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After surgery for stage 1-a ovarian and stage 1(0) endometrial cancer and the oophorectomy that followed...I'm wondering if "libido" will ever be in my vocabulary again. I have been on compounded progesterone and methyltestosterone since I was able to research my options and have recently added ostaderm V to my regimen for vaginal dryness. I'm able to reach orgasm and have a loving marital partner of many years so I know I'm fortunate in so many ways. I was just 44 at diagnosis(4 years ago) and I'm considering switching from methyltestosterone to testosterone...do you feel this is a appropriate thing to consider?I did not have chemo or radiation but did have debilitating menopausal symptoms immediately after the surgery for many months.
Fredric V. Price, MD:
Questions of sexual health after cancer treatment are somewhat difficult to answer. Because "loss of libido" means different things to different people, there is no standard way to approach this problem. Generally, sexual health involves satisfaction with sensation and desire for sexual activity. I try to learn from listening to my patient's sense of how her behavior and attitudes about sex have changed from before diagnosis and treatment to afterwards.
A diagnosis of cancer has profound effects on dynamics within a sexual partnership; this disruption can influence a couple's attitudes about sex. Treatments can also cause physical changes that may make sexual relations less pleasurable for one or both partners. Recovery from hysterectomy and oophorectomy performed for cancer therapy is sometimes associated with changes in the hormonal environment of the pelvic organs. Sexual response and ability to achieve orgasm can be influenced.
When a patient requests help with sexual problems, I try to make sure that her relationship is healthy. Sometimes tension arises from a dissatisfied partner or at worst coercion or threat of violence has made sex no longer pleasurable. Sexual problems can also result from underlying depression due a feeling of loss after an undesired hysterectomy or the diagnosis of cancer. If the partner is understanding and helpful, the chance of helping the situation is greatly improved. If there is a need, I will offer the patient referral to a certified sexual therapist trained in managing such issues.
Estrogen replacement therapy can sometimes help to restore libido. Systemic estrogen is given either by a patch or a tablet, and will reduce hot flashes, improve blood supply to the pelvic organs, and provide moisture for lubrication during sexual arousal. Vaginal estrogen can be delivered in the form of a cream or vaginal tablet to improve tissue elasticity and moisture. Testosterone can be added to estrogen in a tablet, and this combination can be especially helpful in women who have had surgical menopause at a young age. The combination has been shown to improve sexual function. It is critical that the role of hormone replacement in a gynecologic cancer survivor should be discussed with her oncologist.
Judy Knapp, PhD, MSW:
In addition to the medical approaches to enhancing libido that Dr. Price mentioned in his response, I would like to add that I have seen physicians occasionally prescribe Wellbutrin for this indication. Wellbutrin is an anti-depressant that has been in use for many years, but it does not depress sex drive as the newer medicines may.
There is a helpful booklet published by the American Cancer Society called 'Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner'. It can be obtained through the local division of the Society or on the Web at http://www.cancer.org.
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Removal of the uterus, tubes and ovaries for treatment of gynecologic cancers can have a negative impact on the sexual function of the survivor, as well as her sexual relationship with a partner. What are some ways to deal with this problem?