- Question from Website Question: My loss of libido during and especially following BC treatment has been extremely difficult for my partner and it's jeopardizing our relationship. I was 39 years old and pre-menopausal at diagnosis. I had eight rounds of chemotherapy and have been on tamoxifen ever since. I still menstruate. It has been four years, but my lack of libido continues. Can you give any guidance?
- Answers —Su Kenderdine, M.D.: It may be that even though you're still menstruating, you are really in a perimenopause where the ovaries aren't putting out as much estrogen as in the past, and, surely, even if they are, the tamoxifen is working against that. Some women find that adding a testosterone patch can make a difference, but it's never been studied in women with breast cancer, so you can't be sure that it's safe.
What can make a difference is working with your partner about a lot more, and prolonged, foreplay. That may involve baths and massage and reading poetry or erotic things together, or deciding to be together physically in a way that doesn't mean that you're going to have sex. That may allow you to be close and intimate, and some of the arousal then comes back.
- Marisa Weiss, M.D., president and founder: Clearly, it sounds like your sexual life has changed. You may need to discover how your body will now respond, or turn off, to stimulation. Things that helped in the past may no longer do the trick.
You may need to bring in some tips and toys to help re-ignite your sexual response. For example, it may be that the in-and-out of intercourse with the associated friction is too much stimulation of a tender vagina and vulva and clitoris. Instead, it may be that the stimulation of a vibrator directly to the lower vagina, the lips outside as well as the clitoris, might provide significant stimulation without as much friction and discomfort to the area.
There are all kinds of gadgets that you might experiment with. There is a "dolphin" that can be used to stimulate the outside area. You may choose a vibrator that goes into the vagina and also has a little "rabbit" that is attached and stimulates the outside at the same time the inside is being stimulated. There are so many choices. Some of the gadgets can be used yourself as well as with your partner. Sharing toys as an adult can be a lot of fun.
- Su Kenderdine, M.D.: Sometimes our partners can't express anger at our disease and their frustration with the disease except via sex. Only through anger about sex are they allowed to express anger around the cancer. It may be that you use this as an opportunity to draw out your partner's anger because it may not be about just sex but about the cancer. Just as you had to work through your anger about having cancer, your partner may have to go through the same process.
Sometimes doing this in a therapeutic session with a therapist is the best way to go because anger is very scary. A partner feels like they're a bad person if they have any anger around an issue of cancer in their loved one—that they're the worst of the worst. So it probably needs to be handled real carefully and real lovingly.
On Wednesday, May 19, 2004, our Ask-the-Expert Online Conference was called Sleep or Sex? You Can Have Both! Su Carroll Kenderdine, M.D. and Marisa Weiss, M.D. answered your questions about how to maintain sexual intimacy during and after treatment, what to do for loss of libido and vaginal dryness, ways to reduce the fatigue related to breast cancer, and more.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
