Ask an Expert: Intimacy + Sexual Wellness

After our popular Gut Health + Functional Medicine topic, we continued our series with Jennifer Litner from Embrace Sexual Wellness! She is uniquely experienced in providing an encouraging environment for clients to express their worries, needs, desires, and fears.

Below you’ll find her expert responses to questions submitted from members of our community. Read on to learn about intimacy + sexual wellness after a cancer diagnosis -- regardless of whether you or your partner have been through cancer treatment. From loss of libido, disconnection with a partner, your body, or sexual shame – nothing is off limits with Jennifer! 

ICYMI: we went live on Instagram with Jennifer as a follow-up to this — check out the convo here!

I want to know how I can increase my sexual appetite. I am in menopause so I know that also influences things. Thank you.

Sexual appetite (libido/desire) is affected by a number of factors that increase and decrease desire. What has prompted your desire in the past? What deflates it? Sexuality professional Emily Nagoski talks about these factors as gas and brake pedals in her book. Just like you can’t drive a car with a foot on the brake pedal, the same is true for sex. Another thing to consider is how frequently sex is on your mind. For most people I work with, it’s the furthest from it. One way to help boost desire is to entertain more sexy thoughts (think erotica, self pleasure, or sexy stories if that’s your thing). When we have sexy thoughts that are positive, it generally breeds more sexy thoughts. 

Menopause changes the amount of estrogen that ovaries produce, which can have a direct impact on sexual libido. Consider talking to your OBGYN or a sexual health specialist about pharmacological options too (e.g., testosterone, flibanserin and bremelanotide). Working with a certified sex therapist for talk therapy is another good option to address desire-related concerns!

Is it normal to not be turned on by ANYTHING after a mastectomy? Are there ways to heal and find pleasure in sex again?

Yes, this can be quite common. Any significant medical procedure (like a mastectomy) can play a role in terms of sexual desire. Desire is super context dependent, meaning that it changes based on all the different circumstances in our lives. Our sexual interests and stimulation evolve throughout our lives -- so what you may have found to be a turn-on before your mastectomy may not be now. Consider exploring new types of touch, sensation play, erotica, pleasure devices, or building off physical intimacy for starters. Talking with a trained psychotherapist or sexuality educator who is trained in sexual wellness can help guide you through this process can be another option worth trying!

I really do think I lost connection with my private parts. It feels like any of it, it’s not mine. Painful, 0 libido, awkward feeling (with my husband and also myself) I have tried several lubricants, coconut oil, condoms, nada... Does it get better?

Many people have difficulty reconnecting with their bodies during and after cancer treatment. One way is to build connection through sensual touch with all body parts, not solely the genitals. Body affirmations may be helpful, in addition to exploring different options for providing stimulation. Disconnection to one’s body can be explained by a number of biopsychosocial factors (e.g., lack of adequate stimulation, blood flow difficulties, distracting thoughts, anxiety or depression, relational experiences, etc.).

If you are experiencing pain and/or dryness, there are a number of things that may help. First, I would highly consider seeking out a physical therapist that specializes in pelvic health and consulting a gynecologist that specifically treats sexual pain. The Northwestern Center for Sexual Medicine & Menopause is a great option. There are vaginal suppositories that contain estrogens, testosterones, and DHEAs that can help with rejuvenation of the tissue. Additionally, there’s an oral medication called Ospemifene (non-estrogenic) that stimulates estrogen receptors in vaginal tissue that can assist with vaginal dryness. Vaginal moisturizers such as Replens is another estrogen-free option for assistance with dryness.

I was diagnosed with cancer while still in the honeymoon phase of my marriage, and now that he’s my caregiver, we are finding sexual intimacy to be non-existent. How do we make room for our love life amidst this cancer shit?

I know this feels tough and it’s common for sex to fall off the radar when there’s so much going on, especially when caretaking can feel like an intense role for partners. One possibility is to explore role plays that shift the power dynamic. For example, would it be possible for you to play up caretaking in a sexy way (think nurse/patient or teacher/student). Fantasy and role play transport us to a place that feels different from our realities, which is what makes it so appealing for many people. Prioritizing intimate time together regularly is another important step -- make time for both of you to be present and open to connect with the goal of pleasure. Remember, there are so many ways to build intimacy that are not inherently sexual, so that’s also something worth discussing. 

How to prepare yourself to one day have a new partner (currently single), what to tell them about your past, how to cope with anxiety around the “first time after cancer” and open yourself to the experience of sexuality after brachytherapy leaves you feeling like your sexual organs are anything but sexual anymore.

Disclosure can feel difficult for a lot of people. Some people find it helpful to build comfort with new partners by first discussing other vulnerable topics (e.g., past relationships, family, loss, etc.) before discussing their cancer histories, whereas others prefer to jump in and share their stories sooner. When it comes to sex after cancer and brachytherapy, remember that just because you don’t feel sexual anymore does not mean that you can no longer be. First, I want to invite you to hold so much compassion for yourself as you embark on this sexual re-awakening. Next, think about ways to explore sensations with new partners, perhaps taking it slowly, reorienting yourself to physical touch, closeness, and more. Also, lubricant and pleasure devices are your friend!

Advice for when to bring up my cancer history when I’m ready to date again? Or how to approach sex with a new partner(s) with all my scars, deformed breasts, etc?

Disclosure is personal and revolves around your timeline. I’d suggest checking in with yourself to determine your own comfort level and when it feels like the right time for you. That being said, here are a few options for starting the conversation with a new partner: