Blog

Hot Girl Summer

In her song “Hot Girl Summer” Megan Thee Stallion promoted the concept of “having fun,  looking good while doing it, feeling confident in who you are, and not apologizing for being authentically you.” That’s the kind of summer I want for you!

For many American women, a lifetime of media attention on having a perfect body can undermine our confidence for wearing bathing suits and summer clothes. Add the ravages that cancer can have on you physically and emotionally, and walking out to the pool after treatment is a very real challenge.

Body Image and Sexual Intimacy
As a natural response to trauma, women disconnect from their bodies during treatment for breast cancer, and this disconnection impacts appearing in the flesh in private as well. Neither body image nor sexual intimacy are adequately addressed in conventional cancer care, but are very real concerns. Walking out to the pool is one thing, regaining one’s sexual identity and function in the context of an intimate relationship after breast cancer is more complicated.

During (and after) cancer treatment, many women find it hard to maintain relationships. Cancer is a scary word for many people, and a diagnosis can lead to disappointing interactions with people you thought you could count on. Your spouse/partner/significant other may be one of those people who has a tough time engaging with you and the changes you experience, making intimacy more of a minefield. Combine changes in body image, with physical exhaustion, pain, hormonal suppression, and emotional distress, and even the thought of being intimate with a partner can be the last thing on your mind. Working towards acceptance, however,—by both of you—is an integral part of finding a way forward.

Changes to Libido
Women of a certain age, and those in long-term relationships, admit to having less sex and wanting less of it than they may have at the start of a relationship, or earlier in life. Movies, social media, and books elevate the sexual experience as spontaneous, frequent, and hot and heavy. Our culture can make just about every woman feel that any slow down in desire, any fatigue or discomfort, or anything short of daily horniness is abnormal. This is completely untrue.

As discussed in previous essays, our female existence is fraught with work/life pressures that can make sex with our partner the last thing on our minds. Add a breast cancer diagnosis and treatment changes to that pressure, and you may just wonder if you’ll ever  be in the mood again.

Focus on Pleasure
Don’t let the myths about sex get in the way of what is happening for you. Spontaneous desire —what we associate with “spark”—is rare and unsustainable. Instead, try focusing on responsive desire, i.e., when you make time to be in bed with your partner, your body responds to the pleasure that you experience. Pleasure—whatever just feels good—can and should be the goal. Reconnecting with what gives you pleasure is an exploration you and your intimate partner can share. Thinking that pleasure is something easy and obvious is a lie. It may take a bit of effort to figure out what is pleasurable to you now.

You and your partner may need professional help to wade through the issues standing in the way of resuming a comfortable sex life, or you may just need to make time for each other. Spend less time focusing on what you might do in bed, and more time enjoying each other’s company in a shared activity. Then plan some time to re-introduce yourselves with pleasure in mind. Sex coaches and therapists are professionals who can help the two of you on these fronts. If you have breast surgery, ask your surgeon for photographs of similar procedures that you might show your partner so that when s/he looks at your “new” chest, there are no surprises. Communication is important! Talk with your partner about how you feel, what feels good or doesn’t, and what makes sense for both of you to proceed. It also might be a fun field trip to go to a store that carries tools, lubes, and sexy clothes. Two of my favorites are Wink Wink in Bellingham and Babeland in Seattle. I’ve found the employees to be very sensitive, well educated, and helpful.

If you have experience post-treatment and/or menopausal changes to the vagina, like dryness and tightening, try:

Lubricants 

• Natural lubricants like coconut oil, Triple Goddess Rose Oil
• Water-based lubricants like Good Clean Love, Sliquid, Ah Yes
• Silicone-based lubricants like Sliquid, Uberlube

Vaginal moisturizers

• Replens, Luvena, Good Clean Love, Bezwecken Hydration Pearls

Vaginal dilators

• Size-progressing devices that gradually expand the circumference of the vagina over time

Kegel exercises

• Kegels strengthen the pelvic floor to prevent urinary incontinence, but bringing muscles to exhaustion can allow for easier penetration during intimacy.

Vaginal estrogen

• For some women with a history of breast cancer, vaginal estrogen can be a godsend. Small amounts of estradiol are locally absorbed, not systemically, and can improve vaginal tissue quality, urinary retention, and symptoms associated with dryness quickly and definitively. The latest research for topical hormone replacement gives me confidence to recommend this symptom-improving option. Please talk with your provider about using a vaginal estrogen product to decide if a prescription is right for you.

Read More…
If you are interested in reading about healthy sex, grab Come As You Are and Come Together: The Science (and Art!) of Creating Lasting Sexual Connections by Emily Nagoski, PhD, sex therapist and New York Times bestselling author.

If you are interested in a forum for talking about all of the intimacy-related issues above, I’m offering a program for breast cancer survivors in October. There are both in-person and virtual options. The session about intimacy will be co-led by me and Jenn Mason, sex coach and owner of Bellingham’s Wink Wink. Take advantage of our EARLYBIRD discount before Sept. 1!

Yours in Health,
Dr. Laura James, ND, FABNO