Note: This article contains sexual references that may not be appropriate for children.
Cancer diagnosis and treatment can often leave survivors feeling like strangers in their own bodies, says Madeline Elia, LCSW, a counselor with the Simms/Mann-UCLA Center for Integrative Oncology.
“It can change your relationship with your body,” Elia says. “There can often be a sense of betrayal, especially if you're someone who is younger or if you have done a lot in your life to try to stay healthy. There can also be a sense of hyper-vigilance, where any little ache or pain can trigger a sense of fear. Dealing with these kinds of challenges can create a lot of nervous-system dysregulation and a sense of distrust in our bodies.”
These feelings, along with physical changes brought about by cancer treatment, can disrupt body image and healthy sexual functioning, she adds, which is why the Simms/Mann Center recently presented a virtual workshop on cancer and women’s sexual health.
Elia was joined for the nearly two-hour presentation by Rachel Frankenthal, PA-C, MPH, a certified gynecologic oncology physician assistant and Emily Whalen, DPT, who specializes in pelvic floor physical therapy. Together, they addressed the psychological and physiological aspects of sexual health and body image in women undergoing or recovering from cancer treatment.
Feeling safe in the body after cancer
It all starts with restoring a sense of safety in the body, says Elia, who offered several strategies during the workshop, including:
- Breathing exercises to calm the nervous system: Elia shared a body-scan exercise anchored by deep breaths and slow exhales. She invited participants to explore where in their body they noticed pain or discomfort and where they noticed feelings of ease and relaxation. Could they direct the breath into some of the tighter spaces?
“As you do this, you’re sending the signal to your nervous system that, in this moment, you’re safe,” she said.
- Sensual experiences: Practicing mindful awareness of pleasurable physical experiences can help increase the feeling of safety in the body, Elia said.
While taking a shower, for example, tune into the sensations of the water on the skin, the warmth of the environment, the smell of the soap. Maybe even light a candle or burn some incense to further stimulate the senses, she suggested.
Other practices to help tune into physical pleasure include walking barefoot in the grass, paying attention to the sensations in your feet as you go; intentionally noticing what it feels like to embrace a loved one, the closeness and comfort there; relaxing during a massage, recognizing the pressure on the skin and smell of the oils; or even the warmth of placing a hand on our heart while breathing deeply.
- Masturbation: “It’s not something we all feel comfortable talking about all the time, but you’ve got three different professionals here telling you that it’s a really good exercise in increasing your body awareness and increasing your body acceptance,” Elia said.
In addition to providing a safe space to familiarize yourself with your body and what kinds of intimate touch feel good, masturbation increases blood flow to vaginal tissue, which can help mitigate vaginal atrophy. It also releases feel-good hormones such as oxytocin, endorphins and dopamine.
- Mirror exercise: Looking at oneself in the mirror without judgment is a powerful way to reconnect with the body, Elia said.
“It can be especially helpful if you feel like, ‘My body has changed and I don’t feel connected to myself anymore since cancer,’” she said.
The exercise involves wearing something (or nothing) that makes you feel most like yourself and sitting or standing in front of a mirror.
“Do your best to look at yourself with loving, positive regard,” Elia said. “Can you look across your whole body and notice yourself as a whole instead of just what you see as flaws or deformities? Can you look at yourself with awe and wonder? Can you look and reflect on all the things that you've done in this body in this life?”
Physical changes that can affect sexual health
Frankenthal and Dr. Whalen discussed the physical aspects of the body and sexuality after cancer.
More than half of breast and gynecologic cancer survivors report sexual dysfunction — which Frankenthal prefers to call “challenges” — following treatment, she said. Undergoing cancer treatment can be exhausting, traumatizing and painful, “which certainly contributes to how we view our bodies and how we view ourselves,” Frankenthal said. It can also lead to fatigue, hair loss, leave physical scars and cause neuropathy, or a tingling sensation in the fingers and toes.
Cancer treatment can cause physical changes that are both hormonal and structural she noted.
Surgical and medical treatments for gynecologic or other cancers can cause menopause. During natural menopause, the ovaries gradually produce less estrogen. Surgical-, radiation- or drug-induced menopause is much more abrupt.
“That can be a real shock to the system,” Frankenthal said. “Overnight, you went from having estrogen to not having estrogen. In addition to being diagnosed with cancer and going through treatment, it can really just be a lot to take on.”
Side effects of menopause can include hot flashes; mood changes; sleep problems; changes to nails, skin and hair; joint and muscle aches; fatigue; vaginal dryness; loss of libido; and trouble with orgasm.
The majority of women will experience vaginal dryness with menopause, Frankenthal said, which causes the vagina to become thinner and more prone to trauma, such as bruising and tearing. “This probably does not make you want to have penetrative sex,” she said.
She recommended women use a vaginal moisturizer two to three times a week as part of their regular routine, whether or not they are having sex. During intimacy, use lubricant, Frankenthal said. And stay hydrated by drinking plenty of water.
Menopause and radiation treatments can also cause vaginal stenosis, which is a shortening or narrowing of the vagina. The tissue becomes less pliable, which can make sex and penetration painful. Vaginal dilators, which Frankenthal described as “like plastic tampons,” can be used to help break down scar tissue and encourage muscles to relax.
Pelvic floor dysfunction is another common issue that gets in the way of pleasurable sex. The pelvic floor muscles hold and support the bladder, uterus, vaginal canal and rectum/anus, Dr. Whalen explained.
“The pelvic floor is really important for many of our most personal functions,” she said. “We're talking about sex and intimacy, but also urinary function, bowel function and dysfunction. When there's a problem with the pelvic floor, usually any one of those three areas can be affected.”
These muscles often tighten when there’s pain in the region, as with gynecologic cancers. When the pelvic floor is chronically tight, it not only becomes difficult to relax the muscles, but to contract them, which leads to weakness, Dr. Whalen said. These muscles are also prone to scarring from localized surgeries.
She offers physical therapy for the pelvic floor and also advises the use of vaginal dilators to maintain the vaginal opening.
While these issues can be difficult for some patients to discuss, those who attended the Simms/Mann Center’s presentation welcomed the opportunity to hear about sexual health challenges and remedies in such a frank and open manner.
“I’m grateful to hear this information in new ways and get to ask some questions,” one participant said.
“It’s so important for patients to have this information,” another said. “I hope you can keep spreading the word.”
The Division of Gynecologic Oncology is planning a workshop specifically about menopause in the fall.
