(41) Life after Breast Cancer

What nonhormonal and nonmedication regimes can I use for sexual function?

Sometimes women may opt to use other types of treatment (vaginal moisturizers and lubricants) to help their sexual function. The liberal use of local nonmedicated, nonhormonal vaginal moisturizers (Replens or vitamin E suppositories) can provide relief for the symptoms of vaginal atrophy.These agents are recommended for use two or three times weekly. Women should wear a minipad when using vitamin E suppositories because they may stain undergarments. Feminease and Me Again are made from nonirritating ingredients.

The use of water-based vaginal lubricants with intercourse is also encouraged when vaginal dryness and atrophy are diagnosed; however, vaginal lubricants that contain microbicides, perfumes, coloration, or flavors may irritate the sensitive atrophic vaginal mucosa. Lubricate all surfaces as part of foreplay, and be sure to keep lubricant handy in case more is needed. Lubricants may be water or silicone based. Use a lot of lubricant when attempting intercourse if you have vaginal atrophy or dryness. Some brands of water-based lubricants include Astroglide, Slippery Stuff, GV Slip Inside, Hydra-smooth, Sensua Organic, Probe, and KY Jelly. Silicone-based lubricants include Wet Platinum and Eros Women. Good Clean Love and Almost Naked are organic, safe, and effective. By using these natural lubricants, women avoid vaginal irritation. Read labels, and avoid brands that contain glycerin or parabens (www.goodcleanlove.com).

Some other products include: Viacreme® is a topical, water-based lotion with menthol and l-arginine (for more information: www.viacremedelight.com) that is advertised as a product to enhance sexual responsiveness in the genital area. It is also thought to increase genital warming and clitoral sensitivity. To date, no human studies have been conducted to prove the efficacy of this product and many patients complain of severe genital burning and irritation after application.

Another arousal product, available from Johnson and Johnson, is K-Y Brand INTENSE. According to their website (https://www.k-y.com/) this patent-pending gel formula was shown in a clinical study to enhance female arousal and satisfaction. In consumer studies, 75% of women reported heightened arousal, sexual pleasure, and sensitivity. Massaging K-Y INTENSE directly onto the clitoris, as directed, stimulates sensitivity and creates a gentle warming sensation, increasing female pleasure during intimacy. Have you (or your partner) gently massage a drop (two to four pumps) of the product onto your clitoris.

Dream Cream is a nonprescription vaginal cream that is odorless and colorless and combines with your own lubrication to help stimulate female genital arousal and blood flow. Its primary ingredient is l-arginine. To enhance sexual intimacy and orgasm, rub it into the clitoral region approximately 10 minutes before sexual intimacy. It does not contain any hormones, nor does it contain menthol, which can be irritating to some women. The cream is not FDA approved, nor have there been any rigorous scientific studies to prove its efficacy. Other less popular agents include Passion Drops, Lioness, Emerita, Natural Curves, and OMY.

What are some common sexual devices or accessories?

A woman can purchase many sexual accessories to help stimulate the genitals. Some enhance pleasure, whereas others are part of a complex sexual medicine treatment plan. Let your imagination be your guide, and explore your sexual fantasies with your partner. Women who have undergone pelvic surgery; breast cancer patients who have sexual pain syndromes, vaginismus, or other concerns about penetration; or those who suffer from vaginal shortening or vaginal narrowing or who have scar tissue that interferes with or prevents penetration and causes vaginal pain often have pelvic discomfort.

Vaginal dilators may be prescribed and are graded-size vaginal inserts usually made of plastic, glass, or silicone and are often used to facilitate lengthening and widening of the vagina. They may also be used to help stretch vaginal scar tissue that may have contributed to pain and discomfort during vaginal intercourse. Dilators can be used on a regular basis and with water- or hormone based lubricants. Suggested schedules range from once daily for 10 to 15 minutes to at least three times weekly.

Several studies report that ongoing supportive behavioral therapy is instrumental for continued compliance. A formalized dilator program is often used for those who have sexual pain syndromes. Ask your provider if you are a candidate.

How do you use a vaginal dilator? Using the vaginal dilator can help expand the vagina and help stretch radiation changes of tissue fibrosis (such as hardening of the vaginal wall tissue) that may have been caused by cancer therapy. Prepare yourself and your environment for dilator therapy. Make certain that you will have privacy by either locking your door or working with your dilator when you will not be interrupted. Many clinicians advise women to use their dilators in the morning hours just before starting the day for several reasons. At the end of a long busy day with work, family, and social obligations, dilator therapy may seem too consuming. Too often, fatigue and rest supersede sexual rehabilitation. Dilator therapy is also great in the morning because you can jump in the shower if the lubricant was messy and/or has resulted in any vaginal leakage. The dilator should be inserted into the vagina with a generous amount of lubricant. You should lie on your back, bend your knees, and spread your knees apart. With gentle pressure, the vaginal dilator should be inserted into the vagina as deeply as possible while still maintaining some comfort. You should leave the dilator in place for 10 to 15 minutes while remaining on your back. It is often helpful to be distracted by other activities (e.g., reading a book or watching television) while the dilator is in place. After removing the dilator, it is important to wash it with soap and warm water, dry it with a clean towel, and store it in a safe, secure place (adapted from the Memorial Sloan-Kettering Cancer Center’s patient education materials).

