Presented by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for breast cancer survivors at Breast Cancer Foundation , Singapore on Sat, 9 April 2016. Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

1. PRESENTATION NAME
Sexual Healing after Cancer
9 April 2016

2. Dr. Martha Tara Lee
Clinical Sexologist
• Doctorate in Human Sexuality
• Masters in Public Policy and
Management
• Bachelor of Arts (Comm)
• Certificate in Sex Therapy
• Certitificate in Practical
Counselling
• Cert in Life Coaching

3. Agenda
1. Sex Myths
2. Misconceptions about sex
and intimacy after
surgeryTreatments
3. Effects of Treatment
4. Tips for healthy and safe
sexual activity
5. Conclusion

4. Sex Myths
1. Sex is a sensitive topic.
2. Sex is only for making babies.
3. There is a cut-off age for sex
4. He knows what he is doing.
5. There is a “best” way to have sex
6. More sex is better.
7. Faster is better.
8. Sex is incomplete without the orgasm.
9. Need desire for sex.
10.Need emotional connection for sex to happen.

5. Misconceptions about Sex and
Intimacy After Surgery
1. Be grateful to be alive.
2. Things will get better.
3. Sex is about penetration.
4. Sex is about the orgasm.
5. Sex is all about him.
6. No need to think about
sex if single.
7. Too old anyway

6. Can Sex During Chemo or Radiation
treatment hurt your Partner?
• A few chemo drugs can come out in small
amounts in vaginal fluids. You may want to tell
your partner to use condoms while you are
getting chemo and for about 2 weeks
afterward.
• Having sex will not expose your partner to
radiation unless you have an implant that
gives off radiation.
• Do not get pregnant during treatment. Ask
your doctor about birth control.

7. When should a Person with Cancer
not have Sex?
• Ask your doctor if sex would cause a problem any
time during or after treatment.
• After surgery, sex might cause bleeding or pull the
stitches. Sex may also raise your chance of infection.
• Some types of cancer may cause bleeding in the
genital area.
• During chemo or radiation treatment, your immune
system may not work very well and you can get all
kinds of infections.
• Urinary tract infections can be a problem, but there
are things you can do to help prevent them.
• If you notice any sores, bumps, or warts on your
partner’s genitals, or any kind of discharge, find out
what’s going on.

8. Treatments that Affect Sexual Health
Radiation
Side effects such as fatigue, nausea,
vomiting, and diarrhea, often decrease
sexual desire. Radiation treatment to the
pelvis can cause vaginal soreness for a few
weeks after treatment. Scar tissue can form,
narrowing or shortening the vagina, making
sex painful.
Women who have not been through
menopause before radiation therapy can
experience a sudden stop of their menstrual
periods. This is called early-onset
menopause and may lead to reduced sex
drive, vaginal dryness, itching, or irritation.
Any and all of these side effects can result in
painful sex.

9. Chemotherapy
Weight gain or loss, nausea, vomiting
and diarrhea, can affect sexual desire
and self-image. Temporary or
permanent menopause
Breast cancer
surgery
Losing part or all of a breast to surgery can
change a woman’s body image. Breast surgery
can also change how your breast feels or
cause a loss of feeling when touched.
Treatments that Affect Sexual Health

10. Endocrine therapy
Anti-estrogen treatments may cause
symptoms seen with menopause,
including hot flashes, vaginal dryness,
pain with intercourse, and lowered sex
drive.
Other drugs
Some medications, such as certain
painkillers or antidepressants, may
decrease desire or interest in sexual
activity.
Treatments that Affect Sexual Health

11. • Sickness or feeling sick
• Tiredness (fatigue)
• Irritability
• Sadness or depression
• Frustration, anxiety or tension
• Pain
• Bowel problems such as diarrhea
• Breathing, Mouth and Bladder
problems
• Skin changes or scarring
• Changes in your sex hormones
• Concerns about changes in the way
you look
Having Cancer or its Treatment can
Cause

12. • Decrease or loss of sexual desire
• Negative thoughts and feelings during sex
• Difficulty feeling sexual excitement and pleasure
during sex
• Difficulty reaching climax
• Decreased or absent Vaginal dryness and
tightness
• Pain when your genital area is touched or from
sexual intercourse
• Increased unpleasant sensations or numbness in
the genitals
Fears around Sexual Health
After Cancer Treatment

13. • Difficulty with self-esteem because
of feeling ill and being unable to fill
all your usual roles in the family and
at work
• Body image changes from surgical
scars or openings that affect how
you feel about your body
• Affected by what your partner may
experience - some of these same
challenges and concerns that you
do. He or she may avoid intimacy
due to fear of causing you pain.
• Stress in the relationship with your
partner
Emotional Effects of Treatment on
Sexual Functioning

14. Sexual Functioning Concerns and
How to Find Help
Loss of desire for sex after cancer
• Ask a member of your health care team to
check your medications for possible side
effects.
• Get medical treatment for pain during sex
that will not go away or fatigue that may be
affecting your energy and desire for sex.
• If you are in menopause, see a gynecologist
or an endocrinologist.
• If there are no physical causes, see a
licensed mental health professional to find
out if your loss of desire could be related to
feelings of depression,
anxiety, low self-esteem,
or relationship conflict.

15. Sexual Functioning Concerns and
How to Find Help
Negative thoughts and feelings during sex
• Women often find themselves
distracted during sex by
negative images and thoughts,
for example about losing a breast
or being infertile.
• Try focusing on pleasurable
feelings in your body or on a
sexy thought or fantasy. If that
does not help, ask for a referral
to a mental health professional
who can help you change
negative feeling and thinking
patterns

16. Sexual Functioning Concerns and
How to Find Help
Vaginal dryness and tightness, making sexual
activity uncomfortable or painful
• Talk with a gynecologist
• Ask your gynecologist, for advice on using
over-the-counter vaginal moisturizers for
before and during sexual activity.
• You also may benefit from learning to control
the muscles around the vaginal entrance.
• Some women can benefit from low-dose
vaginal estrogen in a cream, tablet or ring
form. Such hormones can help the vagina
regain moisture and ability to stretch with
less getting into the general blood
circulation.

