How a Cancer Diagnosis and Early Menopause Changed My Sex Life
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How a Cancer Diagnosis and Early Menopause Changed My Sex Life

Jun 27, 2023

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When treatment for breast cancer triggered painful vaginal symptoms, I was too embarrassed to talk about it, even with my doctor. But why should menopause prevent anyone from having the sex they deserve?

On a cold February day a few winters ago, I was sitting naked from the waist up on an exam table in my oncologist’s office. The doctor had just completed my once-every-three-months breast exam and was studying my labs. I had gotten used to being poked and prodded like a tomato at the grocery store during these appointments, part of my ongoing treatment for early-stage breast cancer.

In the five years since I had been diagnosed, I’d undergone a unilateral mastectomy and endured targeted hormone therapy. The treatment saved my life but also pushed me into medically-induced menopause at the age of just 37. By this visit, my cancer was thankfully in remission and I was going to live to see my two young sons grow out of diapers. But I dreaded these follow-up appointments, anxious that my doctor would once again find a tiny Tetris-shaped blob on my scan that would throw my life into chaos. This time, I was nervous about something else too.

“Labs look good,” he said, spinning around in his chair to face me as I wrapped myself up in the thin hospital gown. “How are you feeling?” he asked.

I took a deep breath. “Well, everything feels okay here,” I said pointing to my breasts. “But,” I paused, feeling a twinge of embarrassment. “What is it?” he asked.

“I’m having a lot of trouble ‘down there,’” I said, pointing to my vagina. I could feel myself start to cry. “I can’t—it hurts a lot during sex.”

I was flooded with relief when he didn’t balk but nodded in agreement. He explained that vaginal atrophy is a very normal and common symptom of menopause. He was glad I said something because so many women don’t.

When I was first hurtled into premature menopause, it felt like my body and mind had short-circuited. All hell broke loose on a cellular level. Practically overnight, I went from being a healthy, energetic mom to a hot-wired mess. I couldn’t remember the plot of the TV show I’d just watched or the thread of a conversation. I gained weight. My hair started falling out. Although it was easy to feel uniquely cursed, it’s a more common scenario than you might think: An estimated 5 percent of women enter menopause before the age of 40, and people can be pushed into medical menopause for a host of different reasons, including hormone therapy, chemotherapy, radiation, and surgery.

Eventually, through trial and error and many sleepless nights of googling, I got my postmenopausal symptoms under control. I started taking vitamins and supplements for vicious mood swings and hot flashes, and melatonin gummies for insomnia. I tried acupuncture for muscle pain and yoga to maintain bone density. Slowly, my energy levels began to bounce back, and I felt more like my old self. Except for one thing—I could no longer have sex.

My worst symptom of menopause—and the symptom least mentioned even in my extensive internet trawling—was vaginal atrophy, the thinning and drying of the vaginal tissues, which causes extremely painful symptoms during sex. (Think: shards-of-broken-glass-inside-your-vagina levels of pain.) My husband and I had been through a lot together—two kids, losing my mother to cancer, and then my own cancer diagnosis—and he was always by my side. We had an active sex life. In the post-cancer phase of my life, I wanted to feel like a hot, sexy goddess ready for ravaging. Instead, it felt like I was broken. You’d think I would have called my doctor immediately to see what could be done. Except...I didn’t.

I’m a mental health therapist who prides herself on openness, yet it took me years to get help. Why? Because I was embarrassed to admit that my body was changing. I was still young, but I felt old and dried up. None of my friends had gone through menopause, and my mother had passed away. I felt so very alone. When I finally worked up the courage to say something to my doctor, I was grateful to be met with compassion, but many people aren’t. A few of my friends who are also cancer survivors were dismissed after voicing their concerns. One doctor told my friend her vaginal symptoms were caused by lack of sleep. Another doctor said, “You need to use it or you’ll lose it.” Horrifying.

It’s appalling that this kind of misogyny still exists when the public discourse around menopause has radically shifted in the past decade, thanks in part to high-profile figures speaking candidly about their experiences. A few months ago, Drew Barrymore fanned herself through her first perimenopausal hot flash on-air with Jennifer Aniston. Gayle King openly discussed going through menopause on CBS Mornings and referenced her “dry vagina” three times—my new hero! But while hot flashes and mood swings are now funny fodder for talk-show segments, many people still remain reluctant to discuss their more intimate symptoms.

Menopause and sex lives at the intersection of women’s pain, pleasure, and aging, all topics that somehow still—in 2023—make doctors (and society at large) glitch, leaving women to suffer in silence. While a reported 50 to 60 percent of postmenopausal people experience vaginal atrophy, research shows only a quarter of them end up seeking medical help for their symptoms. And when people do, they’re often met with inadequate care in a terrible self-perpetuating cycle: Astonishingly, 3 out of 4 people who seek medical help for their menopausal symptoms don’t receive it. Women’s health continues to be chronically under-discussed, under-researched, and underfunded.

To be honest, even with my own symptoms, I was in denial about what was happening to my body. Not yet 40 years old, I was devastated to think I might never have good, pain-free sex again. At first, I ignored my pain and discomfort, hoping my symptoms would go away, but they only worsened over time. Only when I became desperate to fix my sex life did I finally ask for help.

My oncologist recommended nonhormonal remedies as a first line of treatment, like hyaluronic acid suppositories and coconut oil, but I’d already tried these options and none of them brought me relief. Next, he prescribed me a low-dose topical vaginal estrogen cream. Initially, I was wary about using an estrogen product because my breast cancer was hormone sensitive, but he reaffirmed that the research regarding topical estrogen and breast cancer risk shows that it’s a safe and effective option for survivors. He talked me through all of my options and most importantly, he listened. He understood that quality of life means quality of my love life too. My sex life, my family life, my married life, my hot and sexy goddess life—all of it mattered. Not just being alive, which of course I am lucky to be. But there’s more to it than just bare-bones survival.

I’ve decided to try the estrogen cream, and I’m hopeful it will help. Of course, most women don’t have access to personalized health care from multiple specialists or the time and resources to comb through complicated medical reports and clinical studies. Instead, they are making major health care decisions based on Google searches, Reddit threads, and outdated research. The medical community could be doing a lot more to address the “taboo” symptoms of menopause. Wouldn’t it be nice if doctors took the lead and directly asked every postmenopausal person about their vaginal symptoms as soon as they sat down for an exam, rather than waiting for their patients to bring it up?

I wasn’t expecting my ovaries to shut down at 37 years old following an out-of-the-blue cancer diagnosis. It hasn’t been easy, but through it all, my husband and I have redefined what intimacy looks like for us. Having sex taken off the table forced us to look at our partnership in a whole new way. We started couples counseling and had difficult conversations about sex that ultimately brought us closer together. It’s something that we’ll likely have to do again and again throughout our marriage. Of course, there are moments when the unfairness of it all sits between our bodies, the eternal why: why me, why cancer, why my vagina? But most of the time, I feel grateful to be here, helping others forge a path, even through all those impossible whys.

Anna is a mental health therapist and writer who has been published in The New York Times, Vogue, Salon, HuffPost, and Insider, among others. She is currently writing a book about her experience with medically induced menopause. She lives in the high desert mountains of Santa Fe, NM with her husband and two children. You can find her on her website, or follow her on Instagram.

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