“I’m really suffering here. How do I have that awkward conversation… you know… about dryness… with my doctor about getting help?”
I often hear this complaint from many of my brave patients who have sought help from numerous healthcare providers. Vaginal dryness in the midst of breast cancer treatment is a serious emergency, often made worse when no one is talking about it in the doctor’s office.
Many women believe that if vaginal dryness after breast cancer was an important issue they needed to know about, then their healthcare provider would have brought it up. So when it happens and there’s been no conversation or chance to prepare, that’s an emergency!
Understandably, many women remain self-conscious about initiating a dialogue with their healthcare providers. Often, healthcare professionals are poorly trained and uncomfortable themselves talking about this topic, or else they happen to be in a hurry — or both — and sometimes they may fail to address a laundry list of medical and psychological issues. Many professionals feel that if the woman herself was concerned, she would initiate the discussion. But we know how difficult it can be to start this conversation! The silence is often deafening.
How can you get through this interaction comfortably to address your needs? Here are some helpful tools.
Be prepared. Put pen to paper. Write down your concerns in order of importance and bring this list with you to your appointment. You may also want to print and fill out one of the checklists at the end of this column and bring it to your visit. The checklist can either be given to the nursing staff or your medical professional. These checklists often jump-start many conversations.
Recruit help. It could be the nurse or the medical assistant. Perhaps choose these people as you may be more comfortable with them when it comes to talking about sex, painful intercourse, or vaginal dryness. It’s PERFECTLY okay for you to mention your concerns to these healthcare professionals and encourage them to relay your concerns to the doctor.
Prepare for your visit. You may need to practice and rehearse some scenarios in your head — what should I say? How should I say it? What are the correct words? You may want to practice what you will say in front of a mirror. Write down all the questions that occur to you. Being prepared is half the battle.
During your visit, try to maintain and build positive communication with your practitioner. One great way to do this is to make eye contact regularly. And even though vaginal dryness isn’t the most comfortable subject, try to avoid the temptation to leaf through a magazine or look at your iPhone during the conversation. Do your best look your healthcare provider in the eye and ask specific questions so you can get the answers you need. Be as direct and honest as you can. Review your questions and make sure that you have addressed your agenda for the visit.
Remember that a good doctor is never afraid of a second opinion. If your medical needs are not met and you feel that your vaginal dryness concerns are being ignored, then consider seeking help from other members of your oncology team who may be more willing or receptive to address vaginal dryness. If that doesn’t provide answers, don’t hesitate to get a second opinion from an oncology provider in a different hospital.
Sample Checklist for Vaginal Symptoms
Please fill in this checklist to help aid discussion with your healthcare provider.
Are you experiencing:
1. Vaginal dryness during your normal daily activities? Y N
2. Vaginal discomfort not involving sexual activity? Y N
3. Pain during sex? Y N
4. Vaginal itching or burning? Y N
5. Itching or irritation of the labia? Y N
6. Frequent or recurrent urinary tract infections? Y N
7. Yeast-like symptoms? Y N
8. More frequent trips to the bathroom to urinate? Y N
9. More nighttime trips to the bathroom? Y N
Checklist reprinted courtesy of SIGMA.
SIGMA is an independent, multidisciplinary group of family doctors and specialists interested in menopause and post-menopausal health.
Vaginal Symptoms Checklist
Are you experiencing the vaginal symptoms of menopause? Answer these questions to find out.
- Do you have vaginal dryness?
- Does your vagina feel irritated or itchy?
- When you’re sexually aroused, do you have less lubrication than you used to?
- Do you feel pain, discomfort, or irritation during sex?
- Does your vagina ever bleed after sex?
- Does your vagina seem to have become narrower?
- Do you have frequent urinary tract infections? (symptoms include frequent urination, pain when urinating, or blood in the urine)
- Do you have lower back pain?
- Do you get constipated more often than usual?
- Do you feel something bulging into the wall of your vagina?
- Do you feel any heaviness in your pelvic area (lower abdomen)?
If you answered “yes” to any questions above, you may be experiencing vaginal symptoms of menopause.
These symptoms can affect your personal comfort, your sex life, and your relationship with your partner, and they can get worse over time. Don’t suffer in silence — speak to your doctor to find a treatment that works for you.
Adapted from http://chealth.canoe.ca/
From www.HealthyWomen.org
AlaskaAngel says:
The suggestions are meaningful. Yet I personally used them repeatedly during the early years of being post-tx without success. Why? I obtained copies of all my visits with my providers and not a single one of my providers had the integrity or understanding about these issues to write my concerns about them down as being an essential part of the analysis and treatment process.
Another suggestion I have for providers would be to recognize just how many of the nursing staff who are dealing with bc patients are themselves younger (and pre- or perimenopausal) as compared to the vast majority of bc patients, who are dealing with abrupt onset of accelerated aging due to treatment. These are patients who need to avoid the inflammation of weight gain to avoid recurrence of their disease, yet when they enter medical care they are faced with an army of younger caregivers who have very little grasp of the differences aging poses for this group in achieving success.
pucksmom says:
This is very true. I became very frustrated with my physicians’ lack of interest about this. I tried compounded testosterone cream, which lost its effect over time. I stopped using an estring, and now can’t accommodate one. I was 42 when my periods stopped after the second cycle of high dose chemo 20 years ago. I’m allowed some Estrace because I have chronic UTIs from Multiple Sclerosis. ThIs all becomes extremely depressing, as though sex is on another planet. Surely some physician deals with this issue.