Awkward Auntie Question No. 11

woman at beach

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Question: My tolerance for sex and/intimacy (never strong) has nearly disappeared. How do I recover this connection with my husband?  I don’t have cancer but have had a BSO in the past 6mos, am BRCA+, and have had ongoing elevated numbers. I am also on HRT. (Previvor)

Awkward Auntie: This is a common issue in part due to the loss of ovarian hormones that leads to early menopause that is way worse than ‘normal’ menopause. You have been through a LOT in the recent past along with the knowledge that you are at high risk due to your BRCA + status – libido is a head thing and stress and worry will often take away desire. You don’t mention if the hormone therapy you are taking is local or systemic….. is vulvo-vaginal dryness adding to your lack of interest.

When you say that your tolerance is low or non-existent, are you talking about pain with sexual touch or activity or loss of interest? These are two separate but connected issues. Talking to a sexuality counselor can also help – your partner is likely deeply affected by what you have been through.

One way to increase desire that has good results is the practice of mindfulness – there is a new book that has just been published that I highly recommend. Get a copy and read through it – no pills or potions, just using your head to help!

Better Sex through Mindfulness: How Women Can Cultivate Desire by Dr. Lori Brotto (Greystone Books)

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 10

woman on beach

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Question: My Libido is all over the place. Is there anything I can do to make it more consistent? Sometimes dryness is a problem, which I use lubricants. Other times I am too sensitive. I also want to know if there is something to help with sensitivity. I can’t take estrogen because that will mess everything else up. (Female, Papillary Thyroid survivor)

Awkward Auntie: I’m not quite sure what you mean by ‘all over the place’ but because you also say you would like it to be more consistent, I am going along the path that sometimes you are interested in sex and sometimes not. On the one hand, this is a common experience for many women due to hormonal changes in their menstrual cycle with libido often peaking just before ovulation, Mother Nature wants to potentiate our ability to get pregnant! On the other hand, libido is not merely hormonal and is affected by other more social factors such as stress, fatigue, how we feel about our self and our partner. The dryness and sensitivity you mention can also cause a decrease in libido – if sex or sexual touch hurts, libido drops because we are (usually) aversive to pain.

Using a lube is great – just make sure that it does not contain a whole lot of ingredients that cause irritation – colors, flavors, anything warming or cooling or intensifying. Many lubricants contain glycerin and alcohol and these can cause problems by altering the normal pH of the vagina. The simpler the better and often a silicone lubricant is the best – look for ‘-cone’ at the end of the word (should be just one word) in the list of ingredients.

If you haven’t seen an endocrinologist as part of your treatment/recovery I would strongly recommend that you do so. These experts in hormonal issues usually know more about the topic than oncologists and will give you the best evidence-based suggestion for managing life (and hormones) after thyroid cancer.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 9

reconstructed breasts after young adult cancer

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Question: How carefully do reconstructed breasts need to be handled? My husband and I are going to be getting back into having sex in the new year and I would like to have a medical professional’s opinion on the potential risk of damaging the newly grafted fat. Is everything fair game once I’m allowed to sleep on my stomach again? Are breasts reconstructed from my own tissue safe to handle like original breasts? What about various types of implants (just in case others have the same naive question I do but had different reconstruction)?

I’m 38 and had stage 2 invasive ductal carcinoma in one breast; no chemotherapy (no spread to lymph nodes), no radiation (bilateral mastectomy); I’m on tamoxifen; I had a total hysterectomy and salpingectomy but still have both ovaries. I had a bilateral mastectomy and insertion of tissue expanders, removal of the expanders and DIEP flap reconstruction (I no longer have any kind of implant), and finally fat grafting and revision (removal of the grafted skin patches, and the dog ears on the abdominal incision). One month after the revision surgery, I was applying silicone lotion to the scars as instructed and the skin at the end of my abdominal scar opened up and my finger went into my side; it’s been stitched up again but this made me nervous about the strength of my pieced-together skin and tissue. I feel ridiculous asking my surgeon about how touchable my new boobs are though.

Awkward Auntie: You have really done it all – or had all done to you! And it must have been quite shocking to find your finger under your skin – but that was in the early stages of healing (one month later) and in general terms, we say that full healing takes at least 6 weeks. You don’t say how long ago your surgery was….. but if you are allowed to sleep on your stomach again, then you should be fine to include breast play in your sexual repertoire. Remember that it is YOUR tissue that has been used to create your new breasts and over time (and it can take a long time), your breasts should regain some sensitivity…. some women report that they feel ‘electric shocks’ in their reconstructed breasts for YEARS after the surgery. Altered sensation can be scary for women who have been treated for breast cancer because they usually panic and think that what they are feeling is related to cancer coming back. I would suggest starting off with gentle breast play and it is important to tell your partner what YOU feel and what feels good – and not good. Heavy pressure may not be comfortable for a while….or ever.

