Advice for lack of sleep, pain during sex?


Question from Susan: I am experiencing sleep and sexual problems. I wake during the night as much as seven to ten times. Often, I feel tired the next day. I awake because of hot flashes and being thirsty. When having sexual relations with my husband, due to the dryness, I experience a lot of pain. What can I do for both of these conditions?
Answers - Su Kenderdine You will, eventually, not awaken when you have a hot flash, so at this point, concentrating on allowing yourself to go back to sleep quickly is the key. Because even with that many awakenings, if it's only for 2-3 minutes, you should be able to get enough positive sleep to not be tired.
Marisa Weiss, M.D. If you're struggling with hot flashes because you're in menopause early or your hormonal therapy is just bringing them on, ask your doctor to help you and your body get used to the new climate that you're experiencing.

There are medications like Effexor (chemical name: venlavaxine) or Paxil (chemical name: paroxetine) that can be used in low doses to help reduce hot flashes. Perhaps over time, as your body adjusts to the situation, you may be able to be comfortable without these medications, but many of my patients get significant relief and usually stay on them, sometimes for extended periods of time.

Editor's Note: Paxil is known to reduce the effectiveness of tamoxifen. If you are taking tamoxifen, talk to your doctor about alternatives to Paxil. For more information, please visit the Breastcancer.org Tamoxifen page.
Su Kenderdine You do need a vaginal lubricant. Put it into the vagina before sex, on the outer lips, both the small and larger outer lips, and also on the penis.

The depth of penetration may need to be controlled as well, so you may want to shift to a different position—if you're on top, you may be able to more carefully control how deep and vigorous the thrusting is. If your partner is behind you entering from the rear, he can't go as deeply into the vagina because of the thighs and buttocks tissue, so that can spare the vagina some of the wear- and-tear of reaching climax.

A wonderful method is both of you lying on your sides, holding his penis between your thighs and using a great deal of muscle pressure and tension. Also, masturbating your partner with your hand until he's very close to climax and only entering then puts less wear-and-tear on the tender vagina. It's a new dance that you have to work out, so that it's comfortable, and it can have funny and fun parts to it—all the creative positions you experiment with as part of this.
Marisa Weiss, M.D. That's such great advice, Su. Also, when you're using sex toys, be sure to use lubrication with the toys as well. It's also important to wash them off after usage, using the same soap that you would use to wash off your genital area.

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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