippery slope because we live in a culture with a lot of taboos and shaming about talking about sex and intimacy. As a result, we don’t know how to do it gracefully and it can feel awkward or scary. Add to that, that many of us think our partner should be able to read our mind ~ have you ever said or thought, “If you really loved me, I wouldn’t have to tell you what I want or need because you should know…”? Those words and thoughts can crush intimacy faster than anything.
When we add cancer to the mix, we can become more sensitive, tender, fragile and traumatized, especially when it comes to intimacy and sexuality. Many women feel like “damaged goods”, less attractive and desirable and definitely less sexy. If our breasts are altered or removed, it’s a small step to thinking that we’re less of a woman. We can become hypersensitive to stresses and gaffs, less sure of ourselves and filled with doubt. We can also become sensitive to acts of kindness and compassion.
So matters related to intimacy and sexuality can suddenly feel like being on a roller coaster with lots of unexpected twists and turns. It’s both the challenge and the opportunity to know what to say and do as well as how and when.
In the interest of helping with these topics, here are the best and worst things to know about communicating with your partner about intimacy and sexuality, and why communication really is the best lubrication.
Worst Things to Say and Do
1.Expecting your partner to be a mind reader
When we want our partner to intuitively or automatically know what we want, it’s easy to get into the rut of withholding ourselves. Holding your honey hostage in this way only increases their tension and can have them scrambling for answers that they are clueless about. Any hint of righteousness will kill the spark of intimacy.
2. Being impatient
The days of the quickie are probably over. Between surgeries and other treatments, many women experience sexual difficulties, from loss of libido (the urge to be sexual) to sudden menopause and vaginal atrophy. If we’re afraid that sex is going to hurt, it’s impossible to relax and open. That fear causes contraction in our blood vessels and tissues so that lubrication and the ability to relax our muscles disappear. Trying to get through this quickly can be disastrous.
3. Losing your sense of humor
Taking this all too seriously takes all the fun out of intimacy and sex play. I’m not suggesting making jokes; but rather that you lighten up a bit and relax your expectations. Our bodies, emotions and spirits are radically altered by the cancer experience and this is all new terrain to explore.
4. Expecting things to be the same as before cancer
One of the biggest sources of grief is the loss of who we were, and waiting or hoping that we’ll go back to how we were. When we realize this, grief can rise to the surface, along with some anger and fear, as well as lots of other emotions. Resisting these changes keeps the feelings stuck inside, which makes communication difficult.
Best Things to Say and Do
- Be compassionate and kind
Cancer is a traumatic insult to our psyche, heart, mind and body. When treatment ends or is managed and we’re back to integrating who we are now into life, the question that often comes up is, “Now what?” Even though things may look the same, we are radically altered and everything can feel new.
- Take orgasm off the table
Sometimes we’re do focused on the race to orgasm that we miss the journey along the way. Performance anxiety is like a wet blanket on sexuality, so just take it out of the equation. There are lots of other things that you can do that are sexy, hot and fun, including making out, stroking each other from head to toe and reading erotica.
- Get creative
Remember how you liked to play when you were little and how easy it was to make up games? The same principle applies here. Before you get into bed, sit together and brainstorm about things you might like to try to be playful and intimate. As you brainstorm, just let the ideas and words flow between you and jot down some notes to help you remember.
~ Barbara Musser
Ahhhhhhhh, estrogen…. the very essence of a woman. It is the hormone responsible for many things that make a woman a WOMAN such as breast development, libido, and intelligence (wink). Men also produce estrogen, but in very small amounts. Hence why they lag behind women in the niceness department (as well as breast size…in most cases).
One of the purposes of estrogen in women is to make the sex organs ready, willing, and more importantly able, to have enjoyable sex. Unfortunately, after menopause, even if it is chemo induced menopause, the “kitty” may become unresponsive. But wait, there is hope!
If you are in your twenties or thirties, without medical complications, you probably don’t need extra estrogen as your ovaries and adrenal glands are hard at work producing enough female hormones to keep you feeling healthy and “horney”!
However, as estrogen wanes, due to menopause, drugs, or health issues, the following can happen:
- increased cholesterol, causing arteries to become clogged and possibly leading to a heart attack.
- decreased bone density, possibly causing osteoporosis
- “hot flashes” or incredibly annoying episodes where you feel as if you will spontaneously combust
- sleep disturbance…either insomnia or waking up during the night
- mood swings including (but not limited to…) general bitchiness, homicidal tendencies, and spontaneously crying at Hallmark commercials
- vaginal dryness, and a compulsive tendency to methodically repeat the phrase, “Not tonight honey, I have a headache”.
If you are post menopausal, or have had a hysterectomy that includes an oophorectomy (removal of the ovaries), or if you take medications for estrogen-receptor positive breast cancer, then, I hate to break it to you, but your estrogen has been sucked dry (pardon the pun).
What is Hormone Replacement Therapy (HRT)?