18. Vaginal Renewal
1. Moisturizing the
skin of vulva and
vagina
2. Massaging your
vulva
3. Internal massage

19. Sexual Functioning Concerns and
How to Find Help
Difficulty feeling pleasure during sex
• If you have lost feeling in an
area of your body that gave
sexual pleasure you may
need to find new caresses
that you enjoy. Communicate
with your partner.
• Ask for a referral to a sex
therapist who specializes in
treating cancer survivors.

20. Sexual Functioning Concerns and
How to Find Help
Difficulty reaching orgasm
• Ask your health care team to check your
medications. Antidepressants or anti-
anxiety medicines may make it more
difficult for you to have an orgasm.
• Give yourself time. Try not to pressure
yourself to have an orgasm. Try to have a
goal of enjoying sex and getting as much
pleasure as possible. The nerves that
help a woman feel pleasure around the
clitoris and in the vagina are rarely
damaged by cancer treatment.

21. Pros Cons
Low-dose vaginal
estrogen
replacement (such
as Estring,
Vagifem)
The Estring releases a small
dose of hormone over three
months.
Some oncologists still worry
about breast cancer
survivors using these
products.
The Vagifem suppository is used
a couple of times a week.
A small study found that
some women using
suppositories still had levels
of estrogen in their blood
high enough to interfere
with the benefits of
aromatase inhibitors.
Both Estring and Vagifem
produce a low dose of estrogen.
This is considered to be helpful
treating vaginal dryness with
very little hormone released into
the bloodstream. Generally
thought to be safer than pills,
patches, or creams.
Treatments for Sexual Functioning
Concerns

22. DHEA
(didehydroepiandrostero
ne)
Vaginal DHEA may help treat vaginal dryness
and/or painful sexual intercourse, without
increasing estrogen levels.
Vaginal lidocaine Lidocaine, applied to the vaginal opening just
before sexual activity, may decrease pain and
increase satisfaction.
Pelvic floor physical
therapy
Pelvic floor physical therapy is useful for
women with tight, tender muscles. It helps
with relaxation, and if needed, strengthening
of the pelvic floor muscles. Working on pelvic
floor muscle health can help keep muscles
relaxed and reduce pain during sex.

23. Pros Cons
Learn to relax
muscles around
the vaginal
entrance
Learn methods of relaxation to
avoid pain during intercourse.
Try “Kegel” exercises.
Can help minimize pain,
but may not relieve pain if
tissue scarring is present
in the vagina.Women can use silicone
vaginal dilators to practice
muscle control, starting with a
smaller size and going up to
larger ones. Always use a
water-based lubricant on the
dilator and be gentle inserting
the dilator.
Treatments for Sexual Functioning
Concerns

24. Kegel Exercise
•Frequency
•Duration
•Intensity

31. Sensate Focus
Stage 1
•Without genital touch
Stage 2
•With genital touch
Stage 3
•Go with the flow

32. • Enjoying being close
to each other
• Touching and stroking
• Kissing
• Massaging
• Talking
• Holding hands
Focus on Showing your Feelings for
One Another in Other Ways by

33. Communication
• Code Words
• Red, Yellow, Green
• Open Ended Questions
• Closed Ended Questions
• Scale 1 to 10

34. • Be sure to use a reliable form of birth control to
prevent pregnancy- even if you think your periods
have stopped or your fertility has been affected.
• Think outside the box about sexual activity - it
does not have to involve intercourse or oral sex.
Use kissing, touching, caressing to satisfy each
other.
• Keep communication open. Talk about what feels
good and what doesn't; communicate with your
partner when you are tired or uncomfortable.
• Cancer surgery may result in a particular position
being painful. Try different positions to find what
is best for you and your partner. For example, if
lying on your back during penetration is painful,
having both partners lying on
their sides may be more
comfortable.
Tips for Healthy and Safe Sexual
Activity

35. • Cancer surgery may result in a particular
sexual position being painful. Try
different positions to find what is best for
you and your partner. For example, if
lying on your back during penetration is
painful, having both partners lying on
their sides may be more comfortable.
• Talk with your healthcare team about
coping with changes in your body image
and sexual health.
• For some, talking with other women in a
support group can help.
• While others may find more intensive
help from a mental health provider,
with expertise in working with women
with cancer, useful.
Tips for Healthy and Safe Sexual
Activity

36. • Some practical tips for body image
concerns include exercise,
maintaining a healthy weight,
dressing in clothing that makes you
feel attractive, wearing pretty
undergarments or learning beauty
techniques to manage side effects
such as facial coloring, eyebrow
loss, etc.
Tips for Healthy and Safe Sexual
Activity

37. Why Do Medical and Mental Health
Care Professionals Need to
Understand Sexual Problems?
Sexual problems have
an adverse effect on
interpersonal relationships
and the quality of life.
Copyright 2012 Eros Coaching

38. 1. Sex Is Bigger Than Any
Body Part
2. Even If You’re Afraid To
Ask — Ask
3. Don’t Wait, Act Now
4. You Are Not Alone
5. Don’t Give Up
Takeaways

39. More!
We need
1. Self knowledge
2. Facts
3. Options
4. Techniques
5. Honesty

40. Thank you!
Martha Lee
Clinical Sexologist
Eros Coaching Pte Ltd
Website: www.eroscoaching.com
Email: drmarthalee@eroscoaching.com