When Sex Hurts
Vaginal dryness is one of the most common and painful side effects of cancer treatment for women who have their ovaries removed or who are receiving chemotherapy or taking drugs such as Tamoxifen, Raloxifene, and aromatase inhibitors. It can also be a consequence of natural menopause because natural levels of estrogen decline. Many find themselves living with discomfort. The problem can be especially troubling for women with breast cancer as estrogen therapy is usually not an option for them.
I recently attended a seminar on this topic at the Annual Meeting of the North American Menopause Society (NAMS) meeting in Washington, DC. Using a series of photographs, Dr. Murray Freedman of Medical College of Georgia showed that in the short window of only three to six months, the lining of the vagina becomes thin and dry and the opening of the vagina becomes smaller and less elastic, which can lead to painful sex. It’s called atrophic (aye-TROE-fick) vaginitis, the medical term for thinning of the walls of the vagina and skin of the intimate areas around the vagina that can lead to vaginal narrowing and vaginal dryness. This also occurs after natural menopause. Atrophic vaginitis often causes the tissue around the urethra, the opening that urine passes through, to pout out due to shrinkage of the tissue surrounding it. That leads to burning urination, irritation and increased urine infections.
The painful sex that results causes women to suffer a great deal. What was extremely encouraging was a second series of photographs taken after local treatment with estrogen cream for 3 to 6 months. When applied locally to these atrophic areas, estrogen caused these tissues to appear rejuvenated. Unfortunately, breast cancer patients often can’t use a hormone cream or other form of estrogen because even though it is applied locally or in the vagina, some of the estrogen will be absorbed into the bloodstream.
Several things can help. Keeping sexually active helps maintain the vaginal wall tissues. But not everyone has a sexual partner. Dr. Raquel Arias of the University of Southern California said at the recent NAMS meeting that vaginal lubricants like KY Jelly or Astroglide or even a natural oil such as olive oil can temporarily relieve discomfort during sexual intercourse, but will do little to heal chronic dryness, irritation, itching, burning and soreness. Lubricants do not restore the vaginal pH or the structure of the tissue. If left untreated, this condition can lead to more serious problems such as vaginitis, bleeding, urinary discomfort, bladder infections and painful intercourse.
Dr. Arias mentioned one non-hormonal alternative to estrogen for vaginal dryness that is an over the counter moisturizer called Replens. A number of studies show Replens to be an excellent alternative for breast cancer patients for the treatment of vaginal atrophy. One study found Replens to be as effective as conjugated estrogen vaginal cream. The hydrating property replenishes the vaginal pH to premenopausal levels and reduces the incidence of vaginal dryness, itching and irritation.
The most important thing is to realize is that atrophic vaginitis is the most common symptom of natural menopause and extremely common in breast cancer survivors. Treatments for atrophic vaginitis are available. I believe that as women enter menopause or as they enter into treatment for breast cancer, preventing or minimizing painful sex should be part of the treatment planning. Talking with your doctor early is the best way to manage these symptoms.