Hormone therapy and sexual health For people with hormone-positive breast cancer
Read this brochure to learn about: • Hormone therapy for breast cancer • How hormone therapy can affect your vagina, sexual health, and general wellbeing • Things you can try to help manage side effects • Resources and contact information
Table of contents
What is hormone therapy?...... 4 Hormone therapy and vaginal health...... 5 What can I do about my side effects?...... 7 Hormone therapy and mood...... 18 Changes with intimacy and relationships...... 19 For more information...... 21 Notes...... 22
3 What is hormone therapy?
If your cancer is hormone-positive, your treatment will include hormone therapy. This medicine blocks estrogen and progesterone in the body.
How long will I need to take hormone therapy?
You will probably need to take hormone therapy for 5 years. You may need to take it longer. Some people take it for up to 10 years.
Keep taking it as long as your oncologist has suggested. Your breast cancer is less likely to return if you take all of the hormone therapy you need.
Which medicine will I get?
Your oncologist will choose the best hormone therapy for you. You may need to take a pill every day or get a shot once a month. What you need depends on the type of breast cancer you have.
If you still have periods, you may also need to take medicine that stops your ovaries from working.
4 How can hormone therapy affect my vaginal and sexual health?
Hormone therapy blocks estrogen in your body. This can change how moist your vagina is.
Your vagina may feel more dry, itchy, tight or painful.
These side effects can be uncomfortable. It can change how you feel during sex or a pelvic exam.
Most people with breast cancer have issues with their sexual health. It is normal.
5 Here are some ways hormone therapy could affect your sexual health: • Sexual activity or intercourse could be more painful • Low sexual desire (libido) • Less able to have an orgasm • Pain in pelvis • Sex does not feel satisfying
Here are some ways your vagina could change: • Vagina feels drier • Vagina feels more narrow and less flexible
You are more likely to develop vaginal or urinary tract infections if your vagina is dry.
6 What can I do about my side effects?
There are a few things you can try to help with side effects. These can help even if you are not having sex. You can: • Use vaginal moisturizers (see page 7) • Use vaginal lubricants (see page 8) • Use lidocaine (see page 10) • Stimulate your vagina with a dilator or vibrator (see page 11) • Zestra® (see page 14) • Do pelvic floor exercises (Kegels - see page 15)
These can: • Improve how comfortable you feel overall • Keep your vagina healthy • Make pelvic exams easier and less painful • Help prevent vaginal and urinary tract infections
If your side effects are more severe, your oncologist may refer you to a gynecologist or other specialist. They will help you find treatment or other solutions.
7 Use vaginal moisturizers
Using a vaginal moisturizer regularly will keep your vagina moist. You could use it once a day or 3 to 5 times a week.
You can buy vaginal moisturizers at your pharmacy. They come in three types: • Gels (Gynatrof or Zestica Moisture™) • Capsules (RepaGyn®) • Creams (Membrasin®)
For RepaGyn®, ask your pharmacist because it is kept behind the counter.
You put them in and around the vagina with an applicator or your finger. If using your finger, consider using a plastic finger protector. This will prevent scratching the walls of your vagina.
Some people prefer to use a natural product instead. They use vitamin E, coconut or almond oil. Please check with your doctor to make sure the oil you have is safe for your vagina.
Only use products made for the vagina. Follow all instructions on the box. If you do not, you could harm your body. Use vaginal lubricants
If you have vaginal dryness, try using a lubricant. Lubricant can help prevent pain and possible bleeding during sex or when you have a pelvic exam.
There are 3 types of vaginal lubricants: • Water-based • Silicone-based • Oil-based
Try different ones to find what works best for you. You can buy lubricants at drugstores, adult sexuality shops or online.
Water-based lubricants • Most common type. • Safe for most sex-related activities with condoms and sex toys. Also safe to use with tampons. • Dries up quickly and can become sticky. • Examples: Astroglide®, K-Y Brand®, Durex®, Liquid Silk®
9 Silicone-based lubricants • Often lasts longer than water-based lubricants • Does not break down in water so it can be used for sexual activities in water • Safe for use in and around the vagina • Safe for use with most sex toys and condoms except those made of silicone • Good for people with sensitive skin, allergies or who easily get yeast or bladder infections • May stain bed sheets • Examples: Pjur®, Pink®, Wet Platinum®
Oil-based lubricants • Do not use synthetic oil-based lubricants inside the vagina, with sex toys or with condoms • Only use for massages on your skin • You can use natural oils such as vitamin E, coconut or almond oils in your vagina but not with latex condoms or sex toys
10 Use lidocaine
If using a moisturizer and lubricant does not help reduce pain, you may want to try lidocaine.
Topical lidocaine comes as a cream or gel. It works by numbing the area it is applied to.
It can be used on the vagina to make sex less painful. It can also be used when inserting a tampon.
If you are interested, talk to your oncologist. They can discuss the risks and benefits of this treatment with you. Lidocaine is available over the counter.
Vaginal moisturizers, lubricants and lidocaine are not covered by OHIP
11 Stimulate your vagina with a dilator or vibrator
Using your vagina regularly, or stimulating it, can help improve some side effects of hormone therapy. It can also make having sex more comfortable if you’re sexually active.
To stimulate your vagina you can use a dilator or a vibrator. These can help to: • Increase how much blood flows to the vagina • Strengthen the walls of your vagina • Teach your vagina to relax and not tense up during sexual activity • Reduce pain when you use tampons, have a pelvic exam or during sexual activity
You can buy dilators and vibrators at drugstores, sexuality shops or online.
