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Solutions for Libido Loss: Lubricants, Arousal and New Moves

When asked for sex hints for breast cancer survivors, Sue—a breast cancer survivor herself and a nurse who helps women deal with sexual issues—said, "Astroglide, and more Astroglide. The directions say to put it on the penis, but don't forget to smear it in the vagina, too, LOTS OF IT."

"Being slippery is a good thing," says Dr. Margaret Deansley, a physician, breast cancer survivor, and public speaker. You've got to learn to use the "goop," whether it's Neutrogena Sesame Oil, Astroglide, Today Personal, Surgilube, Ortho Gyne-Moistrin, Moist Again, Replens, Probe, K-Y Jelly (a standard surgical lubricant), Women's Health Institute's Lubricating Gel, or Bag Balm.

Many women prefer Astroglide, Moist Again, the WHI Lubricating Gel (call 800-537-8658), and Probe over other products, because they spread more easily and last longer. If your partner is using a condom, be sure to use a WATER-based lubricant. Petroleum-based lubricants damage condoms.

Replens is an over-the-counter moisturizer that helps the vaginal wall hold on to water, resulting in thickened tissue that is better able to handle the friction of intercourse. Apply it to the vagina three times a week at bedtime, over a period of several weeks. Replens can make intercourse tolerable, comfortable, pleasurable. In one study, 80% of women noted a significant improvement in their symptoms with Replens. It may, however, take months to make a difference, and you'll have to keep using it to maintain its special benefits. It's also expensive.

Learn to use the goop without fuss or ceremony, as a matter of course. Here's how:

• Begin using it during foreplay, spreading it liberally over the labia and clitoris and into the vagina, as well as on your partner's parts that will enter your vagina. You may need to add more later during intercourse.
• If you're bothered by using your hand (or your partner's) to spread the lubricant inside your vagina, and surgical gloves don't help, choose the product that comes with an applicator.
• You may also make your choice based on consistency, odor, or taste. Keep a tube in the bedroom, the bathroom, anywhere you're likely to need it.
• Try using vaginal lubricants the same way you use moisturizing hand cream: frequently and regularly.

Before attempting intercourse, it's important to feel comfortable and relaxed, and then aroused. Some therapists suggest that couples learn to concentrate on comfort and foreplay, and delay having intercourse for some later time. In this way, they can establish a successful pattern of foreplay—particularly genital foreplay—as part of their sexual repertoire.

Foreplay is an essential factor for a woman in becoming aroused, particularly for women who find sex painful. The vagina produces natural lubricants, and the vaginal wall relaxes, widens, and lengthens, allowing less painful, more satisfying penetration. A woman is ready for sex after these changes, just as a man is ready when he has an erection.

Viagra may be of some benefit to women who have difficulty becoming sexually aroused. Strictly speaking, Viagra is not an aphrodisiac, but it may help with the female equivalent of a man's erection, sending blood to the clitoris, vulva, and vagina. This in turn may make sex more comfortable and more enjoyable. (If you are already having orgasms, it is unlikely to make them more intense.) Within a few years we should have the results of several studies looking at Viagra's value for women.

Researchers also are studying whether a testosterone patch known as Intrinsa can increase women's sexual desire. Preliminary research has shown some success, but more research is needed to make sure that the higher testosterone levels produced by the patch are not linked to a higher risk of breast cancer.

If low libido is a problem for you, talk to your doctor. Together you can decide if medication is right for you.

If you aren't feeling particularly attractive or sexy, your ability to become aroused may be inhibited, or you may want to get sex over with as soon as possible. One way to overcome this problem is to imagine yourself as you would like to be, perhaps as some glamorous movie star or romance-novel heroine. Mental turn-ons can be as useful as physical ones.

Arousal can also be started and amplified by movies, erotica, and sex gadgets. Some pretty conservative couples get positive charging from these sources. Besides the magazines on the hard-to-reach racks, there are how-to sex manuals—very respectable. Lonnie Barbach has a video, Cabin Fever, especially designed for these needs: romantic, loving, feminine. Her book Erotic Interlude has helped many patients.

What's on your mind

It's important that you take a close look at what's happening in your head when you have sex. Are you calling on an erotic fantasy to get you in the mood, or are you worrying about pain or the bills you have to pay? Switch the channels in your head; get off "This Old House" and onto "Passion on the Waves."

Keep a journal of your moods through the day. When do you feel the most energized? When do you fade and get cranky? When do you think about sex? Can you detect a pattern, predict when you'd be most likely to consider a little time between the sheets? What about a cocktail hour escape? Or an early-morning dalliance? If daylight inhibits you, close the curtains.

Don't count on an exotic vacation to restart your sex life. "I can't think of a faster way to ruin a vacation," says Dr. Leslie Schover. Take the pressure off and take it slow. According to Dr. Schover, it's better to think in terms of mini-vacations, short breaks in your normal routine, "like closing the bedroom door a couple of hours earlier than usual, with a Do Not Disturb sign hanging from the doorknob."

If you don't feel aroused, your partner is going to feel at least somewhat responsible, and that is going to affect his or her performance. Partners can be more disturbed by a woman's diminished responsiveness than by the absence or alteration of a breast.

Try new positions

Position during intercourse can be crucial. Lying on your side, with your partner entering from behind, is considered the least stressful to the vagina (with the least degree of penetration compared to other positions). It also de-emphasizes the breasts, a plus for some women.

