Breast Cancer Awareness month is celebrated all over the world. Pink ribbons, stories of hope and loss, fundraisers, and the name Susan G. Komen® fill our October.
There are articles on early warning signs of breast cancer, tips on how to avoid breast cancer, and survival storiesincluding those of celebrities like Good Morning America’s Robin Roberts, Grease star, Olivia Newton John, and E! News anchor, Giuliana Rancic.
But what about thriving after surviving breast cancer? We often focus on fighting breast cancer, which is wonderful—awareness and education are vital—but what about all those women who have overcome the acute issue and are now navigating new waters.
One topic that is rarely discussed: Sexual health for breast cancer survivors. Sexual health is a key part of everyone’s quality of life. For this post, we interviewed Michael Krychman, MD, OB/GYN, about sexual health for breast cancer survivors.
As Executive Director of the Southern California Center for Sexual Health and Survivorship, Associate Clinical Professor at UCI and Medical Director of Ann Clinic , (a high-risk breast ovarian cancer center and formerly the Sexual Health and Rehabilitation program at Memorial Sloan Kettering Cancer Center), Dr. Krychman has 20+ years of experience in addressing sexual health topics as a researcher, author, lecturer, and world-renowned specialist in sexual health and survivorship medicine.
Q. What is sex like for women after breast cancer?
MK: Breast cancer patients and survivors are a vulnerable group. Financially vulnerable, stressed to the max, and emotionally vulnerable. There are multiple factors that play into a woman’s sensual and sexual experience: biological, psychological, emotional, and societal.
Breast cancer survivors are transitioning to thriving, not just surviving. Women have gone through aggressive treatments of chemotherapy, radiation, or a surgical mastectomy, and all of those individually and collectively change desire. A woman’s life has been focused for some time on the disease itself, and there can be a disconnect in her emotional and sensual feelings. For women, it’s not just about their sexual feelings, it’s about how they feel about sex (emotions) and the feeling of sex (how does sex feel; the sensation of sex- will sex hurt or even be pleasurable again is the concern?).
After cancer, women have dryness and pain, along with lowered interest. I see a lot of embarrassment from women who come into my center, but then I see a lot of women who are relieved when they find a safe place where they safely talk about sex. It’s almost like a burden of silence is lifted.
Check out this video, for more information about sexual health after breast cancer.
Q. How do you have the conversation with a patient?
MK: As a health care professional, you have to normalize it. Sex has far-reaching health benefits. It is good for your body, brain, sleep, immune system, it lowers stress and may help fight cancer—there’s all kinds of studies on sex and happiness, sex and living longer.
1.) Ask open-ended questions that can’t be answered with a ‘yes’ or ‘no,’ and start from a place of comfort. I generalize it, by saying, “I ask all my patients these questions, in order to better take care of you completely. Many women in menopause, or with breast cancer, or diabetes have sexual problems. How about you?
2.) I can’t stress enough the importance of “silence” for the clinician. Most clinicians interrupt their patients within the first 15 seconds of their patients speaking, because they are very anxious. Patients need time to gather thoughts and help direct the conversation.
3.) For patients, it helps if she writes down her questions before going to see her doctor, and rehearses. Be prepared.
Check out this video for more tips on how to talk to your breast cancer doctor about sexual health issues.
Q. What are the latest advances for the sexual health of breast cancer survivors?
MK: I recently attended a NAMS conference, (North American Menopause Society), and participated in a consensus meeting on how to treat the vaginal changes for women with breast cancer. There are new technologies emerging, but experts agree there is very limited scientific evidence using a placebo treatment for comparison. Watchful waiting with cautious optimism is needed. We need to weight the evidence and counsel our patients accordingly.
Whether it’s laser, radiofrequency, or newer approved medications on the market, all show excellent promise for specialized patients. However, let’s make sure this emerging technology is being used in a medically responsible way.
As a patient, do your research, look at data in a comprehensive way, and separate fact from fiction. Let’s look at technology and understand it, before we rush to implement it.
Q. What do you think we can do to bring awareness to this issue?
MK: We need to start the conversation. It starts early, and it starts with not being embarrassed to say the word “vagina.” It starts with teaching our young girls that it’s okay to learn about the physiological changes women go through in their lives, and it’s okay for women to be expressive and to look after their own well-being not just others.
Many women find it difficult to talk to other women about their sexual health, let alone their health care providers; it’s changing but not quickly enough. We need to empower women to start the conversation about sexual health.
There’s a powerful video I love, Like A Girl, that shows how girls view themselves, and how we can change the conversation, by starting early, with one woman at a time.