Women who have had implants are often instructed to massage their breasts using quite a lot of pressure to reduce the build-up of scar tissue.

In answering this question I searched the medical and plastic surgery literature to see if this has been studied or if there are any websites with specific information about this – and I came up empty handed! It is a real pity that you feel that you can’t ask the surgeon about this – he/she should be talking about this routinely with their patients because if you have a question, it is a pretty good bet that most women would want to know this too!

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  Are you a young adult cancer survivor?  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 8

Dr. Anne Katz

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I’ve recently become sexually active again (I’m 2 years post-treatment) and have been experiencing bleeding during/post-sex. I use lubricant, but I’m wondering if this is a problem for anyone else? I’m going to make an appointment with my gyno, but I’m just concerned. Last time I went in, I was told I wasn’t menopausal yet (though my AMH levels were a bit low). I’m only 23 and this has been very frustrating. The bleeding is spotting because it’s not continuous but it’s initially more than I would typically expect and sometimes continues to spot for a while after. And sometimes there’s pain but not sharp pain, just like soreness?

Awkward Auntie: Firstly, you need to see a GYN and preferably one who has experience with cancer survivors. There could be any number of reasons for the bleeding during and after sex; small tears could be occurring due to friction during penetration and this is causing the spotting and pain. Because you had a stem cell transplant you may have some changes due to graft vs. host disease (GVH) – this is why I am suggesting that you see a GYN who knows about cancer as a ‘regular’ GYN may not recognize the GVH. It’s also possible that lack of estrogen may be causing the vaginal tissue to be easily torn. You did not state whether you are still getting periods etc and we often see early signs of menopause (scary at your age I know) in young women who have undergone stem cell transplantation due to the effects of the conditioning regimen on the ovaries.

Secondly, not all lubricants are created equally – and you may need a more ‘cushiony’ type. Water-based lubricants can dry out quite quickly and a silicone based lube may be better for you. I would try one of these and see if you like it and if it works better. But a visit to a GYN is essential!

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 7

vaginal dryness after a hysterectomy

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I’m a 36 yr old stage 4 colon cancer female.  I’ve had a complete hysterectomy and suffer from vaginal dryness now. Is there anything I can do to permanently restore my body’s natural lubrication?

Awkward Auntie: Vaginal dryness – as well as vulvar dryness – is very common after removal of the ovaries. Because you had colon cancer that is not hormonally driven, you can use some local estrogen to help restore the tissues. You could also use hormone therapy in a systemic form (such as pills) that would address some of the other side effects of life after menopause such as hot flashes if you have those. There are different kinds of local estrogen including a small tablet that is inserted into the vagina, a silastic ring that is inserted into the vagina, or progesterone cream that is inserted into the vagina. Your primary care provider or GYN should be willing to prescribe these for you – and if there is reluctance, perhaps your oncologist can do some education with them. It would also be important for you to use lubricant for any and all sexual touch/play and of course for penetrative intercourse.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

—

More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 6

sex after a cystectomy

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I am a 36-year-old male cancer patient with bladder cancer. I’m told one of the possible outcomes of a radical cystectomy is being unable to have sex. How possible is this, and how does one talk about or learn to live with being that kind of disabled?

Awkward Auntie: Unfortunately the treatment for advanced bladder cancer is aggressive and causes significant erectile problems. I certainly hope that you have been told about these as part of the informed consent process before surgery. There are different approaches to radical surgery and so it is difficult for me to accurately predict what challenges you may have to face after the surgery. What I can tell you however is that while you may experience erectile problems and may not longer have any ejaculate, that does not mean the end of your sex life. Depending on how creative you want to be, the end of penetrative intercourse does not mean the end of an enjoyable sex life. You should still be able to have an orgasm with genital stimulation and with good pelvic floor muscle control, your orgasms may even be more intense. You can still give pleasure to your partner with your hands and/or mouth. Using a vibrator – externally – for you can be an intensely pleasurable experience as well as something you can also use with your partner. I strongly urge you to talk honestly with the surgeon doing the cystectomy to find out exactly what you might face after the operation…. and you should get the answers you deserve.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 5

libido after young adult cancer

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I have zero sex drive. None. My only desire to do it is so that my poor long-suffering partner isn’t doomed to a sex-free existence. How do I build this into my routine again? For a long time the act itself was very painful, now its less so but I just feel uncomfortable and unengaged.

Awkward Auntie: This is a common question; loss of desire (also called libido) is the most common complaint I hear in my therapy practice. Desire is a delicate thing and particularly in women, can be lost (and gained) with the slightest change in how we see ourselves, our relationship, if we’ve had a stressful day etc. It is VERY common for women who have gone through the kind of treatment you had to lose interest, and feel bad about it.