What are some common sexual devices that I can use?

The Eros Clitoral Therapy Device (Nugyn) has been prescribed for patients who have had cervical and other pelvic cancers (e.g., rectal and vaginal cancers). It is a battery operated device and has a small vacuum suction that attaches around the clitoral area. It is designed to facilitate engorgement or vasocongestion in the clitoral tissue. Preliminary data showed that this device may be helpful in combating arousal difficulties after cervical cancer therapy. The device may also be helpful for women with arousal or orgasmic disorders or orgasmic problems. It is possible that this device can be helpful in women who complain of changes in orgasmic intensity and latency. It has not been studied in breast cancer patients. It is costly and is available only by prescription. Medical insurance plans vary as to whether they will cover the expense.

What about commercially available vibrators or self-stimulators?

Vibrators come in a variety of shapes, sizes, and colors. These sexual devices can be helpful for women who may need extra vibratory stimulation in the sensitive erotic areas of both the vagina and clitoris. Vibrators have proven useful during self-stimulatory behavior and can also be used during sexual foreplay. They are available at local pharmacies, on the Internet, and at local sexual paraphernalia shops. Self-stimulators can be used with water-based lubricants. It is important to keep them clean; wash them with soap and warm water using a sponge or cloth and rinse well. Store them in a clean, dry and private place. Vibrators can be used alone as part of self-erotic exploration and sexual play or as part of your sexual repertoire with your partner. Generally, sexual massagers can be used both internally and externally to enhance stimulation, arousal, and pleasure. You can stimulate the labia, vaginal tissue, and clitoral tissue and even enhance testicular or penile stimulation for your partner. If you share your sexual toys, then it is doubly important to cleanse them in between each person’s use. One website, www.drugstore.com, offers home delivery of sexual accessories in a discrete manner, and you will not receive any unwanted e-mails or mailings.

The Lelo line of self-stimulators includes high-end European sexual stimulator products named Gigi and Liv. They are elegant and highly functional, have multiple speeds, and are very quiet.

The Ohmibod vibrators (www.ohmibod.com) combine music and self-stimulation and are helpful for the woman who is suffering from dyspareunia or painful intercourse. The vibrator plugs into your iPod, and as you listen to soothing relaxing music, you can have your mind distracted and allow your body to focus on self-pleasuring without the distraction or fear of pain. Music therapy can be combined to treat vaginismus and other sexual pain syndromes

One new self-stimulator, the Adonis, created by sexual expert Dr. Laura Berman, has gained popularity because it actively stimulates both the clitoral region and the vaginal G-spot. The electronic stimulation device called Slight Touch is a battery-operated, over-the-counter device that applies electrodes to the top of the foot above the ankles and above the buttocks to stimulate nerve pathways to the genital areas. The Vivelle device is a battery-operated external clitoral stimulation device that is worn on the fingers and may help orgasm. It is used with a special lubricant and is available over the counter. Some other very popular female sexual devices include The Rabbit and The Pocket Rocket. Both have been reported to enhance sexual stimulation and orgasmic intensity.

Another excellent self-stimulator is the petit pink, from the Sinclair Institute. It is a pink soft-touch special massager that is compact and powerful; it delivers three vibration speeds. It fits comfortably within the palm of your hand and is also discreet for travel. An added benefit is that a portion of the proceeds from the sale of this product go to support the fight against breast cancer. The Sinclair Institute also has a variety of educational videos and DVDs that come in both explicit and nonexplicit versions. Some helpful titles include Great Sex for a Lifetime, Sexual Imagination, 8 Ways to Spice It Up, and the Better Sex Series. For more information on how to order these products, visit their website at www.sinclairinstitute.com

Magnolia Myrick:

I think of myself as a fairly modern gal, but I somehow missed the memo on vibrators until I was in my 40s. Yo. Maybe I thought I didn’t need one or was too big a prude to use one, let alone buy one-I don’t know. But good heavens, why wouldn’t any woman want to have an entire collection? They’re great! My partner and I use one during sex; he loves it and I love it. What’s not to love? There is a vibrator called the “Pocket Rocket,” which is a good basic-small, battery operated, nothing fancy. The Internet is rife with sources. You take it from there, sister.

Term:

Vaginal dilators – Medical applications that can be placed within the vagina to help restore the vaginal tissues so that they are more adaptable.