Clean your dilator or vibrator after every time you use it. Use mild soap and water.
12 Use a dilator
A dilator is a firm rounded tube usually made of plastic or silicone. Dilators come in different sizes. When you put it inside the vagina, it will gently stretch and feel less tight over time.
Here is how to use a dilator:
• Start with the smallest dilator.
• Put either a water-based or silicone-based lubricant on the dilator depending on what the dilator is made of to avoid damaging it.
• Put it inside your vagina for 1 or 2 minutes each day. Do this for up to 6 months.
• As you feel more comfortable, slowly increase the size of dilator you use.
Example of dilator set Source: Wikimedia Commons
13 Use a vibrator
Most vibrators are made of plastic or silicone. They come in different shapes and sizes. A vibrator may require batteries or it may come with a charger.
Touching yourself with a vibrator can help to increase blood flow to the place you are touching. More blood flow can make you more aroused, and can help your vagina become more lubricated.
You can use a vibrator inside and around the vagina, and on the clitoris.
If you use it inside, a vibrator can gently stretch the vagina. Make sure you use either a water- based or silicone-based lubricant on the vibrator depending on what the vibrator is made of to avoid damaging it.
Do not be embarrassed to ask your nurse, pharmacist or oncologist for advice on vaginal moisturizers, lubricants or devices. It is normal to have questions. Getting advice will help you find the best way for you to improve your vaginal and sexual health.
14 Use Zestra®
Zestra® is an oil-based product that is applied to the outside of the vagina and clitoris. It can make more blood flow to these areas and make them feel more sensitive. Its effects can last for up to 45 minutes.
The gel may make you feel more aroused. During sex, it may help you feel more sensitive and more satisfied.
Zestra® may irritate a dry and sensitive vagina. To help prevent this side effect, you could use a vaginal moisturizer regularly.
Ask your pharmacist if Zestra® is available at your pharmacy. You can also order it online. It is approved by Health Canada.
For instructions on how to use and apply it, please follow the label on the Zestra® box.
Check with your oncologist to see if this product is appropriate for you.
15 Do pelvic floor exercise (Kegels)
The muscles in your pelvic floor control the opening of the vagina, and the muscles you use when you go to the washroom. You can make your pelvic floor stronger with exercises.
Having a stronger pelvic floor can help to: • Make sexual activity more pleasurable and less painful. • Control your bladder if you sometimes leak urine.
To do the exercise, tighten and relax your pelvic floor by squeezing your vaginal muscles. Hold for 20 seconds and relax. This feels like holding in your pee. It is called a Kegel exercise. You can do this either sitting, standing or lying down on the bed.
• Try doing 10 to 20 Kegel exercises. • Do Kegels a few times a week or once a day.
Some physiotherapists are trained to help people with their pelvic floor. If you want a referral, talk to your oncologist or your nurse.
16 Vaginal laser treatments
Laser treatment delivers gentle laser energy to the tissues of the vaginal walls. This may help improve vaginal dryness.
MonaLisa Touch® is a laser treatment approved by Health Canada. It is usually not covered by insurance plans, which can be very expensive.
Talk to your oncologist or gynecologist if you want to learn more about this therapy.
17 How can hormone therapy affect my mood and feelings?
Hormone therapy can also affect your mental health. You may notice changes in your mood. You could feel sad, anxious and irritable.
If you are concerned about how hormone therapy is affecting your mental health, talk with your nurse or oncologist. They can connect you with someone to talk to, such as a psychologist or social worker. These supports are available through the hospital or in the community.
If you have a partner, talk to them about how you feel. Tell them about the changes you are coping with.
18 Changes with intimacy and relationships
Coping with a cancer diagnosis, going through treatments and dealing with their side effects can cause changes in how you feel and how you look.
These changes can sometimes affect: • Your relationships • How close you feel to other people • How you feel physically or emotionally intimate with a partner • Your interest in sex
Many people find it difficult to talk about their sexual health during and/or after cancer treatment. Talking can help you feel better. If you can, talk to: • Your healthcare provider • Your partner if you have one
If you are having trouble talking about how you are feeling, ask your oncologist or nurse how to find a counsellor or couples therapy.
19 To find a specialist or therapist
Your oncologist or nurse can arrange a referral to someone that they think may help you, such as a social worker, gynecologist, psychologist or a physiotherapist.
These specialists and therapists are not always covered by OHIP. If you have another insurance plan, you may have coverage for these services.
The websites below are listed if you want to do your own research before or after speaking with your health care team:
BESTCO: Board of Examiners in Sex Therapy and Counseling in Ontario: bestco.info/therapistlocator
• To find a certified sex therapist near you.
College of Physiotherapists of Ontario: collegept.org/patients
• Search: Pelvic Health or Area of Practice: Women’s Health/Urogenital
20 For more information Websites
Canadian Cancer Society: cancer.ca • Search: sexuality and cancer
Cancer Care Ontario: cancercareontario.ca • Search: sexual health
Rethink Breast Cancer: rethinkbreastcancer.com • Search results: sex
Social support
Cancer Chat Canada (requires registration): cancerchat.desouzainstitute.com • Restoring Body Image and Sexual Health After Breast Cancer: Canada-wide online support group
Wellspring: wellspring.ca • Various in person support groups and classes
Gilda’s Club: gildasclubtoronto.org • Various in person support groups and classes
21 Notes: ______
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Unity Health Toronto cares about your health. For health information you can trust, visit us online at unityhealth.to/learn or visit the Patient and Family Learning Centre at St. Michael’s Hospital.
This information does not replace the advice you receive from your health care provider. If you have questions, ask your health care team.
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