— Experts Say Yes.
You may find yourself facing physical changes and emotional challenges, but you can overcome them.
If you’ve recently gone through lifesaving breast cancer treatment, you may be looking forward to better days ahead. But as you try to get back to “normal life,” you might notice a change in your libido.
“Cancer treatment across the board can take a significant toll on the body, and breast cancer is no different,” says Gabriel Cartagena, PhD, a clinical psychologist at Smilow Cancer Hospital at Yale New Haven and an assistant professor at Yale School of Medicine in New Haven, Connecticut.
About 60 to 70 percent of breast cancer survivors report sexuality issues after treatment, according to a study published in 2019 in Breast Cancer, so if you’re having that experience, know that many other women are, too. We asked the experts and have some treatments and tips to help you fire up your sex life after breast cancer.
How Breast Cancer Affects Your Libido
So you can understand how to combat a low libido after breast cancer treatment and take back your sexuality, let’s look at the causes.
Premature Menopause
Several cancer therapies can lead to premature menopause, according to a study published in 2022 in the Journal of Clinical Medicine. Chemotherapy and radiation therapy, for example, can decrease hormone levels in your body and make your menstrual cycle slow down or stop altogether, says Mary Jane Minkin, MD, a codirector of the sexuality, intimacy, and menopause program for cancer survivors at Yale Cancer Center and Smilow Cancer Hospital. For women whose breast cancer is fueled by estrogen, treatment may include medication to block the production of estrogen, or surgical removal of the ovaries. These measures, too, can bring on premature menopause. With menopause symptoms like hot flashes, insomnia, and dry mouth, sex may be the last thing on your mind.
Emotional Distress
A breast cancer diagnosis comes with a lot of emotions. Women diagnosed with breast cancer can be at a higher risk for mental health issues like depression and anxiety, neither of which are conducive to a high libido, according to a study published in 2021.
Vaginal Dryness
When your estrogen takes a nosedive during and after treatment, your vagina can become very dry, says Dr. Minkin. Lack of lubrication in this area can make sex uncomfortable or even painful, according to the American Cancer Society (ACS).
Painful Sex
Painful sex can also arise from pelvic floor dysfunction, which means the muscles in and around your pelvis can be too tight or too loose. That’s according to the research published in the Journal of Clinical Medicine, which also found that women may experience chronic pelvic pain syndrome (unexplained pain in your pelvis) after breast cancer treatment.
Body Changes
If you have had surgery or other body changes during treatment, such as removal or reconstruction of one or both breasts, you may not feel like revealing the new you in a sexual encounter, and new or missing sensations can make it hard to get in the mood. “Many women who have lost breast tissue, particularly if they have lost nipples, may feel [less] sensation in their breasts, and many women find breast stimulation important for sex,” says Minkin.
How to Get Your Groove Back
This list may feel discouraging to read, but you shouldn’t lose hope. “The important thing is that we can help with most of these issues,” says Minkin.
Medications Minkin recommends nonhormonal (estrogen-free) medications to help with symptoms of early menopause. “An over-the-counter herbal product called Ristela can help improve pelvic blood flow and enhance libido,” Minkin says. One meta-analysis published in 2021 found that women who took Ristela and similar products that contain the amino acid L-arginine experienced more sexual arousal, better lubrication, more frequent orgasms, and less discomfort or pain. Many participants reported no side effects at all, but a few experienced an upset stomach, heavier menstrual bleeding, and headache.
“Women can also consult with their providers about using prescription nonhormonal medications called flibanserin (Addyi) or bremelanotide (Vyleesi),” Minkin says. Addyi may be less effective than other options, and can cause fatigue and drowsiness, according to a meta-analysis published in 2022 in Sexual Medicine. Vyleesi, on the other hand, has shown more promise, according to a study published in 2019, with uncommon mild side effects like nausea, flushing, and headaches.
If your low libido stems from feelings of depression or anxiety, medications, often in combination with psychotherapy, are an option you can discuss with your healthcare provider.
Vaginal moisturizers For vaginal dryness, Minkin often suggests over-the-counter nonhormonal vaginal moisturizers, like Replens and Revaree, which are inserted into the vagina with an applicator a few times a week. “[These] work very nicely for many women,” Minkin says.
Toys A vibrator or similar device could be a worthwhile investment. They can boost sensation and increase blood flow to your pelvis, says Minkin, both of which can amplify desire.
Therapy One or more sessions with a counselor can be helpful, says Minkin. Sexual health counselors often use cognitive behavioral techniques to discover the “why” behind your low libido, and help you unlock thought patterns that may be blocking your sexual drive, according to a study published in 2020. Therapy is also an effective treatment for depression and anxiety.
Vaginal hormones Hormone replacement therapy is often used to treat menopause symptoms. But if you’ve had breast cancer, it may increase the risk that it will come back, especially if your cancer is sensitive to hormones. With vaginal hormonal treatments, a cream, tablet, or ring containing low-dose estrogen is placed directly in your vagina to aid lubrication and strengthen the vaginal lining. Because much less estrogen gets into your bloodstream, this option is generally considered safe, according to the North American Menopause Society. Your healthcare provider can help you decide if hormone treatments are right for you.
Get Reacquainted With Your Body
Breast cancer treatment can leave you feeling like you’re living in a stranger’s body. “A stark change like a mastectomy can leave women feeling separated from themselves,” says Dr. Cartagena. But every woman can get to know and accept her new body.
Reintroduce Yourself Gradually
“The process to reknow your body takes time and begins in small steps,” says Cartagena, who suggests a first step could be to get dressed in the morning with the lights on. After a few days or weeks of this, you might try spending 10 seconds observing your body in the mirror.
“Exposing yourself to your body little by little can allow you to gradually grieve what is different and take notice of what is new that is still important to you,” explains Cartagena.
Reframe Your Sexual Desires
Sex after cancer may look different, and mourning lost sensations is very important, says Cartagena. Looking forward, he encourages breast cancer survivors to study what sex means to them by asking questions like, “What feels good now?”
“If penetrative sex still evokes pain, a patient can explore foreplay, different forms of stimulation, or other forms of intimacy to induce different, fulfilling sensations,” says Cartegena. Sex doesn’t have to mean one thing — it can be whatever you need or want it to be.
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