09/22/2016 05:20 EDT | Updated 09/22/2016 05:43 EDT

Sex And Intimacy After Cancer: A Guide For Women

Cancer diagnosis and treatment can cause physical changes that affect sexual desire. Cancer treatments can put women into permanent menopause and bring on a host of emotions and challenges for women on the cancer journey.

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Written by Alexis Dobranowski, a Communications Advisor at Sunnybrook.

Cancer diagnosis and treatment can cause physical changes that affect sexual desire. Cancer treatments can put women into permanent menopause and bring on a host of emotions and challenges for women on the cancer journey.

"Low libido, vaginal dryness and painful intercourse are very common," said Yulya Kagan, registered nurse in Sunnybrook's Sexual Health and Recovery Clinic (SHARE). "These physical issues add up and many women find themselves not talking about sex or intimacy, avoiding sexual relations and having difficulty in their intimate relationship. This can lead to depression or anxiety."

Kim Barrow, gynecologic oncology social worker, says she hears from her patients that while they want to resume sexual activity, they don't know where to start.

"It's kind of like the stuffing has been kicked out of them and they are rebuilding thread by thread," she says. "When it comes to sexual activity, there's a fear of interfering with healing, and of pain."

But the health-care team wants women who are undergoing or who are finished cancer treatment to know that they can resume sexual activity if they want and when they are ready.

Here are some of their tips.

This is normal.

"Many patients are going through this," Yulya says. "During your cancer journey, your circle of relationships surrounds you for support. Your family and friends help you. Once you are through this journey, you are changed. Things don't snap back to 'normal' - you are a new person now after this experience." And so, she says, some things, like how you get sexual pleasure, might be a little different going forward. "Ask yourself, 'How will I enjoy sex again?"

Focus on intimacy, rather than intercourse.

Try dating and enjoying each other's company. Cook together, explore a new neighbourhood, see a movie. Try new activities and have fun together to feel connected.

If sexual intercourse has been painful, we sometimes start to anticipate pain long before intercourse begins, Yulya said.

So, she says, explore intimacy that isn't intercourse. Try this exercise called Sensate Focus.

  1. Set up time for a date at home or at a hotel. (no kids, no phones or interruptions)
  2. Set the mood - candles, romantic music.
  3. If you have scars or other concerns that make you self-conscious, try a lingerie or something that makes you feel good.
  4. Take turns touching each other, one at a time. Ask your partner lay down on his/her stomach. Take plenty of time to explore your partner's body. Experiment with different sensations and types of touch. You can kiss, pet, touch your partner's body, avoiding genitals and breasts. Do this for 20 minutes. Then switch and have your partner do the touching.
  5. Repeat two times. Then discuss gently what you liked the most.

"When painful intercourse isn't anticipated, you may be more open for intimacy and enjoying it," Yulya says.

Talk to your partner.

"It's hard to talk about vaginas," Kim says. "For many cultures, it's just not talked about at all."

Kim encourages patients to speak with their partners about their fears, desires or lack of desire.

Often, Kim adds, it's the sexual partner who is most fearful of resuming sexual activity.

"This partner may have seen you when you were ill and in pain, and desperately doesn't want to hurt you or harm your healing," Kim says. She encourages her patients to bring their partner to an appointment where she can help facilitate the discussion.

Use a dilator and other tools.

A dilator can help with the physical side of things by preparing the vagina for intercourse (a dilator set slowly stretches the sides of the vagina.) Water-based lubricants (without any hormones in it) can help keep you wet. Non-hormonal vaginal moisturizers can be applied regularly to help ease dryness. There are also other options for numbing your vagina if it is very painful. Speak to your health-care provider.

If you would like more information check out the SHARE clinic online or speak to your health-care team.

For tips for men, check out Sexual health, intimacy & cancer: a guide for men.

And for a personal journey, read Let's talk about sex -- a cancer patient's perspective

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