Used to Feel So Good, Now it Feels SO Baaaaad…

by Marloe EschJune 14, 2019View more posts from Marloe Esch

The Vulvovaginal Blues

Disclaimer: This information is not a substitute for medical care.  Always inform your healthcare team of any concerning symptoms you are experiencing, and consult with your provider before initiating new treatments, therapies, or health routines.

Was just me and my baby
late last night [insert harmonica]
we tried to get sexy
but somethin’ ain’t right….

Ok, so maybe I’m not the greatest lyricist, but there’s a good chance you know what I’m talking about.  Symptoms like vaginal and vulvar (external genital) dryness, along with itching, burning, and irritation are common after cancer.  I call these the Vulvovaginal Blues, and experiencing them can put a serious damper on sexual trysts with your honey.  But even if you’ve noticed that your lady-bits don’t respond exactly as they used to, that doesn’t mean that you are broken or doomed to life of putting up with disappointing, uncomfortable sex.

What’s Cancer Got to Do With it?

Healthy blood vessels, nerves, and hormones all play a role in the genital changes that happen during sexual arousal.  Unfortunately, certain cancer treatments can disrupt any part of this complex process.  For example, pelvic surgery or radiation can alter the blood or nerve supply to your genitals, or cause tissue damage and scar formation.  This can change how stretchy or flexible your vagina is and decrease the tissue’s ability to naturally lubricate when you get excited.

Treatments can also have an impact on the hormone estrogen, which plays a big role in both maintaining a normal vaginal environment and promoting blood flow and lubrication with sexual excitement.  If your ovaries are removed by surgery or damaged with chemotherapy or radiation, estrogen levels drop. Radiation or surgery to the area of your brain that regulates how your ovaries function can also lead to low estrogen.  And endocrine therapy (also called hormone therapy) can alter how estrogen works in your body or stop estrogen production altogether.

So, What’s a Girl to Do?

Consider this: What if we were as diligent about our genital health as we are about our oral hygiene?  I’m serious!  If we brush and floss daily in the name of preventing cavities and gingivitis, surely we can adopt some simple strategies to help alleviate the Vulvovaginal Blues. In the words of stellar sex therapist Sallie Foley, our vulvovaginal maintenance mantra should be to Moisturize, Lubricate, Stretch!”

Vaginal Moisturizers… For Maintenance

Vaginal moisturizers are non-hormonal, over-the-counter (OTC) products that are designed to maintain day-to-day vaginal comfort.  They absorb into the vaginal wall and help the cells lining your vagina hold moisture.  It’s kind of like… hand lotion, but for your vagina (note: don’t actually use hand or body lotion – these can easily irritate sensitive genital tissue!).  Moisturizers come in a tampon-like applicator or as a vaginal suppository, and should be applied regularly, up to 2-5 times weekly.  Look for ones that contain vitamin E or hyaluronic acid, such as Hyalo-GYN.  Other brands include Replens and K-Y Liquibeads.  Ask your provider for recommendations.

Personal Lubricants… For Lovin’

These are non-hormonal, OTC products intended for use during any type of sexual activity or touch (not just penetration) to reduce friction and promote comfort.  The trick is to apply lube liberally to the vulva, vagina, and your partner prior to sexual play.  Lubes can be water-based, silicone-based, or oil-based.  Water-based lubes are easy to wash off and non-staining, and they are compatible with latex condoms and safe for silicone sex toys.  Silicone-based lubes are long-lasting and compatible with latex condoms, but cannot be used with silicone sex toys.

Water- or silicone-based lubricants are generally recommended over oil-based lubes (such as petroleum jelly, mineral or baby oil, and natural oils like olive, coconut, avocado, and peanut) for a few reasons.  For one thing, oil-based lubricants are not compatible with latex condoms.  Additionally, they may trap bacteria and increase risk of vaginal infection.  Some oils can also be irritating to mucosal tissue (olive oil), or may disrupt healthy vaginal bacteria (coconut oil).

Consider avoiding lubes with glycerin, which can be drying and may increase the risk of yeast infections.  Glycerin also increases lube osmolality (yes, I said lube osmolality – flashback to 7th grade science!), which cause tissue damage.  You may also want to avoid certain preservatives, like chlorhexidine, which can disturb the balance of healthy vaginal bacteria. For this same reason, the pH level of a lube is important, too.  Other potential irritants include dyes, scents, flavors, or lubes marketed as “sensation enhancing.” (Seriously, you guys; that warm tingly feeling is from capsaicin – an extract from hot chili peppers!)  A general rule of thumb is the more unnecessary additives, the more likely it is to be irritating to genital tissues.

