How to talk to your Doctor about sex

Get your problem out in the open so you and your doctor can work on a solution. That’s a big hurdle for many people. In fact, one of the biggest barriers to sexual health is that people don’t want to talk about it. Here’s how to get that conversation started.

Sexual Health Issues

Your mental, physical and emotional health affects your sex life. Some issues may affect your ability to have or enjoy sex. Others may affect your interest in sex. Fear of a bad sexual experience might cause you to avoid sex. If you are dealing with any of these common sexual health issues, talk with your doctor:

• Vaginal dryness

• Painful intercourse

• Decreased interest in sex

• Fear of falling pregnant

• Illness, medications or surgery

Improvements in the diagnosis and management of cancer have increased quality of life for patients with cancer both during and after treatment. Many cancer patients are in relationships where sexual activity is part of their lives. Unprotected intercourse can result in pregnancy even when the chance of fertility is considered minimal. Pregnancy may be undesired because of the potential teratogenic effects of cancer treatments, or fear that the pregnancy will negatively affect the course of the cancer. Women undergoing cancer treatment and female cancer survivors are more likely to terminate pregnancy, an action that has psychological and emotional consequences. As a result, it is important to provide appropriate counselling about contraception to these women.

Many contraceptive options are available to female cancer patients and survivors, and the choice can be individualised to the patient’s circumstances. The type of cancer, the age of the patient, her ovarian reserve, comorbid conditions, and potential non-contraceptive benefits all must be taken into account with this decision. It also should be considered that some of the contraceptive options offer protection against certain types of cancer.

With the use of effective and appropriate contraception, women who are undergoing cancer treatment or who have survived cancer can maintain as normal an everyday life as possible without the fear of an undesired pregnancy or of harming their health.

How to manage pain with intercourse and vaginal dryness after breast cancer treatment

If you’ve undergone treatment for breast cancer with chemo or hormonal therapy, you may have experienced changes in sexual function, a side effect that can impact both premenopausal and postmenopausal women. Changes that may affect sexual function for premenopausal women can include irregular menstrual cycles and menopause and related symptoms, while both premenopausal and postmenopausal women can experience reduced sexual desire, vaginal dryness, and inflammation of the vaginal lining that results in burning and redness. Although sexual dysfunction is a difficult side effect to cope with, the following approaches can help you manage your symptoms and once again enjoy intimacy:

Topical anaesthetics may be helpful for patients with severe pain. The most common preparation is 5% lidocaine ointment, which is applied at least one hour prior to intercourse. These anaesthetics have no effect on sexual pleasure, however, over-the-counter lubricants may also be recommended; these include Replens®, K-Y® lubricants, Vagisil®, Astroglide®, Pre-Seed®, Femglide®, and Conceive® a wonderful product whether you are planning to conceive or not.

Low-dose vaginal estrogen therapy may help control vaginal dryness and sexual pain, though their use for breast cancer patients is controversial due to concerns that oestrogen may raise risk for recurrence. Some sexually active breast cancer survivors, however, were more comfortable using vaginal oestrogen treatment when closely monitored, as this method results in less systemic oestrogen absorption than the oral or skin route (patch). There have been no clinical studies showing an adverse effect on survival or recurrence of cancer with vaginal oestrogen use in breast cancer survivors. Vagifem® (estradiol vaginal tablets) and Estring® (estradiol vaginal ring) are preferred over vaginal oestrogen creams by patients; both agents have demonstrated a 90% improvement in atrophic symptoms.

Active management of sexual dysfunction after breast cancer treatment may further help alleviate symptoms by allowing survivors to enjoy regular sexual activity, which can have its own therapeutic effects: regular sexual activity has been shown to improve vaginal atrophy by stimulating blood flow to the area.

Start the conversation with your doctor ASAP.

Written by Prof Elna McIntosh

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