Overview

I attended a wonderful session at the Ovarian Cancer National Alliance’s annual conference titled, “Female Sexual Dysfunction: A Mind-Body Approach” by Cheryl B. Iglesia, M.D FACOG. Doctor Iglesia is the Director of Female Pelvic Medicine and Reconstructive Surgery in the Departments of Ob/Gyn. and Urology at Washington Hospital Center in Washington D.C.

Due to the sensitive subject matter I was a little apprehensive going into the session. Dr. Iglesia’ warm, down-to-earth manner and sense of humor quickly broke down the barriers and helped me to feel very comfortable.

What’s the Problem?

If your sex life isn’t as wonderful as you had hoped, you’re not alone. Forty-three percent (43%) of women in the U.S. report dissatisfaction with their sexual function according to Laumann’s study published in JAMA in 1999.

The main reasons for this dissatisfaction are lack of interest in sex, arousal difficulties (lubrication), pain during sex, anxiety about performance, and lack of orgasm. Many medications such as SSRI anti-depressants such as Prozac, Beta blockers (for high blood pressure) oral contraceptive pills, and amphetamines can cause a lack of sexual desire.

Some of the events that contribute to sexual dysfunction are vaginal birth trauma, hysterectomy (removal of uterus), oophorectomy (removal of ovaries) and menopause. Most ovarian cancer survivors have experienced several, if not all, of the events that cause sexual dysfunction.

Ovarian Cancer’s Impact on Sexuality

To compound the problem, ovarian cancer also has a negative impact on our sexuality. If 43% of the general population of American women is unhappy with their sex lives, imagine how prevalent it is for us! Due to our ovarian cancer we may have body-image issues related to our surgical scars, weight gain or loss, edema, or an ostomy.

The removal of the ovaries and the subsequent loss of estrogen causes sexual dysfunction (especially if the survivor was pre-menopausal when diagnosed with OVCA). Oophorectomies lead to atrophy and loss of elasticity in the vagina which can cause painful intercourse. Removal of the ovaries can also lead to loss of sexual desire since 50% of our testosterone is produced in the ovaries. With testosterone deficiencies there is a decreased sensitivity to sexual stimulation in the nipples and in the clitoris. Our mental states such as depression, anxiety, and fear can also negatively impact our sexuality. Is it any wonder we’re having trouble in this area?!

Defining the Problem?

So what’s the answer? Well, it depends on the cause of the problem. To manage your sexuality concerns it’s important to have open discussions with your partner and to educate yourselves about the causes and potential solutions. Don’t be afraid to get professional help if needed; you’re worth it. Getting plenty of rest and exercise are simple lifestyle changes that can help your sex life. Remember that this is a multi-faceted problem since sexuality is a complex play of nerves, hormones, glands, and psyche.

Hope and Solutions

The good news is that there’s hope and help for our problems. The most common type of female sexual disorder is loss of sexual desire. Others are problems with arousal, pain, and lack of orgasm.

Desire Disorder: Erotica and Testosterone Replacements

Some ways to increase your sexual desire are to consider what’s sexy to you.
Some things that have helped other women are:

• Changing their sexual routine (soft lights, candles, sexy clothing, music, Kama Sutra)
• Exercises/sexual massage: touching but no penetration
• Developing sexual fantasies
• Female-centered erotica such as Lady Chatterley’s Lover, Bridges of Madison County, and The French Lieutenant’s Woman.

Since most of us are testosterone-deficient due to the loss of our ovaries, you may want to ask your physician about testosterone replacements such as:

• Methyltestosterone (1.25 to 2.5 mg/day)
• Micronized oral testosterone (5 mg bid)
• Testosterone injectables/pellets
• Testosterone propionate 2% qod on the clitoris
• DHEA (50 mg/day) available from GNC stores
• Combination estrogen/testosterone such as estratest

Arousal Disorder: Erotica, Lubricants, and Medicine
In addition to erotica, lubricants can help with the arousal phase of the sexual function. Examples of lubricants include:

• Astroglide
• KY Jelly (plain, silky, hot) which is long-lasting
• Slippery Stuff
• Replens
• Vi AMOR
• Pjur

Most of these lubricants can be purchased online at www.drugstore.com. If you take an anti-depressant, you may want to switch to Wellbutrin since it has fewer sexual side effects than SSRIs. Some women use complementary and alternatives medicines. Please check with your doctor before taking these:

• Yohimbine
• L-arginine
• Ginkgo biloba
• Avlimil (studied on only 85 women for a short time)
• Cinnamon oil
• Via-crème
• Moistened Altoids

Pain Disorder: Medical/Surgical Intervention, Hormones, and Alternate Sexual Practices
There are many approaches to dealing with painful sex including:

• Vaginal dilators
• Pelvic-floor physical therapy (www.apta.org to find a therapist)
• Kegel exercises (do 60 Kegels per day)
• Sex therapy
• Estrogen replacement such as:
  - Estring (vaginal ring that does not increase systemic estrogen level)
  - Vagifem tablets
  - Estrogen cream (Estrace and Premarin)
  Please check with your oncologist before trying estrogen replacement.

Many women find alternate sexual practices to be a solution to their vaginal sexual pain disorder. When considering these practices please discuss them with your partner and think about what you feel comfortable with; it should feel good physically and emotionally satisfying to you.
Alternate sexual practices include:

• Mutual masturbation
• Oral sex (oral-genital relations)
• Anal sex

Orgasm Disorder Solutions

Some solutions for orgasm disorder include:

• Directed masturbation
• Pelvic floor rehabilitation
• EROS - (small device that goes on the clitoris and has a soft suction action which increases blood flow. EROS costs about $300.00.)

Other devices that helps women achieve orgasm are vibrators.
Names of popular vibrators include:

• AcuVibe Softtouch Massage
• Kama Sutra Toys X-Commander
• Doc Johnson I Vibe
• Pocket Rocket Vibrator
• Natural Contours Personal massage/vibraor
• The Rabbit (for the G spot and the clitoris)
• Vielle clitoral stimulators (aka Clitor-Critters) attach to your fingers for masturbation.

Personal massagers/ Vibrators are available from the following websites:

• www.goodvibes.com
• www.drugstore.com
• www.grandopening.com (for The Rabbit)
• www.aswechange.com
  

Treatment Advice:

• Be proactive with sexual education!
• Counseling
• Books:

- “Making Love the Way We Used to…or Better”  by Alan Altman, M.D. and Laurie Ashner
- “365 Days of Sensational Sex”  by Lou Paget
- “Passionate Marriage”   by David Schnarch, Ph.D.
- “The Sex-Starved Marriage”   by Michele Weiner-Davis

10 Tips for Improving Your Sex Life:

1. Make love with all your senses.
2. Be romantic and have some fun.
3. Renew your life.
4. Exercise daily.
5. Use it or lose it.
6. Maintain your vaginal fitness.
7. Drink plenty of water.
8. Stop smoking.
9. Use some lubrication:, Astroglide, KY, Pjur Woman Bodyglide.
10. See a Doctor

Resources for Survivors:

Professional help is also available from the following resources from the following spurces

•        Association of Sex Educators, Counselors and Therapists www.aasect.org
•        American Physical Therapy Association (see the Women’s Health Section)     www.apta.org

Although most of us experience some degree of sexual dysfunction due to our OVCA diagnosis, the good news is that our sex lives can get better. If you are considering medication to enhance your sexual function, please discuss it with one of your doctors. Of course prescription medications should be obtained only from one of your doctors. Here’s to feeling better. Cheers!