I just had sex with my husband and it hurt like hell. It’s not because of anything he did; we’ve always had great sex. It’s just that intercourse has been painful since my cancer surgery, which included a radical hysterectomy. (This involves the removal of the entire uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina.) The painful intercourse could be caused by a number of factors. It is likely that I have scar tissue where my cervix was removed, and friction against the vaginal cuff is painful. There’s also a condition called vaginal stenosis, where the vagina is actually shortened or narrowed as a result of vaginal radiotherapy or certain gynecologic cancer surgeries.
My vagina certainly seems less accommodating since my surgery, as even the insertion of a speculum is painful. My gyn-oncologist gave me two different size vaginal dilators, which are white, smooth plastic cylinders designed to help stretch and relax the vaginal muscles and break up any existing adhesions. There’s also the issue of vaginal dryness. Pre-cancer, I never needed lubricant for sex. I was slow to accept it, but since my hysterectomy threw me into full-blown menopause at age 44, lube is now a must for intercourse.
However, the most significant issue, I’ve discovered, is that lack of estrogen causes the vaginal lining to thin. Our comfy interior cushion is gone. Think of your favorite pair of slippers with the fleece lining ripped out. That’s now my vagina, apparently. The estrogen replacers available for post-menopausal women aren’t safe for us. They can increase the risk of cancer, and as someone with the BRCA1 genetic mutation, I have to avoid hormones altogether. (I now even avoid soy products because of the phytoestrogens contained in soybeans.) There is one pharmaceutical vaginal cream my doctor deemed safe. However, the prescribed dose is three times a week and I had trouble remembering to use it consistently. It takes at least 90 days to see any results, which means that consistency is key.
I was a newlywed when diagnosed with cancer. I had my surgery the day before our four-month wedding anniversary. My husband and I always had a healthy, compatible sexual relationship. The changes that occurred in my body after my surgery have been a source of grief for me. I’ve had to mourn the loss of the uninhibited sexual being I was “before”. I’ve had to recognize that intercourse now takes a bit more planning and effort. I don’t even think about sex the way I did before. Now I worry about how badly it might hurt, which doesn’t exactly set the tone for spontaneous romance.
I had an epiphany of sorts after I took a recent social media poll among gynecologic cancer survivors about their sex lives. Without exception, every woman polled experienced painful intercourse. And no one had a quick fix. Many women polled said they’d simply given up their sex lives after surgery. Some hadn’t had intercourse in years and expressed gratitude for their wonderfully understanding partners. Others talked about their failed marriages. This saddened me greatly, as we’ve lost so much because of our cancer. Our bodies are no longer the same. We can no longer reproduce. We live in constant fear of recurrence. And on top of that, we have to lose our identity as sexual beings and potentially even our partners? Hell to the no.
Seeing this was a bit of a wake-up call for me, as I am not ready to give up sex or the emotional intimacy that goes along with it. I realized that if I want to improve my sex life, I have to do the work. I have to go to Vaginal Boot Camp, which for me means: inserting a vaginal dilator every day until I’ve worked my way up to the appropriate size; using safe medical remedies on a consistent basis; and consulting a vaginal physical therapist (yes, they have those). Rather than avoiding sex because of the pain, I must set aside my disappointment and embarrassment and do whatever it takes to regain as much of my mojo as possible.
Cancer has already taken so much from me. I’m not letting it take my sex life too. At least not without a fight.
Image via Mark Montgomery.