Amid the onslaught of questions and worries that can be prompted by a bladder or kidney cancer diagnosis, most women are not immediately concerned with how the disease and its treatment might affect their sex life. Though sex may not be as top-of-mind as issues like survival itself or caring for a family, it is still a significant aspect of quality of life that is worth preserving and nurturing.
Maintaining a healthy sex life while dealing with cancer requires open and honest discussion both between partners as well as with a cancer care provider, but it may be difficult to know exactly what to discuss. We spoke with Dr. Tanaka Dune, a urogynecologist within the Weill Cornell Medicine and NewYork-Presbyterian Hospital (WCM/NYP) Center for Female Pelvic Health, and our Genitourinary (GU) Oncology Program’s own Dr. Ana Molina to find out how to guide the conversation.
Fighting cancer can be physically and mentally exhausting, leaving many women without much energy or desire to engage in sexual activity. Additionally, the potential aesthetic changes to the body caused by treatment, such as scarring, hair loss and weight fluctuation may hamper confidence or lead to feelings of unattractiveness. Yet, if all parties are consenting and communicative, it is safe to have sex during and after cancer treatment.
Women should be aware, however, that certain types of chemotherapy can damage the ovaries and lead to vaginal dryness, irritation and/or atrophy (thinning and shrinking of vaginal tissue due to lack of estrogen), which may cause discomfort during sex and otherwise.
“You should never be aware of your vagina,” says Dr. Dune. “If you become aware, that’s when you need to start talking about it.”
Healthcare providers work with the best interest of the whole person in mind, so women do not need to be afraid to ask questions or feel embarrassed about how much they do or do not know about sexuality. Clinician assistance often leads to better patient health outcomes, faster. For example, it can be difficult for women to discern between pain in the vagina and pain in the pelvic floor, the network of muscles that supports the vagina and other pelvic organs, and a doctor can ask clarifying questions to determine the appropriate next steps to treat the issue and suppress the pain.
As with most elements of cancer care, there is no one-size-fits-all approach to navigating sex during and after treatment.
To combat chemo-induced vaginal dryness, for example, lubrication options are abundant, granting patients the ability to customize based on individual needs and preferences. Certain compounds found in lubricants can trigger yeast infection, irritate the vulva and/or dry out vaginal and anal tissues, so women should avoid using petroleum-based lubricants like mineral oil or Vaseline, as well as those that contain nonoxynol-9, glycerin, glycols or parabens. Instead, they can opt for silicone- or water-based lubricants, or natural oil lubricants like vegetable, olive, peanut, avocado or coconut oil. To reduce vaginal tightness, doctors may recommend use of pelvic floor physical therapists, who teach exercises that involve contracting and relaxing vaginal and pelvic floor muscles. This type of therapy can be achieved manually and/or with the use of vaginal dilators.
For issues of insecurity and anxiety that may disturb some women’s sex lives, possible remedies include psycho-social and/or psycho-sexual support services. The WCM/NYP Genitourinary Oncology Program connects patients and spouses/partners with support groups and counseling and can even offer hair-preserving cold cap therapy or a wig prescription to combat chemotherapy-induced hair loss that may contribute to a lack of confidence.
“Addressing psycho-social issues together with your partner via counseling or support groups can have a positive impact on your life and intimate relationships,” says Dr. Ana Molina.
Since most forms of cancer treatment weaken the immune system, it is especially important that women use barrier protection during oral, anal and vaginal sex to prevent exchange of bodily fluids that can lead to sexually transmitted disease.
Patients should note that while the Internet is a fantastic tool for resources and self-education – often preferred because of the ability to search for information within the comfort of one’s own home – it is best to check with a healthcare team before acting on health advice found online.