Two New Books for Women on Sex after Cancer

I have recently read two new books intended for patients. The first is by Dr. Lori Brotto, a psychologist in Vancouver who has been doing research and clinical work for many years on incorporating mindfulness techniques into sex therapy. Her projects have included GYN cancer patients and also explored online treatment formats. Her recently released book, Better Sex Through Mindfulness: How Women Can Cultivate Desire is published by Greystone Books in Canada and is available on in Kindle or hardback versions.

Dr. Brotto focuses on how women can improve their awareness of pleasurable sexual feelings by practicing mindfulness techniques. Mindfulness is a form of meditation that focuses attention on body sensations while just noticing distracting thoughts and letting them go without judging oneself. Most of the exercises she presents are intended to help women accept that sexual desire may not appear as a bolt of lust out of the blue, but instead can grow from awareness of pleasure and intimacy once a sexual encounter has already begun--a circular theory of sexual desire originally proposed by Dr. Rosemary Basson, also one of Dr. Brotto's mentors. As  Dr. Brotto points out, the sensate focus exercises introduced in the 1970s by Masters and Johnson as part of the new treatment of sex therapy have many similarities to mindfulness.

At least one chapter is devoted to coping with pain in the vaginal and vulvar areas by noticing sensations and gradually learning to focus attention on more pleasurable aspects of touch, or reinterpreting pain as a tolerable sensation rather than as a catastrophic stress. 

I think this book includes many helpful suggestions, although at times I felt that techniques of cognitive behavioral sex therapy other than mindfulness were treated a little dismissively. Although anyone can gain from practicing mindfulness, it does take some dedication and work, and comes more naturally to some than to others. The exercise descriptions are often a page or two long, and I wonder if some women might have trouble following all the steps correctly on a self-help basis. Dr. Brotto often works with women individually or in groups. In general, however, worth the read.

The second book also recently published is Sex and Cancer: Intimacy, Romance, and Love after Diagnosis and Treatment (Rowman & Littlefield). Also available on in Kindle or hardback, this volume was written by a gynecologic oncologist on the faculty at the University of Colorado, Saketh Guntupalli and a medical writer and cancer survivor, Maryann Karinch. Their credentials are excellent, but I found this book rather limited. It is intended for women who have had cancer and are facing sexual problems. It is supposed to inspire hope, but one of the first "facts" is that women in strong dyadic relationships are more likely to survive cancer. Given that half of American women over age 50 are sexually inactive, often because they are divorced or widowed, this seems like a discouraging message. Other oversimplifications: androgens in the brain cause sexual desire and dopamine is a "pleasure" chemical. The book focuses on the most common types of gynecologic cancer with very few graphical illustrations and superficial explanations. The major sexual side effects of pelvic radiotherapy on vaginal size and blood flow are glossed over. The "illusive" [sic] G spot is treated as factual when its existence is at best controversial. The new understanding of the structure of the clitoris and its role in pleasure even during penetrative sex is ignored. A lot of time is devoted to describing the details of a research study done by the book's author with 328 women at one institution. Although the results are interesting, they add little to what is already known from many years of such surveys. 

The book does include a variety of personal anecdotes that explain what it is like to go through different cancer treatments and the emotional experience of coping with cancer while in a heterosexual relationship. The role of general "stress" or anxiety and depression in leading to sexual dysfunction is emphasized, but coping with specific treatment side effects, such as vaginal dryness, loss of desire, having an ostomy or incontinence, or partial vulvectomy is not. Pelvic rehabilitation specialists are recommended, but detailed advice on dilators, vibrators, and vaginal lubricants and moisturizers is very superficial. The authors recommend coconut oil for vaginal lubrication which would not be on my list. Many pages are devoted to flibanserin, a drug that may help a minority of women improve sexual desire but has limited efficacy.

In summary, if I were a gynecologic cancer survivor looking for practical answers to sexual problems, I would be frustrated by this book.

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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