Sex "Hurts" After Cancer: Hormone Replacement HRT, Lubrication and Loving Touch

Dear Susan,

I hope you can help me. After I had breast cancer I became rather dry and sex started to hurt (well penetration does).

The pain is consistent and sharp. (Well, it starts at penetration and is sharper when thrusting and eases a little when pulling back) . If I had to compare it to anything, I would probably say that it kind of “feels like the first time.”  Only then it subsides after 2 or 3 thrusts. Now it doesn’t. Now I  cannot bear a second thrust, let alone a third. It is as if I’m a couple of sizes too small! I also have that same pain when the gynecologist uses her special ‘thongs’ to take a pap smear, only then it hurts only a little.

In the mean time I’m in menopause as well. I would love to have normal sex again, but it hurts even with lubricants and I cannot have HRT or even hormonal creams because of the cancer history. My doctor told me, “There are other ways to make love.” In other words “learn to live with it.”

My doctor has told me that HRT and anything hormone related (cremes as well) are too big a risk for me, as my breast cancer was a very aggressive and hormone related/fed cancer. Apparently they don’t want to risk it as even cremes would probably introduce small amounts of the hormones in my blood stream and thus put me at higher risk of relapse and get breast cancer all over again.

Do you have any advice for me?

I am really desperate. I’m only 51 and consider myself far too young to never have fulfilling sex again.

I used to be able to have normal sex and I would love to have that again with my new partner.

Nancy

Dear Nancy,

You are not alone and there are many things you can try.  I sought the advice of a couple of my trusted experts and here’s what they said:

ADVICE FROM DR. DEBORAH METZGER, Endocrinologist/Gynecologist

Dear Nancy,

There are over 30 published medical articles covering tests of HRT given to women with breast cancer (you can find them online and read for yourself) and there does not appear to be any evidence that there is an increase in recurrence of cancer.

If this is unacceptable, then you might want to put a capsule of DHEA vaginally, which may help.

The other alternative is to use a small amount of estradiol vaginally.  To reassure my patients who choose this option, I measure their estradiol level before and after starting the estradiol.

Hope this helps!

Dr. Metzger

Deborah A. Metzger, PhD, MD
Harmony Women’s Health
650-229-1010
650-229-1011 fax
[email protected]
www.harmonywomenshealth.com

Note: The body of medical research on HRT and cancer continues to get updated since the media scare of nearly a dozen years ago. Sometimes your doctor may not be up on the latest research. Search online and take the articles in to your doctor for an updated opinion.

ADVICE FROM CHAS AUGUST, Relationship Expert and Sexual/Cancer Analyst

Dear Nancy,

Here are some excerpts from a blog post I wrote all about this issue:

For women undergoing treatment for cancer, that treatment most often includes a chemically induced “menopause”, a turning off of your estrogen production.  Estrogen triggers vaginal and clitoral engorgement, as well as lubrication, all of which supports libido.  No estrogen and soon you will experience vaginal dryness and/or clitoral tenderness.  The vaginal walls can become “friable” – dry, readily crumbled, brittle.  Penetration will feel uncomfortable, maybe even painful.  Fear of that pain or discomfort will compound the dryness and soreness.  The dryness and soreness will compound the fear. The more discomfort the less libido.  And one day, there you are, in a sexless relationship.

I was taking to women’s health expert Dr Jeanne Alexander (MD, Psychiatrist) about what can be done to get healthy sexuality back into a relationship and we agreed that there is no substitute for behavior.  If you want the physical intimacy back in your relationship, when you feel ready to gently begin to bring sexuality back into your connection, you are very likely NOT going feel libido – horniness, desire.   Even in the absence of that desire, schedule time for sexuality with your partner (make a date), then, keep that date.

Don’t just jump into bed and start “doing it”.  Romance each other.  Candlelit dinner?  Music? A Fox-trot?  Talk, flirt, laugh.  It’s OK to talk about your fear, your lack of “fire”, but don’t let that stop you.  Make sure the date includes getting naked and holding each other, perhaps massaging or caressing each other from head to toe? If you want to try some manual stimulation, have a bottle of lubricant open, nearby, and use a lot of lubricant.  Make an agreement that no “performance is required – she doesn’t “need” to lubricate, he doesn’t “need” to get hard.  Just let your bodies remember how nice it feels to give and receive loving touch.

About hormone cremes:  I am not an oncologist and cannot offer medical advice.  IMO, you would benefit from a second or third opinion about the risks and benefits of a a very mild hormone creme to reduce vaginal friability.  That said, your current Doctor may be giving you the exact, best advice.

Hope this helps.

Chas August
Intimacy, Relationship and Life Counseling
http://chasaugust.com/

With love,
Susan Bratton