Solutions for Libido Loss: Arousal

Breast cancer can affect so many aspects of your life, and unfortunately your sexual health is not immune. The mental and physical exhaustion, painful intercourse, and loss of libido that some people experience as side effects of breast cancer treatment, or as symptoms of the cancer itself — none of these are great for your sex life. 

To top it off, it may be hard to devote the mental energy needed to prioritize your sexual health, particularly when the process of treatment can feel so all-consuming. 

"I think that when women are going through the process of being diagnosed with breast cancer or starting treatment, a lot of their life goes on the back burner," says Kristin E. Rojas, M.D., a breast cancer surgeon who runs the Menopause Urogenital Sexual Health and Intimacy Clinic (MUSIC) at the Sylvester Comprehensive Cancer Center in Miami. But, as she points out, once they get through the life-saving parts of treatment, it makes sense for people to look to regain a sense of normalcy, and sex is a big part of that. 

And sex can be especially therapeutic during this time, explains Anne Katz Ph.D., RN, FAAN, a certified sexuality counselor. "It's a distraction," she says. "It's 10 minutes of not having to think about other stuff. It's about affirmation. It's about love. It's about being grateful for what their partner is doing in terms of supporting them. It's a survivorship issue because people just want to be the way they were before."

But sometimes, when you’re ready to get back to it, your brain and body just don't seem to be on the same page. Unfortunately, adds Rojas, people are "often surprised to learn that their body doesn't feel like their own anymore."

Where did your libido go? A big part of getting back to a healthy sex life, of course, is actually wanting to have sex in the first place. And to do that, you’ll want to understand what’s keeping you from getting in the mood.

If you're struggling with your sexual health, the first step is to talk to your doctor. "Women don't raise the question because they don't want to seem weird," says Katz. And although doctors should be the ones to raise the issue during appointments, she says, they often don't. 

"Healthcare providers tell them about everything else," she says. "We talk about diarrhea… we talk about gross things. So folks think that if this was important, we would talk about it. And the result is a deafening silence."

Before worrying about libido though, Rojas recommends treating any issues related to pain with sexual activity. Particularly when women are on estrogen suppressing medications, they can develop vaginal dryness and genitourinary syndrome of menopause, which is often accompanied by dryness, painful sex, and urinary issues. 

"Once we get through the pain part," says Rojas, "I find that, oftentimes, the desire follows."

She tells patients to minimize the use of irritants near their vulva, such as products with artificial fragrances, harsh soaps, and alcohol-based wipes. Instead, she says, those experiencing discomfort around their genitals should use vaginal moisturizers with hyaluronic acid or lactic acid, in addition to silicone-based, hypoallergenic lubricants during sex. 

Pelvic floor physiotherapists can also be helpful. Pelvic floor therapy can help you strengthen and relax your muscles, which can make a huge difference if you're tensing them in anticipation of pain.

And remember: Sex is about so much more than intercourse. If penetration is painful, there are so many other ways to experience pleasure.

Once issues of pain have been dealt with, it can make sense to consider certain lifestyle changes. After all, says Katz, "desire… is this ephemeral thing. It's affected by fatigue, pain, if your partner irritated you, stress, body image — all of those.”

If you have a romantic partner, it might help to refocus on your relationship, perhaps with the help of a relationship therapist. 

You could also look at your sleep hygiene. Are you getting enough sleep? Are you using screens in bed? Rojas says the bed should be used for sex and sleeping only. 

If you've been exercising less, it might be time to get back into it. Working out increases your natural testosterone levels, which has an impact on libido. And exercise just plain makes you feel good in your brain and better about your body. 

Also, it can be helpful to schedule out sex or date nights. Some folks are resistant to this, as they feel the lack of spontaneity ruins the romance. But desire is not necessarily spontaneous anyway and is, in fact, very much connected with arousal. Putting intimacy on your calendar not only encourages you to set aside time that might otherwise feel in short supply and gives you time to mentally prepare. It also allows you to think about the things that get in the way of your desire so you can eliminate them, and to incorporate more of the things that turn you on, whether audio erotica, toys, massage, or an extra-long makeout session.

If all else fails, medication may be the answer. For one, various cancer treatments can have an adverse impact on desire — some more than others. If you think a medication is stifling your libido, talk to your doctor about the possibility of either adjusting your dosage or switching to another prescription.

There are also a couple of medications approved by the FDA for treating low desire in women. The first, flibanserin (also known as Addyi), comes in tablet form. Vyleesi, meanwhile, is administered via an injection you give yourself in the abdomen before sexual activity. These are not designed for use by people with a history of breast cancer, however, so if you want to try one of these medications out, it’s important to talk it over with your care team.

As you move toward reclaiming your sexual self, remember to stay focused on your own needs. "Even unpartnered," says Rojas, "feelings of guilt, shame, and a loss of femininity can be really pervasive." If you don't feel ready to reincorporate sexual activity into your life, know that that's okay.

As you return to yourself, allow yourself to immerse yourself in the aspects of your life that bring you pleasure, sexual or not. 

"Many patients like to focus on themselves and put their needs first instead of focusing on other people's needs," says Rojas, "and I think that's really important."