Many women have trouble getting in the mood for sex during and after treatment for cancer. It is tempting to say this could be solved with one of the new medications recently approved to boost women’s desire. These prescriptions may help some women—but loss of desire for sex after cancer typically has multiple causes. Many women can regain desire without needing medication. In Will2Love's online self-help program, Sexual Health and Motherhood after Cancer, women can explore a tool called My Desire Checklist to identify causes of low desire and solutions for each.
- The most common reason women lose desire is that sex has become physically painful. If sexual caressing and penetration hurt, women begin to dread sex rather than looking forward to it. If you are having pain in the genital area during sex, the first step is to see a gynecologist. Some cancer centers have a gynecologist on staff with special skills in treating sexual problems after cancer. Gynecologists who work with menopausal women are also often familiar with problems related to cancer. Cancer treatments that put women into temporary or permanent menopause can decrease vaginal lubrication or stretchiness. Such changes normally happen gradually when menopause occurs. Other common causes of painful sex include scar tissue from radiation therapy or surgery in the pelvic area or temporary irritation of the delicate vaginal lining from some chemotherapy drugs. Women who have had stem cell or bone marrow transplants from a donor can get inflammation in the genital area. Self-help options to avoid pain include learning how to use vaginal moisturizers and lubricants, using vaginal dilators, or avoiding positions that trigger pain (Sexual Health and Motherhood after Cancer) It takes some time, persistence, and open sexual communication between partners to gain confidence that sex will be enjoyable again.
- Many women treated for cancer go through months of chronic fatigue, nausea, or pain outside the genital area. If you feel lousy, you will have a hard time getting energy for sex, although it is important for partners to keep on enjoying cuddling, kissing, and nondemanding touch. If you have support programs in your cancer center or community, an integrative medicine or cancer rehab specialist can work with you to reduce your physical symptoms.
- At least a third of women treated for cancer start taking medicine for depression or anxiety. These drugs may be helpful for mood and coping, but also can blunt your desire for sex. If you are past the first crisis of diagnosis and treatment, talk to your doctor about whether it is time to gradually reduce your dose. Remember, too, that narcotic pain medication and alcohol are both sexual desire killers!
- Worries about appearance also lead women to avoid sex (and dating for those who are single). Men worry about disappointing a partner because of an erection problem after cancer. Women worry that cancer has made them less attractive to a partner. Usually, a woman is more turned off than her partner by changes in her body, but we are surrounded by images suggesting that only a perfect, young, thin woman is sexually desirable. Some body image challenges related to cancer are tough, for example, hair loss and pallor during chemo, having an ostomy, surgical scars, losing a breast or a limb, or visible changes from treatment of a head and neck cancer. If you are having trouble feeling lovable and sexy, get support and suggestions on increasing your self-confidence (Sexual Health and Motherhood after Cancer). Seeing a mental health professional who is familiar with cancer treatment may be helpful.
- If you are not feeling attracted towards one partner, but notice that you can get interested in sex when you hear an erotic story or see a sexy scene in a video, your relationship may have suffered from the stress of going through cancer. Perhaps your partner disappointed you by not providing enough emotional or practical support. If you feel angry or alienated, it would be normal for your sexual desire to decrease. Your relationship may need some repair work. If you are unsure how to start, some couple counseling may be a good option.
- If you have ruled out or tackled all the factors discussed above, but just cannot get in the mood for sex, your cancer treatment may have affected your sexual desire directly. Scientists do not completely understand how hormones and other chemicals trigger desire in the brain. After chemotherapy, some women say it feels like a desire switch has turned off. One clue may come from a study I did with colleagues at UT MD Anderson Cancer Center. Women treated for breast cancer were asked to look at sexy pictures and other types of pictures while responses in their brains were measured by a special scan called fMRI. Women who had chemotherapy had less brain response to the sexy pictures than women who did not ever have chemotherapy. Such changes, like the memory problems often called “chemobrain” may be linked to inflammation or damage. Desire or memory problems may get better with time, but for this group of women, a medication could be an option.
- Recently, the Food and Drug Administration (FDA) has approved two medications to treat lack of sexual desire in women. The first is a pill is called Flibanserin (Addyi®), originally tested as an antidepressant. Flibanserin may increase sexual desire for some women but also can have some nasty side effects, such as fainting and nausea. It is currently approved for women not yet in menopause, although a recent study found some positive results in menopausal women, too. An even newer drug approved by the FDA is bremelanotide (Vyleesi®). A woman injects bremelanotide at least 45 minutes before starting sexual activity. The drug binds to nerve cells in the brain that are responsive to melanocortin, a chemical that may help the brain produce dopamine. Dopamine carries messages between nerve cells and appears to be involved in triggering desire for sex (among many other things). Most common side effects were headaches, flushing, nausea, and irritation at the injection site. It can also occasionally cause darkening of a woman's gums or skin. Since bremelanotide increases blood pressure, it is not recommended for women who already have high blood pressure. It is only approved for women who are not in menopause. Both of these drugs are unsafe for pregnant or breastfeeding women.
Whenever drugs for sexual desire are tested in women, the group that receives a placebo (sugar pill) shows positive changes, suggesting that the problem is rarely just something physical. In trials of flibanserin or bremelanotide, the group that got the active drug had only slightly better results than the placebo group. Several years ago, a testosterone patch for women failed to get FDA approval because it was no more effective in raising sexual desire than a placebo. It is conventional wisdom that low levels of the hormone testosterone are a major cause of women's low desire. Some scientists believe, however, that the hormone triggering desire in women’s brains is estrogen rather than testosterone.
Giving women extra testosterone only seems to help desire problems when levels are boosted way above normal. High levels of testosterone can contribute to other health problems, like cardiovascular disease. Some types of breast cancer, especially aggressive tumors seen in younger women, have receptors for testosterone, and could grow or spread. Even though no form of testosterone replacement is approved in the United States for women, some doctors prescribe "off-label" testosterone gels designed for men or compounded testosterone vaginal creams. Unless testosterone is given as part of a research study, a woman should think carefully about trying one of these unapproved treatments.
This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.
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