Vaginal Dryness and Painful Intercourse

Vaginal dryness is a common problem for women who are getting or have gotten cancer treatment. It can cause painful intercourse (also called dyspareunia). Dryness happens when there is not enough lubrication (moisture) in the vagina. The decreased lubrication is often caused by low levels or a lack of estrogen in your body or changes to your vaginal tissue. These changes can be caused by:

• Pelvic surgery.
• Radiation to the ovaries.
• Chemotherapy.
• Hormone therapy.

The drop in estrogen levels causes the vaginal tissue to thin and make less natural lubrication, which can cause itching, burning, or pain/discomfort all the time, not just during sexual activity.

The following may help with vaginal dryness:

Vaginal Lubricants

There are many vaginal lubricants on the market, such as AstroGlide, Durex, Femglide, KY, and Wet, as well as less pricey store brands. These products should 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. There are also petroleum-based products, but these can harm the latex in condoms or diaphragms, making them not work as they should. Petroleum can also cause bacteria to grow in the vagina and can lead to infection. Do not use Vaseline or baby oil.

Ask the pharmacist for help if you have questions about which lubricant to buy. There are ones that are standard, ones that have  edible flavors, and some warming liquids. Be mindful that some products are more gentle to the vaginal tissues than others and you may not want to use a lubricant that has any type of herbal extracts, scents, or colors. You can buy these products online if privacy is a concern.

Vaginal Moisturizer

Replens is a long-lasting vaginal moisturizer. It helps vaginal tissue become elastic and moist again. Replens should be used 3 times a week for at least 3 months, as it can take this long to work. Women can also use Replens or a vaginal lubricant before intercourse for added effect. This product is not estrogen-based (so it is safe for breast cancer patients). Ask the pharmacist for help if you have questions. You can buy these products online if privacy is a concern.

Vaginal Estrogen

Vaginal estrogen creams are put in the vagina, often 2 to 3 times a week at bedtime. These products are absorbed (taken up by your body) quickly by the vaginal tissue, causing higher estrogen levels in your body for the first 3 to 4 months. These creams are not absorbed as much after 3 to 4 months, but still cause higher than normal post-menopausal estrogen levels. These products should be used with caution in breast cancer survivors because of the effect on estrogen levels.

Estring is a silicone ring that is placed in the vagina and stays for three months. Vagifem is a tablet placed in the vagina once a day for 2 weeks, then twice weekly. Both products slowly release a low dose of estrogen, causing relief of vaginal dryness. Although the levels of estrogen in the body are lower with these products, 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 increased quality of life and the low risk involved. These products should not be confused with Femring, which is a form of hormone replacement therapy that releases higher doses of estrogen.

In women with a uterus, there is concern that the lack of progesterone in these products could cause changes in your endometrium (the inner lining of the uterus). Studies have not confirmed this, but some care providers will ask women who use these products to have vaginal ultrasounds to find any changes early.

Soy Products

Soy comes from a plant that is made up of isoflavones. Isoflavones are a type of phytoestrogen, which works much like estrogen in the human body but with less effects. Soy products have shown many benefits, such as:

• Lowering cholesterol.
• Lowering blood pressure.
• Giving some relief for mild hot flashes during menopause.

Although it would seem likely that natural estrogens like soy would help relieve vaginal dryness, studies of these products have not shown that they help with vaginal dryness or atrophy (thinning or wasting of the vaginal tissue).

Other Tips for Dealing with Painful Intercourse

Decreased vaginal lubrication may not always be the primary or only cause of painful intercourse. Surgery or radiation therapy may have left scars or less flexibility, causing discomfort. It can help to try different positions to find one that is more comfortable. Remembering that sexual activity can include more than intercourse is another way to enjoy intimacy with your partner without pain.

Anxiety and tension can make it harder to relax and enjoy yourself. Try creating the right environment: candles, lighting, music, or a glass of wine can help create the "mood." Communication is important between partners. Without knowing what is painful, your partner cannot help in finding the solution.

Other Helpful Links

OncoLink: Sexuality & Fertility

Breastcancer.org: Menopause and Menopausal Symptoms

American Cancer Society (ACS): Managing Female Sexual Problems Related to Cancer