Elephants And Tea - September 2021 - 15

INTIMATE ISSUES WITH MARLOE Sexuality
To learn more, check out the article on the Vulvovaginal
Blues (authored by yours truly) that appeared in
an earlier issue of Elephants and Tea.
Consider pharmacologic interventions.
Prescription options for treating sexual pain related
to vulvovaginal atrophic symptoms are available,
including topical estrogens, topical androgens
(DHEA or prasterone), topical anesthetics (lidocaine),
and oral medications (ospemifene) (Carter et al., 2018;
NCCN, 2021). Some of these treatments do not have a
lot of data regarding their safety and effectiveness in
cancer survivors and AYA populations, however. If
OTC options haven't worked for your symptoms, have
a discussion with your provider about what might be
appropriate for you.
THE CYCLE OF SEXUAL PAIN
Sometimes vaginismus develops over time, in response to
painful experiences with sex. For example, if someone has had
sexual pain in the past (possibly related to changes with chemo,
radiation, or surgery, for example), her pelvic floor muscles
may be extra tense during subsequent sexual encounters, as
her body braces for anticipated discomfort. This involuntary
protective response backfires, though, because it usually just
contributes to more pain. Over time, the cycle of anticipating
and experiencing pain can lead to feeling anxious and fearful
about pain during sexual encounters, avoidance of intimacy, and
relationship stress.
Pelvic floor physical therapy.
I swear to you that your friendly local pelvic floor
physical therapist just might become your new best
friend! In my opinion, these professionals are the most underrated of the essential members on any
cancer survivor's sexual healthcare team.
Generally speaking, physical therapists (PTs) specialize in helping people restore and maintain
movement and physical function after illness and injury. Pelvic floor physical therapy is (you
guessed it) a specialty area that focuses on rehabilitating pelvic floor function. These PTs work
with both men and women to address problems like pelvic pain, sexual dysfunction, and bowel
and bladder incontinence.
Pelvic floor physical therapists can assess sexual and pelvic pain and utilize a variety of therapeutic
techniques to improve symptoms. These can include strengthening exercises, muscle
relaxation techniques, manual tissue manipulation and massage, as well as mind/body and
breathing techniques, biofeedback, and vaginal dilator therapy.
Vaginal Dilator Therapy (VDT).
VDT is both a preventive technique and a treatment option for different causes of sexual pain. After
pelvic radiation, VDT can help prevent the formation of adhesions, when the mucosal tissues on either
side of the vaginal walls become stuck together. DVT can also help prevent vaginal stenosis (that
narrowing, shortening, and loss of elastic stretchiness), which can develop after radiation, surgery,
or with hormone changes. VDT is also used to assist women in learning how to control and relax the
muscles around their vaginal entrance, promoting more comfortable intercourse.
The purpose of VDT is to regularly separate the walls of the vagina, and to stretch the vaginal
tissue and the pelvic floor muscles. A VDT session consists of inserting a cylindrical plastic or
rubber tube (they come in multiple, graduated sizes and sometimes even fun colors) into the
vaginal canal and leaving it in place for a specified amount of time (usually a matter of minutes).
Someone on your healthcare team (your doctor, nurse, or pelvic floor PT) should provide edREFERENCES
AND BIBLIOGRAPHY:
American Cancer Society. (2021). Managing female sexual problems related to cancer. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/
problems.html
Bachmann, G., & Santen, R. J. (2021, May 25). Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment. UpToDate. https://www.uptodate.com/contents/genitourinary-syndrome-of-menopause-vulvovaginal-atrophy-treatment
Bober, S. L., & Krapf, J. (2021, June 18). Overview of sexual dysfunction in female cancer survivors. UpToDate. https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-female-cancer-survivors
Carter, J., Lacchetti, C., Andersen, B. L., Barton, D. L., Bolte, S., Damast, S., Diefenbach, M. A., DuHamel, K., Florendo, J., Ganz, P. A., Goldfarb, S., Hallmeyer, S., Kushner, D. M., & Rowland, J. H. (2018). Interventions to address sexual problems in
people with cancer: American society of clinical oncology clinical practice guideline adaptation of cancer care Ontario guideline. Journal of Clinical Oncology, 36(5), 492-511. https://doi.org/10.1200/JCO.2017.75.8995
National Comprehensive Cancer Network. (2021). NCCN clinical practice guidelines in oncology: Survivorship [Version 1.2021]. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
Shifren, J. L. (2020, July 16). Overview of sexual dysfunction in women: Management. UpToDate. https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-women-management
Vaginismus. (n.d.). What causes vaginismus? Retrieved on July 20, 2021, from https://www.vaginismus.com/causes-of-vaginismus
Wincze, J. P., & Weisberg, R. B. (2015). Sexual dysfunction: A guide for assessment and treatment (3rd ed.). The Guilford Press.
ELEPHANTSANDTEA.COM
SEPTEMBER 2021
15
This chronic cycle of sexual pain can be very frustrating for
women. If you feel this is something you are facing, ask your
provider for a referral to a pelvic floor physical therapist (see
below), who can help you find ways to break the cycle through
different techniques. A counselor or therapist can be helpful,
too, in finding ways to disrupt this pattern.
Fear and anxiety in
anticipation of pain,
which leads to...
Involuntary tightening
or spams of pelvic floor
muscles, which leads to...
Pain with sexual activity,
which leads to...
Avoidance of intimacy, due to...
ucation and a demonstration of the technique,
along with specific instructions to follow
regarding the duration and frequency of the
therapy. Usually, after these initial instructions,
women can complete these exercises at
home. To be effective, VDT should typically
be done at least 3-4 times a week.
Vaginal dilators are considered medical
devices and can be purchased online, and
your insurance may cover the cost. Ask your
healthcare team for recommendations. For
more details on how to use a vaginal dilator,
check out Memorial Sloan Kettering Cancer
Center's website.
BOTTOM LINE
Sexual pain after cancer is a common experience,
but it shouldn't be something you feel
like you have to suffer through! There are a lot
of options for managing and improving these
symptoms. Ask your provider for help in determining
what may be causing them, so that you
can find a way to change that pain back into pleasure
again.
https://www.elephantsandtea.com/sexuality/used-to-feel-so-good-now-it-feels-so-baaaaad/ https://www.elephantsandtea.com/sexuality/used-to-feel-so-good-now-it-feels-so-baaaaad/ https://www.ascopubs.org/doi/10.1200/JCO.2017.75.8995 https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf https://www.vaginismus.com/causes-of-vaginismus https://www.mskcc.org/cancer-care/patient-education/how-use-vaginal-dilator https://www.mskcc.org/cancer-care/patient-education/how-use-vaginal-dilator https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html https://www.uptodate.com/contents/genitourinary-syndrome-of-menopause-vulvovaginal-atrophy-treatment https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-female-cancer-survivors https://www.doi.org/10.1200/JCO.2017.75.8995 https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf https://www.uptodate.com/contents/overview-of-sexual-dysfunction-in-women-management https://www.vaginismus.com/causes-of-vaginismus http://www.ELEPHANTSANDTEA.COM

Elephants And Tea - September 2021

Table of Contents for the Digital Edition of Elephants And Tea - September 2021

Contents
Elephants And Tea - September 2021 - Cover1
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