Cancer and its treatment can affect women’s sexual health in many ways. What are some of the questions and issues you address?

 

Is the patient’s treatment going to put her into menopause? Or if a woman who’s on menopausal hormone therapy is diagnosed with breast cancer, is she going to have to stop estrogen? How can we help these women have a comfortable vagina so they will be able to have sex?

 

Is this something that will directly affect the patient’s sexual organs? For example, people who’ve had radiation therapy for intestinal cancers or genitourinary cancers may have direct scarring issues, which we can usually deal with.

 

If they’re having a mastectomy, it’s psychologically devastating for many women. They’re going to be losing a sexual body part. Body image is important. Trying to make sure that women realize they’re much more than just their breasts is important.

 

What about the side effects of cancer treatment in this area of women’s lives?

 

For some women, chemotherapy and other types of treatment will put them into menopause. And for some women, although not everybody, they’ll stay in menopause. If they have an estrogen receptor–positive breast cancer, most oncologists won’t be super thrilled with us giving estrogen therapy. Then we have alternatives that we can use to treat the menopausal symptoms. We now have a whole bunch of medications that are really pretty good at taking care of hot flashes, including a whole new class of nonhormonal drugs called NK3 receptor antagonists.

 

What are some other options you can offer for these issues?

 

We can give many of these women estrogen replacement therapy. For vaginal issues, we can often prescribe vaginal estrogen, and we can recommend they use dilators, which can help stretch things. We can do all sorts of cool stuff to help. We’re very big on telling all our patients that they have to have a vibrator. Vibrators actually have therapeutic value because they increase pelvic blood flow. So not only is it fun, but it’s also good for your pelvis. If a woman has a surgical procedure for a gynecological cancer that shortens her vagina, there are soft rubber rings that actually act as bumpers so that the penis can’t penetrate too far. It’s a terrific gadget. So almost any kind of cancer can have an impact, but the good news is we can take care of most of the stuff.

 

What is your message for people with cancer who are dealing with changes in sexual health and intimacy?

 

It doesn’t mean the end of your life as a woman. And it doesn’t mean you’re going to be miserable with menopausal symptoms forever. We have a lot of new things that weren’t available five years ago, let alone 20 years ago.

 

With the treatments that you can offer, do you see patients once again enjoying normal sex lives?

 

Absolutely. No question. We can make sex more comfortable.