Not so many years ago, if you went to your doctor with any of the above symptoms, he/she would likely have written a prescription for a hormone replacement therapy (HRT) pill. Most likely it would have been the drug Premarin. Premarin is produced from pregnant mares’ urine (hence the name: PREgnant-MAre’s-uRINe). I dunno, call me crazy but I find it hard to believe that ingesting anything from the pee of a horse can be good for the body (it ranks right up there with the eye of a newt or the spit of a toad to me. Somebody stop me if I am carrying the witch analogy too far). However, before Premarin, the only option available to women in menopause was to take injections of hormones. Needless to say, when Premarin was released in pill form, women lined up for it.
But creating a chemical from something that you would not usually ingest and metabolize (horse pee) and as with any pharmaceuticals, Premarin was not without side effects.
Synthetic hormones, such as Premarin, do not work “in tune” with your body (unless you are a horse) and therefore may produce more problems than they were meant to correct. Some of the risks associated with this drug are cervical cancer, breast cancer, and blood clots. Hmmmm, let me think this over, so I go into early menopause because of my breast cancer, then I have to take a HRT which may cause breast cancer. Something just does not add up here.
Mother Nature to the Rescue
Bioidentical hormone replacements are estrogen medications made from plants, namely soy and wild yams (not sweet potatoes) and they mimic, more closely, the actions and mechanisms of your own body’s natural hormones. While still a form of HRT, they are a more “natural” way to get your hormones because they are made from substances your body recognizes like food. However, while bioidenticals may seem like the obvious choice (given the many pregnant, beer guzzling mares out there needing a break), more studies need to be done to determine their long-term side effects. And like synthetic hormone replacement, those with estrogen receptor positive cancers won’t be candidates for bioidenticals, unfortunately.
I can’t take estrogen, so what do I do now?
Poor kitty before estrogen cream
O.K then, here is where it gets personal…..My only problem was with the kitty. After having a bilateral mastectomy, chemotherapy for stage III breast cancer fried my ovaries and I entered the no-estrogen zone. Then, three years later, I was treated to a hysterectomy with an oophorectomy (all girl parts including ovaries removed) because of a benign uterine tumor. This left me void of every part that made me a female of the species…..no boobs, no ovaries, no uterus, I was officially an android! And understandably, my kitty suffered greatly. (The official medical term is “vulvovaginal atrophy” or “VVA” as us hip-but-shrivelled-up gals call it.) Imagine, if you will, going from a plump juicy grape to a five-year-old raisin…..that has been left out of the box…..in the scorching sun…..O.K, I’m sure you get the picture. And the worst part was, I really thought I just had to “suck it up” and there was nothing I could do about it. But luckily for me (and ole fluffy), I was wrong.
Women with a history of breast cancer, specifically estrogen receptor positive breast cancer, should not go near estrogen, or anything that resembles estrogen, because of the increased risk of stirring up those cancer cells that are fed by said hormone. However, here is the good news: It is possible to have your estrogen, and NOT eat it too. Using low dose estrogen directly on the vaginal tissue is an extremely safe and effective alternative to hormone pills or injections if your kitty is your only issue.
The vaginal wall tissue is like a sponge when it comes to soaking up estrogen preparations. This has a direct effect on the thinning vaginal wall tissue and actually brings it back to life. It changes the appearance, the plumpness, the color, and the ability to lubricate. It really was amazing to see and experience the change. (My spouse thought it was pretty cool too.)
An extremely small amount of the estrogen is absorbed into your body, but based on recent and ongoing research, it is not enough to increase the risk of cancer recurrence and it’s safety is currently widely accepted in the medical community.
I have the cream prepared in a compounding pharmacy using bioidentical estrogen because then I can get the estrogen made with natural ingredients and without all the chemical preservatives that the drug companies use in their preparations. (I don’t use paraben preservatives because of their ties to cancer.) A single dose of the cream is inserted into the vagina several times a week for 6 weeks, then weekly to maintain kitty health. Dosages vary, but the dose is going to be hundreds of times less than any oral hormone replacement therapy you would ever get.
Same kitty after 6 weeks of vaginal estrogen cream.
The result, in my case, was so worth the effort. Not only were things working well in the “customer satisfaction” department, but I also cut my risk of bladder infections dramatically. Bladder infections, or UTI’s are common in postmenopausal women because the tube for the bladder is right next to the vagina. When the vagina and the tissue around it is dry and shrunken, the whole area becomes malformed leaving a slight opening to the bladder where there should be plump tissue to cover it. This opening allows bacteria to enter the bladder causing frequent infections. Plumping the tissue closes the path for bacteria and reduces the risk for infection.
If kitty is looking a bit haggard, or you are getting recurrent bladder infections, see your gynecologist to discuss topical bioidentical estrogen therapy to see if it’s right for you. You’ve got nothing to lose but ol’ wrinkle-puss.
Note: Be aware that not all compounding pharmacies know what they are doing. It is important that you find a compounding pharmacy from your doctor that has lots of experience with these types of preparations.
Reproduced with permission from Susan Gonzalez, RN … From the publication “100 Perks of Having Cancer plus 100 Health Tips for Surviving It”