It’s no surprise that Diane Keaton’s and Jack Nicholson’s film, Something’s Gotta Give, resonated with women of a certain age. The movie portrayed a 50-60ish woman who, after having sex for the first time in a while, was ecstatic to discover she wasn’t “closed for business.” Women who are involuntarily closed for business are not having intercourse. More than likely they've had their ovaries removed, are post menopausal, have had chemotherapy or are taking estrogen blockers like Arimidex. For many women, estrogen can restore their sex lives. If you can’t take estrogen, however, there may be several things you can do, but before we go there, let's talk about the relationship between estrogen and sex.<PREVIEWEND>
Without estrogen, the vagina atrophies: It becomes shorter, narrower, dryer and has less elasticity, plus the walls of the vagina can tear easily, and sex can be extremely painful. The vagina may also be more prone to infections. A lack of estrogen can also contribute to a waning libido as can stress, having a baby and some medications. If you have vaginal problems or a low sex drive, you should first see your gynecologist to make sure nothing else is going on.
Last week I took Dr Susan Love to lunch, and we talked about estrogen and women who've had breast cancer. She was quick to point out that research on decreasing vaginal dryness has only been done on women who've not had breast cancer. Those studies found that estrogen creams appear to have a higher absorption than the low-dose Estring or Vagifem. If you've had breast cancer and your doctor approves you for estrogen, talk to him or her about prescribing Estring or Vagifem. Also, be aware that bioidentical hormones are still hormones, so don’t let anyone tell you they’re safer or better for you because they’re not.If you can’t or don’t want to take hormones, Andrea Bradford, Ph.D. psychologist and instructor of Gynecologic Oncology at MD Anderson suggests using a combination of techniques. For starters, use a vaginal moisturizer several times a week and a lubricant each time you have sex. Check the labels on non hormonal over-the-counter products and avoid those with alcohol, propylene glycol and parabens. For some women, personal lubricants that are oil or silicon-based can cause more friction and therefore more pain, and lubricants with glycerin are known to promote yeast infections, so water-based products are preferable. My favorites are Replens Single-Use Disposable Applicators and Wet Naturals Barely Bare. This particular Replens and Barely Bare may be harder to find, but you can purchase them at the RETAIL THERAPY store on BreastCancerSisterhood.com. You may also want to read my blog, Breast Cancer, Vaginal Dryness and Sex for more information about lubricants and exactly where and how to apply them.
You might also want to find a specialist who treats painful intercourse and vaginal dryness. They may suggest a set of vaginal dilators that, over time and with lubricants, can stretch your vagina, plus you can order them online. The specialist will probably have you start with the smallest dilator you can comfortably fit into your vagina. Try to progress to a new size each week with the understanding that each new size will be uncomfortable. Take it slow.
Changes in self-image due to breast cancer and the natural aging process make some women less comfortable with their bodies. One of the biggest factors in a post menopausal woman’s sex life is her relationship with her partner and whether she’s comfortable talking explicitly about what works and what doesn’t work to get her aroused. Most women require more than hugging and kissing. They need direct stimulation to the genitals and more than they needed before menopause. Perhaps we should rename “foreplay” to “men-o-pause.” Men, oh pause here, longer!
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