|Carolyn Vachani RN, MSN, AOCN|
Vaginal dryness and related painful intercourse (called dyspareunia) is one of the most common problems reported by women who are receiving or have completed cancer treatments. This sheet provides the facts on products and suggestions to relieve this common problem.
There are numerous vaginal lubricants on the market, including AstroGlide, Durex, Femglide, KY, and Wet, as well as less expensive store brands carried by many pharmacy chains. These products are designed to be used just before or during sexual activity. Be sure to read the labels and choose products that are water-based / water soluble, or silicone-based. Petroleum-based products are available, but these can damage the latex in condoms or diaphragms, making them ineffective. Petroleum can also act as a harbor for bacteria in the vagina and lead to infection. Ask the store pharmacist for help if you have questions about ingredients. Lubricants are available in standard preparations, edible flavors, and warming liquids. These products can be purchased through many Internet sites, if privacy is a concern.
Replens is a product known as a long-lasting vaginal moisturizer. It is designed to help vaginal tissue regain elasticity and moisture. Replens should be used 3 times a week for a minimum of 3 months, as it can take this long to achieve the desired effects. In addition, women can also choose to safely use Replens or a vaginal lubricant prior to intercourse for added effect. This product is not estrogen-based (so it is safe for breast cancer patients), but studies have found that it can work as well as an estrogen-based cream in relieving dryness. Ask the store pharmacist for help if you have questions. These products can also be purchased at many Internet sites, if privacy is a concern.
Vaginal Estrogen Products
Vaginal estrogen creams are inserted in the vagina, generally 2-3 times a week at bedtime. These products are rapidly absorbed by the vaginal tissue, resulting in elevated estrogen levels in the body for the first 3-4 months. After that time, absorption is less, but still results in higher than normal post-menopausal estrogen levels. Given the risk of estrogen stimulating breast cancer growth, these products are not used in breast cancer survivors, but can be an option for others.
Estring is a silicone ring that is inserted and remains in the vagina for three months. Vagifem is a tablet, inserted in the vagina once a day for 2 weeks, then twice weekly. Both products slowly release a low dose of estrogen, resulting in relief of vaginal dryness. Although the levels of estrogen in the body are lower with these preparations, they are not zero. The risk to breast cancer survivors is thought to be low, but long-term studies have not been done. Most oncologists are comfortable prescribing these products for breast cancer patients, realizing the importance of quality of life and the low risk involved. These products should not be confused with Femring, which is a form of hormone replacement therapy, which releases higher doses of estrogen.
In addition, in women with a uterus, there is concern that the lack of progesterone in these preparations could lead to endometrial changes. Studies have not confirmed this, but some physicians will follow women who use these products with vaginal ultrasound to detect any changes early.
Soy products have shown various benefits, including lowering cholesterol and blood pressure, and may provide some relief for mild hot flashes during menopause. Although it would seem likely that natural estrogens, such as soy, would help relieve vaginal dryness, studies of these products have not shown a benefit for vaginal dryness or atrophy (thinning or wasting of the vaginal tissue).
As for soy and breast cancer, most studies have actually found a preventive effect when used as a food or powder supplement in moderate amounts (up to 25 grams a day). Some laboratory studies have shown that higher doses may stimulate breast cancer growth, but results vary so it is hard to get a definite answer. If you want to try soy products and are concerned about breast cancer risk, you may want to stick to soy found in food products, which would make it less likely to exceed the 25 grams a day.
Other Suggestions for Dealing with Painful Intercourse
Lubrication may not always be the primary or only cause of painful intercourse. Sometimes surgery or radiation therapy may have left scars or limited flexibility, causing discomfort. Experimenting with various positions may help discover a position that is comfortable. Changing the view that sexual activity has to be intercourse is another way to enjoy intimacy with your partner without pain.
Anxiety and tension can result in an inability to relax and enjoy yourself. Try creating the right environment: candles, lighting, music, or a glass of wine can help create the "mood". Of utmost importance is communication between partners. Without knowing what is painful, your partner cannot help in finding the solution.
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