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  • Writer's pictureRebecca Marcus

Reviving Your Sexuality After Cancer

So you have been through the big C word. You survived it. Chemotherapy. Radiation. Surgery. Now what? Life should be the same. But, really is it? Asking if you can complain about sex, when a few months ago you were afraid of dying? Cancer is terrible. Life after cancer doesn’t have to be. There is no need to suffer in silence. There is a field of specialized physical therapists who treat people like you all the time. Pelvic floor therapists have extensive training in the evaluation and treatment of pelvic floor muscles and vaginal tissue, as well as looking at the person as a whole. Although people can have a whole cluster of symptoms after cancer treatment that can be addressed with physical therapy, we are going to devote this blog to unspoken; sex.

Radiation, either external beam or internal brachytherapy reduces elasticity of tissue and causes narrowing and shortening of the vaginal canal. Surgery can cause scar tissue restrictions. Hormonal changes from ovary removal, hysterectomy, or certain medications can cause vaginal tissue thinning, muscle atrophy, vaginal dryness and reduced libido. Ovarian cancer is an invasion to your pelvic region. It is a normal brain reaction to guard and protect areas of threat and pain. Guarding overtime leads to muscle spasm. Tight pelvic floor muscles may cause pain with sex and difficulty achieving orgasm or penetration.

The common vaginal presentation of post gynecological cancer patients can include reduced vaginal tissue elasticity, pelvic floor muscle spasm, scar tissue, and reduced lubrication. Patients have told me nurses in the hospital said, “pick your size” and have discretely placed a dilator in a paper bag with no instructions. Before we even look inside, let’s start with the basics. Vaginal hygiene is not properly taught. You walk into the store and there are soaps, bubble baths, and bath bombs. Does your vagina need all those chemicals, coloring and glitter? Lactobacilli are good bacteria in your vagina that control odor, so you don’t need anything more that good old warm water to clean and pat to dry gently. Your vagina needs oxygen too, prolonged wear of tight, non-breathable undergarments can contribute to irritation. Next is hydration, by consuming the proper amount of fluid, it’ll keep your vaginal tissue hydrated as well. If that is not sufficient, there are other products one can discuss with their physician to reduce vaginal tissue thinning and irritation; from coconut oil, V-magic, to hormones. Lubricants can assist with dryness, but one must be careful when selecting. Lubricants that contain parabens and glycerin can be a source of irritation. Water, oil or aloe- based lubricants are often best tolerated. My favorites recommendations for water- based; Slippery Stuff and Good Clean Love, aloe based; Aloe Glide by Desert Harvest and oil- based; coconut, almond or olive oil. Positioning can also play a role in pelvic floor muscle relaxation. Hip and back orthopedic issues may limit one’s mobility for certain positions. A physical therapist can recommend appropriate positions based on patient’s limitations and may suggest use of pillows to support extremities that are guarding. And now let’s get to it. Pelvic floor muscle spasm and tightness is just like any other part of your body. A tight neck, back, or hamstring. Different massage, stretching and breathing techniques can be used to relax and retrain the muscles of interest. Pelvic floor muscles are addressed the same way too! Pelvic floor therapist are trained in specialized manual therapy and myofascial release techniques for the entire pelvic region. You will also be guided with breathing, meditation, and relaxation exercises, and dilator instruction if needed. You will learn how to drop the stress you have been holding there, relax the muscles you clench and maintain lengthening with stretching tools such as dilators and wands. I have helped so many cancer patients enjoy the things they use to love. You can too.

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