Vaginal dryness is a very common side effect of some breast cancer treatments. We explore some practical things that can help.
We get lots of calls to our Helpline about vaginal dryness. But it can be a difficult subject to bring up.
‘It is embarrassing so it is not talked about,’ says Debby Holloway, nurse consultant in gynaecology. But, she says, women should be able to have an open conversation about it with their healthcare professional.
Vaginal dryness won’t get better on its own, so seeking help to manage it is important.
All about oestrogen
‘Vaginal dryness happens due to a lack of oestrogen,’ explains Debby.
Some breast cancer treatments block or reduce the amount of the hormone in your body. Because oestrogen helps maintain the vagina’s moisture and elasticity, a lack of it can cause the vagina to become dry and less supple, and may make sex or intimacy painful.
If it’s not treated it can get worse, and may lead to loss of sex drive and emotional problems alongside the physical ones.
‘If it hurts when you have sex,’ says Debby, ‘this can lead to not wanting to have sex as there is a fear it can hurt. This circle is difficult to break.’
Ways to help dryness
‘There are many different products that can be used for vaginal dryness,’ says Debby, ‘and some of them are available on prescription or can be bought from a chemist or online.’
While you might want to try some of the products mentioned below, talk to your specialist team too. Vaginal dryness and irritation can also be caused by an infection, so it’s a good idea to see your GP to rule this out.
1. Try moisturisers or lubricants
Vaginal moisturisers – such as ReplensMD, Senselle or Hyalofemme – provide long-term relief for dryness and discomfort, and are not just for use during sex. You can use most types every few days, and they’re most effective when used regularly over time.
Moisturisers are usually applied with a pessary (a small, soluble block that dissolves in the vagina) or tampon-style applicator.
Vaginal lubricants are shorter acting than moisturisers, and only provide temporary relief. They’re intended to help prevent friction and pain during sex and intimacy, and work best if used by both you and your partner. Lubricants are available as a pessary or a tube of liquid or gel. You could try Yes, Pasante TLC or Sylk.
It’s worth trying different brands – you might prefer some to others – and you can use lubricants and moisturisers alongside each other. But don’t be tempted to substitute moisturisers or lubricants with Vaseline, hand cream or body lotion.
2. Ask about oestrogen products
The most commonly used treatment for vaginal dryness is hormone replacement therapy (HRT), but this is not usually recommended for women after a diagnosis of breast cancer.
However, some specialists may prescribe a topical hormone treatment, which is applied directly to the area, to help reduce dryness and discomfort. This could be an oestrogen pessary, vaginal tablet or cream.
When you use vaginal oestrogens, it’s thought that very small amounts of the hormone are absorbed into the body. Therefore, vaginal oestrogen may be more safely prescribed for women taking tamoxifen, because tamoxifen is thought to counteract any oestrogen entering the bloodstream.
If you’re taking an aromatase inhibitor – such as letrozole, anastrozole or exemestane – vaginal oestrogen is not usually recommended. But it might be worth asking your specialist team if switching to tamoxifen is an option.
3. Intercourse can help
If it’s comfortable for you, sexual intercourse can stimulate blood flow to the vagina and help maintain its suppleness and elasticity. Using a vibrator or masturbating can also help in the same way.
4. Exercise your pelvic floor
Doing regular pelvic floor exercises can increase blood flow and relax your pelvic muscles. Knowing how to relax these muscles can help ease pain during sex or intimacy, and also help you feel more relaxed during procedures such as a smear test.
You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet (but don’t do this often because it can be harmful to the bladder).
To strengthen your pelvic floor, sit comfortably and squeeze these muscles 10 to 15 times in a row. Don’t hold your breath or tighten your stomach, buttock or thigh muscles at the same time. When you get used to doing this regularly, you can try holding each squeeze for a few seconds. Every week, add more squeezes, and rest the muscles between sets.
Six other things that might help
- If penetrative sex is too painful, consider other forms of intimacy.
- Keep lubricants near the bed so you don’t have to get up to find them.
- Don’t use scented soaps, lotions, bath oils or panty liners as these can dry out the vaginal area.
- Try switching to a different washing powder or fabric conditioner, as some can irritate the area.
- If you smoke, try to cut down or give up completely.
- If you need to have a smear test and are experiencing vaginal dryness, tell the nurse or doctor beforehand so they’re aware.
Find out more about sex and intimacy after breast cancer.
Content created March 2017; next planned review 2019