Our sexuality is a part of who we are. Because of its highly personal nature, it can be an uncomfortable topic for many people to discuss. Research shows us that about 60 percent of transplant patients experience at least one sexual side effect from their treatment. It is also reported that one-in-three sexually active men give up sex after their transplant. Sadly, not all people who experience one or more post-treatment side effects seek the help they need to determine if they can reclaim the intimate aspects of their lives. This blog will give you a basic understanding about the changes that could be causing the concern, the possible treatment options, and the ideas that may be helpful to coping with changes in your post-treatment sexuality.
It is important to understand that sexual health involves the combination of a variety of aspects; therefore, it is important to be aware of how each factor can affect the issues that arise with sexuality. At the foundation of sexuality there lies the components of function, desire, self-image, relationship and attitude. There are many physical side effects of cancer treatment that could affect one’s sexual health, including: dryness, stenosis, pain, irritation, loss of sensation, stamina, fear of infection, cGVHD, nerve damage, difficulty with achieving or keeping an erection, trouble reaching an orgasm or having a dry orgasm, low testosterone/estrogen changes, decreased blood flow to the genital area, incontinence and side effects from medication. It is best to rule out any major physical issues when one is trying to reclaim sexuality. Physical symptoms have a variety of treatment options so try what you are comfortable with before you sacrifice this part of your life. Review the following suggestions for men and women to discuss with their doctors.
FOR MEN:
- Inquire about whether or not certain medications that may cause dysfunction could be changed
- Discuss diet and exercise options
- Ask if you are a candidate for hormone replacement
- Discuss oral medications for erection
- Ask about vacuum erection devices, (make sure you are properly educated on the effective use of the device)
- Consider seeing a certified sex therapist
- See a urologist
- Discuss injections and the proper training for administering them
- Consider vasodilators
If none of these suggestions work for you, consider the possibility of a surgical prosthesis or a vascular reconstruction.
Each treatment has pros and cons to talk over with your healthcare team. For example, oral medications are often costly, while insurance often pays for vacuum erection devices. However, these devices require practice and training. A surgical prothesis tends to yield good results, but it is an irreversible procedure.
FOR WOMEN:
- Ask your doctor whether certain medications that may cause dysfunction could be changed
- Discuss diet and exercise options, including Kegel exercises, which strengthen the pelvic floor muscles in order to support the uterus, bladder, small intestine and rectum.
- Ask if you are a candidate for hormone replacement. This option includes the use of intravaginal creams because many oncologists do not like to prescribe oral estrogen to women after they have gone through treatment for cancer
Also explore the following suggestions:
- The use of vaginal moisturizers, usually three times a week
- Using water or silicone-based lubricants during intimate encounters
- The use of a vibrator (Fiera hands-free suction device)
- Vaginal Dilator Therapy for stenosis (Soulsource or Milli three times a week for 15 minutes. (This option can be painful.)
- Clitoral stimulators (EROS), usually used for five minutes, three times a week to increase blood flow
- Laser Vaginal Rejuvenation (Mona Lisa Touch; the cost is about $1,200 and requires three treatments, three months apart, to help with vaginal atrophy)
- Oral medications such as Addyi or Osphena
It is also important to note that managing physical issues more effectively can help. For example, if one is dealing with Chronic Graft Versus Host Disease (cGVHD), finding ways to manage its many tough symptoms will put you in a better position to try reclaiming areas of your life that you had to abandon during the transplant process.
Be patient and communicate with your partner. It is important to have a flexible mindset when being intimate. Try different approaches at least a few times before you decide on whether or not it is currently right for you. Also, the patient needs to lead the conversation, making sure to ease your partner’s mind about feeling hurt or pressured. Take a gradual approach. Treatment has caused many changes in your body. You might not crave sexual intimacy as you once did. However, you may find that you can still enjoy being sexually intimate once you try to engage. You may also discover that there are alternative approaches that allow you to enjoy some of what you did in the past. A good exploratory exercise that can be tried with your partner is Sensate Focus, a step- by-step approach to try awakening your sexual awareness.
The following link outlines the process, https://health.cornell.edu/sites/health/files/pdf-library/sensate-focus.pdf.
Addressing issues relative to body image, anxiety, and relationship are key to overcoming sexuality concerns. If you feel broken and unattractive, or if your relationship is facing many challenges after the transplant, consider seeking help with a counselor who has expertise in this area. Attitude, thoughts, and feelings are core components of a healthy sex life, so it is important not to ignore them. You are adapting to the current reality in every aspect of your life. Try to reclaim all you wish, but also find ways to make the best of whatever you reclaim.
Additional resources for you to explore on this topic can be found at:
