In today's society, we're constantly inundated with sexual imagery and often feel pressure from pervasive narratives about sexual expectations.
Breast cancer is a transformative experience on many levels, not least of which is the way it reshapes one's sexual identity. With treatment-induced menopause, the changes aren't just physical – our entire hormonal landscape shifts, potentially upending our libido.
How do you navigate these changes? How do you reconcile societal expectations with your own evolving feelings?
If your post-treatment libido has dwindled or vanished, and it's causing emotional distress, this episode is for you. We'll dive deep into the hormones influencing your desire, discuss treatment options for physical and emotional concerns, and explore ways to reshape your perceptions and beliefs about intimacy post-breast cancer.
Resources:
Breast cancer facts and figures
Preserve Your Muscle Mass
Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline
Why Women Should Care About Testosterone
Read Full Transcript:
A couple of years ago, I was at a conference, and one of the sessions was on weight training after menopause. When the presenter began the session, he stood in front of the room and asked a standing room only audience.." what is the reason why women go through menopause, and a woman from the center of the auditorium yelled out So you can gain weight, stop liking sex and give your husband an excuse to leave you for a younger woman!
Now the room roared with laughter at that but there was some true pain in her statement. And the truth is that menopause and all that comes with it is a struggle for many women and for many survivors. It's challenging when it comes to naturally and it can be even more challenging when its a forced change that happens before you're ready for it.
Today, I'm going to focus specifically on the lack of sex drive that is common to many postmenopausal women. I'll talk about sex drive is lower after menopause and how hormones and breast cancer treatment play a role in that.
Now sometimes, low or no sex drive isn't a problem because you may not have a sexual partner or your partner may have a libido similar to yours and a low sex drive works for both of you and you find other ways to enjoy each other and express your affection.
I spoke with a woman recently who told me that she rarely feels like having sex but it doesn't bother her at all. She and her husband cuddle with each other and they both talk openly about the fact that they aren't that interested in sex anymore but their relationship is still close and loving.
Perfect!
Low libido is only a problem if it bothers you. And that's typical because you don't feel like you used to or your partner wants sex more than you do and it creates distance or conflict in your relationship.
So today, we're going to talk about what happens to your libido in menopause whether it comes about naturally or it's chemically induced menopause, and what you can do if your lack of sex drive bothers you or it's creating a problem in your life.
First I want to acknowledge that this is an uncomfortable topic for a lot of survivors.
A couple of weeks ago one of the members of the Breast Cancer Recovery Group posted a question asking if anyone else struggled with low libido, quickly followed by an apology for asking in case anyone was offended.
Interesting right.
But not only was no one offended, but many women also raised their hands with yep, me too.
One of our helpful members then posted a link to the sex and breast cancer conference hosted by the New York chapter of Susan g Komen.
The link to that conference, the presentations, and the websites used as resources is posted in the show notes for this episode which you can find at ...bcrc.com/90
But circling back to the point of women being uncomfortable with conversations around sex here's a statistic to put that into perspective.
According to a 2007 study in the Journal of Current Oncology, only one-quarter of the nearly 40% of menopausal women who suffer from symptoms of atrophic vaginitis sought help for their symptoms.
Atrophic vaginitis is the thinning, drying, and inflammation of the vaginal walls that can occur with low estrogen levels.
That study went on to say that In addition to the direct sexual side effects related to low estrogen levels, breast cancer treatments often result in early and more severe menopausal symptoms, in addition to fear, anxiety, body image concerns, and sexual dysfunctions related to altered pelvic health.
I want to be very clear about that because I want you to know you're not alone if this is something you struggle with and I hope that you'll become more comfortable with the discussion as you listen to this show and check out the research posted in the show notes.
Another study published in 2011 in the journal of sexual medicine looked at more than 1,000 women who were within the first year of their breast cancer diagnosis.
They found that 70% of the women studied report sexual dysfunction.
77% of these women had vasomotor symptoms like hot flashes, sweats, palpitations, and of those who did have vasomotor symptoms, they were twice as likely to have sexual function issues.
These issues were exacerbated for women on aromatase inhibitors and for those who had body image issues, they were 2.5 times more likely to have sexual dysfunction...so ladies... it's time to talk about this and bring some awareness to what is a significant QOL issue for many survivors.
Let's think about these symptoms first of all..who feels sexy when they're having a hot flash, vaginal dryness, painful sex, and feeling self-conscious about the changes in their breats???...uhm...no one.
I'm almost 9 years out of treatment and my husband knows that he has about a 30-second cuddle limit before I'm too hot and he needs to get out of my personal bubble. Maybe 60 seconds but that's pushing it.
Now, in addition to low estrogen, testosterone levels also play a part in female sex drive. We ladies produce much smaller amounts of testosterone from our adrenal glands and ovaries. The average amount of testosterone in an adult female is 8-60 nanograms per deciliter of blood where an adult male has an average of 240-950 nanograms per deciliter of blood.
To put that into perspective a deciliter is a little more than 3 ounces and a gram is 1/30 of an ounce and a nanogram is one billionth of a gram...so that's not a whole lot of testosterone but, testosterone is powerful stuff.
In women, testosterone is important for sex drive, muscle to fat distribution, red blood cell production, and fertility.
And according to an article in medical news today.com symptoms of low testosterone levels can include:
Now combine that with the fact that 97% of women diagnosed with breast cancer in the US are over the age of 40 according to Cancer.org and additional health issues compound the effects of lower hormone levels.
One of the big issues being that we lose lean body mass...or muscle and our metabolism slows because of that. Also, as we age typically...this doesn't apply to everyone but typically... our lifestyle changes and we become more sedentary.
According to Harvard Health, we lose 3-5% of our muscle mass with every decade of life after the age of 30 unless we're consciously and consistently building muscle through some type of resistance training.
That has a lot of impact on our health, the appearance of our body, our physical independence, and our self-esteem.
So now we have hormone changes, changes to our breasts, changes to our skin depending on your treatment, vasomotor issues, less muscle, and more body fat.
And many of us are on tamoxifen or aromatase inhibitors for 5-10 years which have the side effects of
a loss of libido or a decreased interest in sex.
When you hear that you may think that's not sexy… but I want to point out that those are just sets of circumstances, and some of them, like lower body fat and increased muscle mass, are within your control to change.
These circumstances do not mean that you're not sexy but they may impact your drive to want sex. Additionally, many breast cancer survivors struggle with mild to moderate depression during and after treatment and that can also have an impact on low libido.
So what can you do if low libido is something that is creating a problem for you and you're looking for some relief?
First, it's important to have an open conversation with your doctor. You can ask to have some blood work and even check to be sure you have normal levels of testosterone.
Of course, when it comes to hormones as a breast cancer survivor you want to be very careful and always work with a physician. Too much testosterone can cause unwanted side effects for women and your body has the ability to aromatase testosterone which means it can convert some of your testosterone into estrogen which we definitely want to avoid.
Sexual problems in all people who have been through cancer are so prevalent that the American Society of Clinical Oncology (ASCO) created and published guidelines on interventions to address sexual problems in people with cancer.
You can find a link to those interventions in the show notes for this episode and use them to have a discussion with your physician.
Some of those interventions include psychosocial counseling, couples counseling, and cognitive behavioral therapy which is a great way to change the way you think about a specific problem in your life.
If dryness or pain is an issue that causes you to avoid sex there are different moisturizers that physicians can work with and the guidelines for interventions also suggest that doctors use lidocaine to make women more comfortable.
Another suggested intervention for women who have had hormone-positive breast cancer and are taking AIs is the use of Doctor prescribed DHEA a hormone produced by our adrenal glands.
From a dietary standpoint, eating foods that are high in zinc and magnesium may help to keep testosterone from binding to other proteins and from aromatize into estrogen because of the way these minerals work in our bodies.
Foods that are high in zinc include pumpkin seeds, oysters, spinach, and red meat.
Seafood, beans, nuts, and green leafy veggies are also excellent sources of magnesium.
Every little bit can help.
In an article on breastcancer.org about the loss of libido says that concentrating on having an orgasm may add stress to the whole situation and that focusing on the pleasure of other physical interaction may reduce some anxiety and actually restore pleasure sooner.
And somewhat piggybacking on that idea is an article in psychology today titled put your attention on arousal, not orgasms.
We, women, tend to take a little time to get warmed up. So focusing on arousal even outside the bedroom can help improve libido. So this may be a good time to reinstate date nights, and infuse some romance and flirting back into your romantic relationship throughout the day.
Also, take a very deep dive into how you are thinking about your sex drive. Last week I did a show on limiting thoughts and even in a situation like low libido, it's important to examine how you're thinking about yourself. Are you telling yourself repeatedly that you don't have a sex drive?
Even though that may be true at the moment, it's a limiting statement that doesn't allow for exploration.
Training your brain to change that into something like "I’m looking for ways to increase my libido so I feel >>>>>and you feel in the blank.
Do you want to feel sexy, is it a feeling of normalcy that you’re after, or do you want to feel closer to someone?
Thinking like this helps your brain to be more solution-oriented, more creative, and open to exploring options.
As you’re examining your thoughts around your sex drive you might also want to make a list of what things used to arouse you and then your thoughts around why you found those things exciting.
It’s pretty remarkable what the brain can do to get the body going when you allow it to wander through fantasyland for a while. But if you stop that from happening by repeatedly telling yourself I don’t have a sex drive, you’ll never get to that place.
In fact, an article I read called why women should care about testosterone suggested that having more sex or masturbating frequently will increase libido by increasing the level of testosterone in your blood. In that article, the author links to studies that show small increases in the serum levels of testosterone in women after orgasm and it also suggests that these levels remain elevated for some time afterward.
So we have the medical side where your doctor may be able to help you by testing your testosterone level, adjusting your medications, treating vaginal dryness and pain through moisturizes, and pain-relieving solutions. In an upcoming show where I interview Lee Nivinkus a Nurse practitioner and master injector, she also will tell you about injections and laser treatments that are available to treat vaginal dryness and atrophy.
And we have the brain side of examining how you’re thinking about your relationship. Does it need a boost of fun, connection, communication?
Then How are you thinking about your desire to have sex?
Why do you think it’s important to increase your sex drive?
Are there other ways to foster satisfying physical closeness?
Have you examined your thoughts around what would make you feel sexy or more excited?
And last but not least there’s what you can do for your physical body.
I always seem to circle back to this because it’s so important as a foundation to feeling good about yourself.
Are you exercising regularly? Are you consciously maintaining and building lean muscle tissue in your body? I don’t care if you’re 5 or 75 you are never too old to exercise and transform your body. Never.
When you trigger the wonderful pathway of chemical reactions that exercise ignites, you begin to change the way your body looks and feels and the way you think about it.
It’s incredible how working on the body, getting it up, active, feeding it well, and increasing your energy will influence your level of confidence and internal strength.
That’s a pretty big menu of options to explore but I wanted you to know that help is available if low libido bothers you.
I strongly encourage you to check out the sex and breast cancer online conference hosted by Susan g Komen.
They have a great line up of presentations that range from feeling heard by your physician to pelvic floor health, managing pain, and dryness, and taking a mindful approach to desire and even how to bring humor and acceptance into the bedroom.
At the beginning of this show, I told you that this whole topic was inspired by a conversation in the Breast cancer recovery group. If you haven’t joined what group yet, you can find it on Facebook and there’s a link to it in the show notes for this episode thebcrc/90.
I invite you to come and be a part of this community of survivors who are looking for positive ways to move forward in life after breast cancer, think in healthier ways, and support each other through the long term side effects that we all experience.
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