Whether you were already menopausal or were abruptly deposited into menopause after treatment for your cancer, you’re probably familiar with what happens to your vagina when you lose estrogen.
You may experience the burning, itching pain of thin, dry vaginal walls and fragile skin on your genitals. You don’t lubricate like you used to, so sex can be difficult or painful. Or, if you’re experiencing the muscle spasms of vaginismus, sex may be impossible. Less estrogen is a good thing for some cancer treatments, but it’s darned tough on the vagina and, by extension, on your sex life as well.
So, while vaginal health is important for all women during menopause, it’s critical for those undergoing cancer treatment. Your vagina and pelvic floor need a lot of TLC right now to stay comfortable and responsive. Fortunately, compared to the other things going on in your life, taking care of your bottom is usually straightforward and inexpensive. Besides, keeping your vagina in good shape might eliminate one problem area and allow you to stay in touch with your sexual self, too.
Consider this four-part approach to caring for your vagina and pelvic floor.
First, use vaginal moisturizers and lubricants.
Moisturizers are your first line of defense. These are non-hormonal, over-the-counter products that are intended to keep your vagina hydrated and to restore a more natural pH balance. They should be used two or three times a week, just as you’d moisturize any other part of your body. Lubrigyn, PrevaLeaf Oasis, and Emerita are examples of moisturizers.
Using moisturizers is important whether or not you’re having intercourse. It should just be part of a regular health maintenance regimen.
Use lubricants liberally before intercourse, on sex toys such as vibrators, and any time you touch the delicate tissue on your genitalia. Also apply lubricant to your partner’s penis.
At this point, keep your lubricants plain and simple—no scents or flavors; avoid warming lubes. Don’t use any product with glycerin, which can create an environment conducive to yeast infections, and don’t use petroleum-based lubricants.
Second, keep your pelvic floor toned. “The pelvic floor is really important in keeping your internal organs in place, preventing incontinence, and enhancing sexual pleasure,” says Maureen Ryan, nurse practitioner and sex therapist.
Plus, knowing how to relax your pelvic floor muscles is helpful if you’re experiencing the involuntarily spasms of vaginismus.
Kegel exercises, in which you flex and relax the muscles around your vagina, will tone the pelvic floor. Or, you can purchase exercise tools to tone your pelvic floor muscles. This is a great way to make sure you’re exercising the right muscles.
Third, use dilators if your vaginal capacity is compromised. Dilators are cylinders that come in sets with various sizes. They’re meant to gradually increase the size and capacity of the vaginal opening, which can be important, especially after some cancer surgeries and treatments that constrict the vaginal opening or create scars and adhesions.
To some extent, dilators are helpful just to reassure you that you can tolerate something in your vagina again.
Start with the smallest size dilator, lubricate it, and gently insert it as far in as you can tolerate. Try doing kegel exercises, tensing and relaxing your pelvic floor muscles. Can you feel your muscles close around the dilator? Keep it in for maybe ten minutes and repeat this exercise several times a week. Move on to the next largest size when you can tolerate it.
Fourth, use a vibrator (lubricated, of course). Self-stimulation increases blood flow to your genitals and helps reacquaint you with the feelings and sensations of your body. The more stimulation you can bring to the area, the healthier it will be.
The point is to keep the vulvo-vaginal area moist and flexible, to increase blood flow, to stay responsive, to maintain capacity, so that when you and your honey are ready to start your engines, you’ll both enjoy a smooth ride.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.