Confused yet?  I get it — shopping for lube can be intimidating if you don’t know exactly what you’re looking for.  The bottom line is that there are many options when it comes to lube, and not all of them are created equal.  More details about personal lubricants can be found in two great resources from Dr. Lynn Wang, and at A Woman’s Touch.

The consultants at your local sexual health shop are also a wealth of information and would be happy to help you sort through the Land-o’-Lubes.  Or you can also order online, if you prefer.  Either way, I’d recommend starting with several samples and trying them out.  Tell your partner it’s all in the name of research!

Stimulation and Stretch

Do you stretch in the mornings after getting out of bed, or as a part of your regular exercise routine?  Feels good, right?  Stretching our muscles can be invigorating, improve flexibility, and prevent against injury.  Well, as it turns out, a regular stretching routine can also benefit our genital health.  Gentle stretch and massage of vulvovaginal tissues promotes blood flow and improves natural lubrication, vaginal flexibility, and sensation.  Also, in the way that stretching before a run can loosen up our muscles and joints, a gentle stretching routine prior to engaging in sexual activity can improve comfort.   Check out the The Vaginal Renewal Program, developed by the sex-perts at A Woman’s Touch, for a how-to guide.

Isn’t There a Prescription for This?

In general, OTC vaginal moisturizers and personal lubricants can be super helpful in managing bothersome symptoms of vaginal dryness after certain cancer treatments, and both the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) recommend trying these first.  But for women who continue to have symptoms, it is worth asking your provider about prescription options.

Low-dose vaginal estrogen or DHEA (another type of hormone) are two types of prescription treatments for vulvovaginal symptoms.  Because there is limited research addressing whether or not topical hormonal treatments are safe for women with estrogen-dependent cancers, both the NCCN and ASCO guidelines stress the importance of discussing the risks and benefits with your provider.  Both safety and quality-of-life are important to take into consideration — be your own advocate!

Beyond the Blues

Discomfort with penetration is a common sexual complaint for young women who’ve been through treatments for cancer, and it’s often related to symptoms of vulvovaginal dryness.  But there are other possible reasons for pain with sex that should also be taken into consideration.

  • Did You Remember to Preheat? It’s funny because it’s true!  Women tend to require more time to warm up than our male counterparts, and sometimes we survivors just take a little longer to feel good-and-ready.  Try building interest and anticipation with kisses, snuggles, touch and massage on the couch for a while before moving things to the bedroom.  Or heck, use your new stimulation and stretch routine (see above) as your own private sexy-start-up.
  • Muscle Memory. Pelvic floor muscles can tighten around the vaginal entrance in response to touch or anticipation, making penetration difficult or painful. Physical therapists who specialize in treatment of the pelvic floor muscles can help women learn how to consciously relax these muscles and decrease discomfort.
  • Does Your Vagina Need a Sick Day? Bacterial vaginosis (BV), yeast infections, urinary tract infections (UTIs), and certain sexually transmitted infections (STIs) can cause pain or burning with intercourse.  Detection and treatment are key to improving symptoms.
  • Maybe it’s Mucositis. Providers are pretty good at warning us about oral mucositis – that raw, painful inflammation and ulceration that can happen inside our mouths with certain chemotherapies.  But ALL of our mucous membranes can actually be affected in this way, including our vaginal lining.  If you are concerned that this may be an issue, talk with your provider about your symptoms.  Avoid penetrative activities during this time to allow for healing and decrease risk for infection, and don’t introduce any moisturizers or lubricants to the area without first getting your provider’s OK.

Talk With Your Provider…

  • …if attempting penetration is painful. Ask for a physical exam, which can help determine whether there is something other than simply lack of lubrication that may be cause for concern.
  • …before starting a routine with vaginal moisturizers or a new lubricant, even if they are OTC. It’s also a good idea to check for sensitivities or allergies by testing a sample on the skin of your inner arm before applying to your genitals
  • …if the OTC things you’ve tried aren’t working
  • …if you think you may have an infection, vaginal mucositis, or muscle spasms
  • …if you have any other questions about your sexual health

A Couple of Final Thoughts

If you have a partner, he or she might also be a little confused about some of the changes to your sex life or how your body responds to touch.  Remind your partner that just because your body’s response has changed after cancer doesn’t mean that how you feel about them has changed!

Also, remember that there’s a lot more to sexual satisfaction and enjoyment than just our genital response.  Sex can be hard to talk about, but good communication and a willingness to be creative are crucial to overcoming any obstacles you might face.  Your sex life is worth the effort!

References:

:-)