This is the first in a series of posts about sex, sexual dysfunction, and available treatment options for breast cancer survivors. Before we get started, disclaimer: I am NOT a medical doctor. I’m speaking as a scientist and a survivor. I encourage all breast cancer survivors to have frank discussions with their oncologists and other physicians on their care teams about sexual dysfunction that often results from surgery, chemotherapy, radiation, estrogen suppression and other therapies.

First thing’s first – do not let ANYONE tell you that you shouldn’t complain about sexual dysfunction because (a) you should just be grateful to be alive, (b) you’re too old to be thinking about sex, (c) it’s just something women have to deal with because of the mystery and complexity of women’s bodies or some other fucking bullshit. You DESERVE to experience sexual pleasure and satisfaction. You have every right to SEEK treatments.

Seriously, there are at least 4-6 boner pills on the market, and no one’s busting old men’s balls about using them. And insurance covers them. Spoiler alert – insurance doesn’t cover most of what’s available for women. #fuckthepatriarchy

So, what causes sexual dysfunction? Well, for starters, getting your boobs CUT ON OR CUT OFF has a MAJOR impact on body image and sexual function. With a total mastectomy*, most women lose their nipples as well as sensation in the area of reconstruction. Now, for me, nipple sensation is a pretty big deal for sexual gratification. I was lucky enough to be a candidate for oncoplastic surgery – which is a fancy way of saying I was able to have a large lumpectomy followed by breast reduction and a lift. Even though I was lucky enough to have breast conserving surgery, my nipple sensation isn’t the same. I mean, my surgeon (who is wonderful and this is not meant to disparage him in any way) cut around my nipples in the process of moving them higher on my breasts after removing excess skin and lifting. Sometimes, I get weird tingling sensations akin to electric shocks in my nipples, and the psychological effects of surgery definitely affected my desire to have them touched and stroked. I have a FANTASTIC husband who helped me find my new normal in the bedroom, but it was and still sometimes is a struggle.

First best advice – get to know your new body on your own. Explore the terrain, find out what feels good and what doesn’t. There’s an adjustment period, and you won’t be the same, but you CAN find pleasure again.

In addition to surgery, breast cancer treatments like chemotherapy, radiation, estrogen blockers, and other drugs can wreak havoc on your body, your sexual desire and responses, and your ability to achieve orgasm. In my case, thanks to medically-induced menopause, I’ve experienced vaginal dryness and problems climaxing. My spirit and body are willing for the most part, but it’s a LOT harder to get there. Fortunately, I’m not shy and asked my medical oncologist what could be done, and even better, I found out that there are actually options available to help. Not enough. We need more research, but there are treatments available. I’ll talk about a few of them in this post and will cover more as I learn about them and try them.

**.Vaginal lubrication and hydration – chemotherapy (which can push women into menopause) and medically induced menopause/estrogen suppression therapy can make your vajazzle as dry as the Sahara, which is uncomfortable in general and during sex in particular. Replens vaginal moisturizer is commonly recommended, and it’s helped me personally. Another product I’ve tried is Revaree, a vaginal moisturizer that contains hyaluronic acid, which attracts and retains moisture. I’m on the fence about which I like best, but both have helped, and they have the benefit of being hormone-free. However, be aware that Revaree, unlike Replens, is not compatible with condoms. Aside from moisture and hydration, lube is your best bedroom friend!

**Arousal and climax – I was pleasantly surprised to learn that there are more options than I anticipated. One that I tried recently is Vyleesi, a treatment for hypoactive (low) sexual desire disorder (HSDD). It’s injectable, so if you’re squeamish about needles, take that into consideration. On the other hand, it’s like an Epipen in that it’s preloaded and injection is as easy as a push and a click. One of the side effects is nausea, which I did experience, but it’s reported to go away over time. I’ll report back on that. What I CAN report is that it worked well for me in terms of achieving orgasm! One trial so far, but I’ll repeat the experiment for sure. Something that I haven’t yet tried but plan to test out are topical treatments, including “scream cream.” There are various formulations that can include hormones or be hormone-free. The hormone-free varieties often include active ingredients like sildenafil (active ingredient in Viagra), and other vasodilators, which stimulate blood flow by relaxing the vascular smooth muscles. These treatments do require a prescription and can be ordered from online pharmacies.

Toys and aids – vibrators are AMAZING! There are so many varieties to choose from, and they’re super fun to use and add to your bedroom game. I used a couple before cancer, and they are staples for me post breast cancer. Some of my favorites include the Dame Fin, Butterfly Kiss, and Rabbit styles. Don’t want to visit a sex shop? You can find EVERYTHING online, including sex toys, and have them delivered discreetly right to your door. Again, test them out and explore on your own as you get to know and accept your new body. Find out what works for you, and definitely get your partner involved in the fun. Pros include price and safety. You don’t have to spend a fortune, and you don’t need hormones or other drugs to enjoy toys – just don’t go…too big too fast.

**Laser Therapy – Not going to lie – hearing the word “laser” as a treatment for vaginas, as in OMFG you’re going to LAZE my vajayjay??!! scared the crap out of me. But, being a rational person, I listened with an open mind and am now considering this treatment. And, treatments like this offer hope for women suffering from vaginal atrophy. MonaLisa Touch is one laser treatment option that stimulates collagen production for tissue regeneration. Aside from the whole laser to the vagina thing, cons include expense. And (not surprisingly, but still infuriating) insurance doesn’t cover the procedure.

State of mind – A healthy body and mind are key for great sex. Aside from the usual stuff – eat right, drink plenty of water, exercise – mindfulness and meditation are great tools for stress relief and relaxation, which is key to satisfying sex and reaching climax. They’ve helped me in and out of the bedroom. Know what else has helped? Romance novels! Now, I’m totally biased because I write romance as my side hustle, but I was an avid reader LONG before that. A great love story can be just the thing to spark desire and fantasy. The mind is truly the most powerful sex organ. One of my go-to sites for romance recommendations, Smart Bitches Trashy Books, covers romance novels featuring cancer survivor characters and recommendations for cancer survivors!

This is the short list and the beginning of my coverage of this topic. I hope it becomes a conversation. Feel free to comment or message me. Share your experiences, tell me (and my growing group of followers) what works for you, what doesn’t, and how you go about broaching the subject with your doctor, your partner, or other professionals. Knowledge is power, and knowing you aren’t alone out there is powerful and healing, too!

*Nipple-sparing mastectomies are a thing and definitely worth asking your breast surgeon about.

**Most of this information comes from the Women’s Institute for Sexual Health (WISH) in Nashville, a FANTASTIC resource for women experiencing sexual dysfunction.