Sexuality-MW: The Body3
The Medicine Wheel: Managing Sexual Side Effects
of Cancer Treatment


Medicine WheelSpritualPhysicalEmotionalMental
(See the Sexuality Resources leaf of this branch for websites with specific details for management)

What is premature or early menopause?

  • Known as the end of your monthly cycles, the change of life or simply "the change", menopause normally occurs in most women in their late 40s to early 50s (but can occur earlier or later)
  • If you have your ovaries removed or receive chemotherapy or radiation to the pelvis, you may go through menopause earlier than normal (premature menopause)

What causes early menopause in cancer patients?

  • Normal aging
  • Removal of the ovaries (oophorectomy) by surgery
  • Cancer treatment (radiation therapy, chemotherapy)
  • Lack of estrogen to body tissues

What happens if I do not have enough estrogen in my body?

  • You will have hot flashes or flushes
  • You may feel irritable or weepy
  • You may have difficulty getting to sleep or staying asleep
  • You may have muscle and joint pain
  • Your vagina with not stay moist and flexible
  • You will have increased wrinkling
  • You may have increased weight gain and weight is hard to loose

What are hot flashes?

  • Hot flashes or flushes are a sudden onset of an uncomfortable feeling of intense heat
  • Along with the sensation of heat you may have sweating and skin flushing, usually in the face and chest
  • A hot flash usually lasts about 3 to 5 minutes
  • Recovery from the hot flash takes about 30 minutes
  • Some women have 2 or3 hot flashes each day; some may have 30 to 40 hot flashes each day

What treatments may be helpful to manage hot flashes?

  • There are many methods suggested for treating hot flashes.
  • Among them are estrogens, some antidepressants, herbs and other complementary methods such as vitamins, yoga and acupuncture.
  • Some may work for you and some may not.
  • Always talk with your healthcare provider before taking any medicines, herbs or vitamins as they may interfere with your cancer treatment.

What are some ways to decrease hot flashes without medications?

  • Wear loose clothing; use natural fibers and layer your clothing
  • Avoid spicy foods, hot tea/coffee, and alcohol
  • Try to lessen stress
  • Exercise daily
  • Keep your thermostat at < 70 during day and <65 at night

Why do I have pain during intercourse?

  • Pain during intercourse can occur in those who have surgery or radiation therapy to the pelvis
  • Pain may occur if you have less lubrication (dampness) in your vagina than is usual for you
  • If you are not aroused when you have intercourse, you may have less lubrication
  • Being afraid of having pain can cause less lubrication and cause the vagina to tighten, this causes pain which then increases your fear of having pain

CeCe Whitewolf
Confederated Tribes of Umatilla
Dx 1998 Breast Cancer


"But the issue is vaginal dryness. They didn't tell us with our chemo with all of our drugs that we would have vaginal dryness. And I've always wondered what the heck is vaginal dryness. Well now I know when you have sexual activity, your body puts out kind of a lubrication so that as the penis enters the vaginal area it doesn't hurt. It's not dry like sandpaper, when you have vaginal dryness you don't have that lubrication anymore and so like right now my vaginal canal is dry and if Ron and I have sexual activity we have to use a lubricant. And I didn't know what they meant by using a lubricant, where in the world do I get a lubricant. What's that all about? I'm 55 years old. Nobody told me these kinds of things as when I was growing up so we've also learned that in addition to, we'll keep talking about the lubricant.
You go into the grocery store, you go into Fred Meyers or Safeway and you go to where they have the male condom places that's where they have those lubricants, it's like a they said it's a KY jelly or some kind of little squeeze bottle thing that we've got that we use. And Ron puts it on himself and he put some inside me and it helps us with are sexual activity. Um… I can't say it is as much fun as it used to be though because they're still great deal of vaginal dryness."

to play Video Vignette - click audio only

What can I do if I have pain or discomfort when I try to have intercourse?

  • Let your partner know what is painful
  • Try different positions
  • Use additional lubrication (gels or creams such as K-Y jelly®, Astroglide® or Replens®; can also use glycerin or saliva; "DO NOT" use Vaseline®, Vicks Vaporub® or any other petroleum-based product)
  • Increase time for sexual arousal before trying intercourse
  • Take your pain medication prior to beginning sexual activities
  • Do not have intercourse if you have vaginal sores or heavy bleeding from radiation therapy or if you have a low white count (check with your provider first)
  • If you have vaginal narrowing you may need to use a vaginal dilator to keep the vagina open and flexible.

    Dilator Set Sizes:
    Unit Front Diameter Back Diameter Length
    1 - Dilator 3/4" [19mm] 7/8" [22mm] 3-1/2" [90mm]
    2 - Dilator 15/16" [24mm] 1-1/16" [27mm] 4-5/16" [110mm]
    3 - Dilator 1-1/8" [30mm] 1-1/4" [32mm] 5-1/2" [140mm]
    4 - Dilator 1-3/8" [35mm] 1-1/2" [38mm] 6-3/8" [163mm]
    5 - Handle Universal Handle fits dilators 1 through 4

  • Your provider can tell you how to get a dilator.
  • In place of a commercial dilator, you can use a small candle covered with plastic (saran-type) wrap or a condom (standard taper candle about 6-8 inches in length).
  • Be sure to use a water-based lubricant such as K-Y jelly® or Astroglide® or you can use saliva to lubricate the dilator (plastic wrapped candle). Plastic wrap or condom is removed and thrown away after use.
  • Over time, you will increase the size (width) of the dilator (or plastic-wrapped candle) to increase the size of the vagina.
  • Having regular intercourse will also keep the vagina from narrowing.
  • Some women may have a vaginal infection that can cause pain. If you have a creamy-white discharge or have itchiness in the vaginal area, you may have an infection. Contact your provider for the appropriate treatment.

What should I do if my interest in sex is less than I want it to be?

  • For some women increased vaginal lubrication and decreased pain may increase your interest in sexual activities
  • For others, drugs used to treat erectile dysfunction in men, such as Viagra® may be helpful
  • Sexual counseling may help; ask your provider
  • Talking with your partner and finding ways to be intimate and emotionally close also may increase your interest in sex



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