Our thinking about female desire has changed over the last 10 years or so. We used to assume that women, like men, should or do have feelings of desire all the time, what we call spontaneous desire…. but our more current thinking is that for many women, desire is REACTIVE, that is our desire kicks in once we become aroused (physically or mentally). So if you sit around waiting to feel spontaneous desire, you may be sitting around for a long time… So if your partner is understanding and patient, ‘fooling around’ with no end goal (sex) as the target may ignite your desire.

That said, you have been through a LOT – and the pain or discomfort you are left with will of course impact on your desire….the disengagement you describe may have something to do with the disengagement you had to take on to get through the treatments that are violating for many women. In order to be sexually responsive your head needs to be connected to your body and sensations – this is the OPPOSITE of what you needed to do when going through treatment! Using a good lube may help with some of the discomfort as radiation dries out the tissues and you may need some local estrogen as well.

Seeing a sexuality counselor who knows about cancer might be a good idea as well as seeing a GYN who knows about the treatment you have had.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

—

More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 4

libido after cancer

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I am a woman. I used to have a very satisfying sex life and high libido. Because of breast cancer I had to have a double mastectomy (no more nipples and no sensation). Then chemo put me in menopause. I am not allowed to take replacement hormones as my cancer was estrogen positive. I feel like I have been “castrated” – doctors don’t tell you your clitoris will shrink, your vaginal canal will shrink and become rigid. I have zero interest in sex (pain plus no libido, plus the several times I have been able to have some kind of an orgasm it has been so weak I barely noticed it), I am single and still young. What can I do? Is there a way to rehab the body?

Awkward Auntie: This is a long and complex answer because this is a complex situation. Chemotherapy causes menopause in women and it is usually way worse than ‘normal’ menopause. Many oncologists will prescribe local estrogen for women like you as the systemic exposure is minimal. This is the only thing that will really help with the dryness and shrinkage that you describe. I believe that it is a woman’s choice whether she wants to use this or not and not the decision of the oncologist to refuse to talk about it. You can try using vitamin E oil on the vulva for daily comfort and you must use a good water or silicone based lube for any kind of penetration. Find one that has the least amount of ingredients – silicone lubes often have just one or two ingredients. Using an external vibrator to ramp up your arousal response and use it often. This takes time and patience… but your body can relearn to feel pleasure and that will increase your libido. But the reality is that things are not going to be as good as they were before because so much has changed. There is no magic recipe or rehab – but time and exploration can open new avenues for sexual pleasure.  The following is a good resource too!

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 3

sex with one testicle

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: Can a person still have sex after an orchiectomy?

Awkward Auntie: The short answer to this is “yes!”. A testicle (ball, nut – whatever you call it) is not essential for sex. Losing one testicle will not affect anything related to sexual functioning but some guys may experience changes to their body image if they are not given a prosthesis (artificial testicle placed into the scrotum). This is usually done at the time of the removal of the original testicle.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

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More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer* – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.

Awkward Auntie Question No. 2

dating after young adult cancer

Ever had a question about relationships or sex that you just can’t ask your oncology care provider?  Ever felt too shy to ask a nurse or doctor a question but really need the answer?  Now you can ask those questions and get answers from Dr. Anne Katz, the Awkward Auntie!

Q: I had acute lymphocytic leukemia as a toddler. I’m now 23 and healthy. I have a little scar on my chest from a surgery. I get questions about it when I’m at the pool or with a new partner. How could I best answer/deflect questions without making things awkward or ruining the mood? I don’t remember much of my treatment since I was so young, it’s always uncomfortable for me to explain. I usually say “I had surgery when I was little…” or “I had cancer when I was really little, but I don’t remember it” etc. (23 year old man.  ALL)

Awkward Auntie: Thanks for this great question. It sounds like you have dealt with this in a really good way. Just stating the facts without going into a whole long story is the best way to deal with questions like these. If the other person wants more details they’ll ask for them or they’ll just move on to something more interesting to talk about. You don’t even have to say ‘cancer’ … just stating that you had surgery when you were little and you don’t remember it is truthful and probably all that others need to know.

One way to deal with discomfort is to make a joke about it. “Oh this little scar? Small Game of Thrones accident” might work if you’re a GOT fan. Or perhaps “Oh that’s where Cupid’s arrow pierced me the moment I saw you”….

Some people get a tattoo to cover up the scar – but you have to find a tattoo artist who knows how to work with scars.

You can learn more about this great program, find the answers to past questions, and submit a question of your own by going here!

—

More about the Awkward Auntie program:

Dr. Anne Katz, also known as the Awkward Auntie, is a certified sexuality counselor and nurse who has written a couple of books about young adults and cancer* – and all the things that happen to your body, relationships, and sex during and after treatment.  She will be answering any and all questions that you send to AwkwardAuntie@lacunaloft.org or that you submit in the form below. You don’t have to give your name or other identifying information – but it might be helpful for her to know how you identify yourself by gender, your age and what kind of cancer and treatment you had.

YOU CAN ASK HER ANYTHING…. Don’t hold back!  Your questions will be answered periodically and posted on our Awkward Auntie page.