Sex Matters: Managing Your Mojo, Part 2

By on February 4th, 2015 Categories: Sex Matters

In Part 1 of this column, we talked about some of the factors healthcare providers look for to determine a diagnosis of Female Sexual Interest/Arousal Disorder.

If you’re struggling with symptoms that suggest this diagnosis, it’s important to see a specialist to find out for sure and learn about treatments that may help. Your specialist will take detailed cancer and medical history to look at any possible underlying medical and hormonal changes and to discover any potential psychosocial problems that may have an effect on libido or suggest a biochemical cause.

In addition, your specialist will want to give you a complete physical examination and to rule out vaginal dryness. Your sexual medicine expert or oncologist may order hormone blood tests. Sometimes, in the crisis of cancer care, chronic medical conditions such as thyroid problems may be overlooked and may be associated with lowered sexual interest. Ask your health insurance provider if blood work, such as thyroid testing, is covered, and talk to your healthcare provider about whether the benefits of extensive blood testing outweigh any financial expense.

Treating sexual desire issues can involve many different approaches. It’s important for your healthcare provider to check for any underlying chronic medical illnesses. All medications that can potentially interfere with the sexual response cycle should be evaluated. Be sure to have a list of all your current medications when you go see your provider to discuss your sexuality concerns. Antidepressant medications maybe affect desire and arousal, but it is never advisable to stop any medication without first discussing it with your healthcare professional!

Hormones may be considered the mainstay for treatment of libido issues, but rest assured, there are many women without any estrogen or testosterone who still have good sexual interest. The libido story is much more interesting that just estrogen and testosterone. Other substances connected to libido function include brain chemicals such as serotonin, dopamine, oxytocin, melanocortin, endorphins, and norepinephrine, just to name a few!

Most women diagnosed with breast cancer will not be candidates for systemic hormone replacement therapy (HRT), so we will not be covering this topic. Unfortunately, there is no Food and Drug Administration (FDA) approved medication for the treatment of lowered libido in women. The good news is that there are some non-hormonal medications on the horizon currently under investigation in clinical trials. Flibanserin and Bremelanotide remain hopeful potential medications, although they are currently unapproved and remain untested in the breast cancer population.

Some women may opt for complementary therapies, such as herbs and supplements, for the treatment of libido concerns. However, some herbs and supplements can interfere with conventional medications, so it’s best to check with your healthcare professional to make sure they are safe and effective.

A sexual counselor or specialist may recommend simple ways to improve sexual desire. Some examples include making sexual intimacy a priority, setting aside time for physical and emotional connectedness between you and your partner, and planning dates that may help enhance the relationship. Some people find that reading erotic stories can help. Other basic recommendations include increased physical activity, maintaining an active social support system, and eating a well-balanced diet.

Guided imagery and a variety of relaxation techniques are some common exercises that may be able to help people with lowered libido. We will cover these in greater detail in future columns.

Sexual boredom and lack of excitement may contribute to lowered sexual interest in long-lasting relationships. Some women may become distracted or unable to focus on pleasure during sex, and this may short-circuit their desire. Mindfulness has been shown to be helpful for people diagnosed with cancer. We will devote a column to mindfulness, too!

Sometimes simple suggestions to enhance pleasure and originality for the sexual relationship are needed. For some people, using sexual devices, such as a vibrator or self-stimulator, or other erotic accessories can be exciting. Changing sexual positions or the location of sex or even the time of the day when sexual intercourse occurs may help recapture some sexual excitement. Counseling – whether it’s couples counseling or individual sex and behavioral therapy — may also be important. Cognitive behavioral therapy can include sexual exercises, intimacy enhancement exercises, and development of communication skills, and may include an in-depth discussion of the barriers to sexual behavior.

We will discuss a variety of differing interventions in greater detail in the months to come. We want to help you refocus on your libido and reclaim your desire. What worked for you, and what was not helpful? If you’re comfortable sharing, please let us know what you have tried.

Michael L. Krychman, M.D.C.M., is the executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, California. He is the former co-director of the Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer. Dr. Krychman is also an American Association of Sexuality Educators, Counselors and Therapists (AASECT) certified sexual counselor. He is an associate clinical professor at the University of California, Irvine, Division of Gynecological Oncology, and the medical director of Ann’s Clinic, a high-risk program for breast and ovarian cancer survivors. His special interests include menopausal health, hormone therapy, sexual pain disorders, loss of libido, and chronic medical illness and its impact on female sexual function as well as breast cancer sexuality. Dr. Krychman is also a member of the Breastcancer.org Professional Advisory Board.

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