Keep your vagina in shape

If you want to stay sexually active or you hope to become active, you'll need to keep your vagina lubricated and in condition. That means stretching the vaginal canal, stimulating the membranes to produce natural lubricants, and increasing overall elasticity and resilience. Actual intercourse will then be more comfortable and pleasurable. (It also makes medical pelvic examination more tolerable.) Use it or lose it: If you don't have a partner to keep your vagina stretched and supple, it's up to you.

Practice without a partner

If intercourse continues to be painful, give it up for a while and practice with a dildo, a rubber instrument with the size, shape, and consistency of an erect penis. Don't be surprised at how realistic—veins and all—it may look. (Different sizes, shapes, and colors are available.) It will be more gentle, less emotionally burdensome, and perhaps fun, too. (Be sure to use a lubricant with it.)

You can also purchase a box of small, medium, and large hard, straight plastic vaginal dilators, available through special-order medical supply companies. (Ask your doctor or nurse.) Most women don't like this medical product, though, because it's unnaturally hard, straight, and uncomfortable, and they end up not using it.

Many stores, such as Good Vibrations in San Francisco, California, provide mail-order catalogs and ship in a plain brown wrapper. Started by a sex therapist determined to make vibrators more generally accessible and available, Good Vibrations has a toll-free telephone number and well-trained representatives who are happy to answer questions in a straightforward, discreet, and helpful fashion (800-289-8423).

You don't have to buy any gadgets. You can improvise with a lubricant and an object like a candle or a suitably shaped vegetable, wrapped in a clean plastic bag. But buying a commercial device is often a step in the right direction because it means you're taking this advice seriously. So find a large hat and dark glasses and go shopping!

Loss of Libido after breast cancer

Perhaps the most frustrating change in your sexual life is the loss of libido, of "those urges." You've lost your hair, your breast is altered or gone, you've put on weight, you have no energy, you're tired, you're nauseated, and you hurt in new places. No wonder you're not feeling sexy.

Your sex life may be altered by vaginal pain resulting from breast cancer treatment, especially after bone marrow transplantation. Certain chemotherapies can cause short-term ulcers in the body's mucous membranes (mouth, throat, vagina, rectum). Physical changes may result from treatment-induced menopause, tamoxifen therapy, or the end of hormone replacement therapy. Add the psychological stress, and pleasure from sex may seem like ancient history.

Advice from your doctors, or from friends who've been down the same road, may help, but some impairment of sexual function is generally unavoidable. Over time, however, things do get better.

Depression and libido

Depression is a common result of both the diagnosis and the treatment of breast cancer, and it directly affects your interest in sex. If you're depressed, sex may be the last thing you want to deal with. (You may even develop a real aversion to sex.) A sensitive partner picks up on this and holds back. But then, when you've recovered, your partner may continue to show no interest in sex, and you may assume it's because you're no longer desirable.

If you are depressed and unable to turn the corner, you need help. Try to consider therapists or group support. You've undoubtedly heard of the success of new medications, but you'll have to be careful. Some therapies for depression may cause loss of libido, including Prozac (chemical name: fluoxetine) and Zoloft (chemical name: sertraline). Medications must be carefully administered and monitored by a qualified medical professional (usually a psychiatrist). Effective dose levels are important and not always appropriately prescribed, and for many medications it takes three weeks or more for you to feel the benefit.

Depression, however, is too debilitating a condition to ignore, so be sure to seek help. There are some things that time alone doesn't heal.

If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take. Some antidepressants -- including Paxil (chemical name: paroxetine), Wellbutrin (chemical name: bupropion), Prozac, Cymbalta (chemical name: duloxetine), and Zoloft -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.

Hormones and libido

You may find that it has become harder to get aroused, and even harder to experience orgasm. "It takes so long to make it happen," said one woman. This dullness of response—if you can call it a response—is a consistent complaint. You must be open with your doctor, so that he or she can suggest appropriate medical solutions. Loss of desire and drive may be directly related to your lower estrogen, progesterone, or testosterone levels, brought on by your breast cancer treatment.

If you're having problems with sex, you might want to try downplaying the importance of orgasm, at least for a while. While you're recovering, try concentrating on pleasure from touching, kissing, and imagery, rather than penis-in-vagina orgasm. De-emphasizing vaginal orgasm may actually allow it to happen again sooner than you expected.

For some women who've had minimal interest in or opportunity for sex before all this happened, loss of libido may not be much of a problem. But if it is for you, talk to your doctor about the possibility of a hormone evaluation. A woman's sex drive is somewhat dependent on the hormone testosterone (the primary hormone in men), produced in the ovaries and the adrenal glands. A little goes a long way, and an adjustment may help restore sexual interest.

But if your testosterone level is within normal range (20 to 60 nanograms per deciliter in a blood test), more testosterone probably won't help. In fact, too much testosterone can produce acne, irritability, and male characteristics such as facial hair or a deepened voice. In addition, it's not known if "testosterone replacement therapy" is safe for women with a personal history of breast cancer.

Pain, nausea, and libido

Painful intercourse can destroy your interest in sex faster than anything else. Vaginal ulcers that arise during certain chemotherapies (such as 5-fluorouracil) are a major source of such pain. The ulcers may be particularly severe in women who have had bone marrow transplantation, but they do go away when treatment ends. Women with genital herpes may have an outbreak of the disease brought on by stress and a weakened immune system. Steroids and antibiotics can cause yeast infections in the mouth and vagina. Pain medications, narcotics in particular, can also reduce libido.

Menopause, whether natural or treatment-induced, can cause thinning and shortening of the vaginal walls. Vaginal dryness (lack of natural lubrication) is another menopausal side effect. These conditions can contribute to pain during sex.

Nausea, a side effect of chemotherapy, can kill your interest in anything, particularly sex. And some anti-nausea medications depress libido.