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Pelvic floor health/sexuality was also an important presentation on Patient Day, as it is an area that affects many of us after surgery, radiation or chemo and yet is rarely focused on as part of post-treatment care. Treatments such as chemo, radiation and surgery can weaken and damage the tissues or tighten the muscles in the pelvic floor, causing symptoms such as pain, leakage, or tightness. The vaginal canal can become shorter and tighter, making intercourse painful. Despite these challenges, there are interventions that can help. 

It is best to get an assessment from an oncology-trained physiotherapist, who will understand the issues related to cancer after-effects. In the case of pain or tightness in that area, a physio might work with the woman to relax the pelvic floor muscles through stretches and breath work. It is re-teaching the body to relax. Vaginal dilators or wands can also be used to gently and slowly open the area up again. These are apparently available on-line and can discretely be delivered to a home address. Some physio offices will order these devices for clients, if required.  Creams can be applied to soften and moisten the tissues externally and estrogen tablets or cream can be administered inside the vagina to improve the tissues. There is apparently no danger of estrogen spreading throughout the body with these applications.

LeslieA  

Thank you @LeslieA for this post. I wanted to build on your thread based on my recent visit to the Sexual Health Clinic at PMH in Toronto (Dr. Roebotham). I have dealt with painful vaginal issues since my cancer treatments and have been utilizing the services of this clinic. I also apologize for the length of this post.

One thing that gave me hope is that there are quite a options/approaches to utilize. The goal is finding what works best for each individual. Please note that I'm not endorsing any specific product or usage. As @Leslie said it's important to meet with a trained professional either a pelvic physiotherapist, osteopath or gynecologist or gynecologist/oncologist with oncology understanding, for advise/counsel.

I have used "Vagifem" and "Intrarosa", both are estrogen tablets/ovules used daily (typically at bed time), to help with internal moisture issues. Intrarosa is the newer of the products. Leslie is also correct that they are safe to use as the estrogen does not spread beyond the vaginal canal. They are prescription based and you do need to give them 3 months of consistent use to determine if they are working. My health plan covered the Vagifem but not the Intrarosa. It may be different for each person based on the coverage you have. 

I'm also now going to be using a 'compound' gel product which is used on the vaginal opening "vestibule", to help with some moisture challenges. It's an estrogen/testosterone mix. It's a prescription product and I'll be using it in combination with Vagifem. Again....lots of options to try.

Dr. Roebotham also suggested vaginal moisturizers and lubricants. Both can be purchased over the counter. Vaginal moisturizers tend to be used on an on-going basis, 2 - 3 times a week whereas Lubricants are situational based. Vaginal Moisturizers come in multiple formats (creams, gels, suppositories). You need to find the one you are most comfortable using. For me, again, I tend to use them at night to 'keep stuff where it needs to be" 😁 for as long as I can. An example of a Moisturizer is "Replens". There are other options. Note that some formats can interfere with use of condoms so it's important to reach and understand packaging. As for vaginal lubricants which tend to be used situationally e.g., just before or during sexual activity, there are again various types (water-based, oil-based, and silicone-based). Each have their pros and cons and it's again important to understand what works best in your situation. I have a pamphlet on all of this that I picked up from PMH. I'm going to see if I can scan it and share in a separate post, with full credit to PMH of course.

Lastly, as @LeslieA mentioned, there are products such as "dilators" which can be useful to improve pelvic floor coordination and tightness to "loosen" the vaginal wall which can help with pain. It was recommended I discuss this with my pelvic physiotherapist who can recommend a brand and can provide some suggestions on best way to use it in conjunction with my physio therapy. I'll follow-up on this post in a few weeks after that happens.

I know this is a lot of information however, we tend to 'shy away' from this stuff. I'm happy to answer any questions anyone has. Again, I'm not an expert nor endorsing any of the items mentioned above. I've just learned a lot in the past 2+ years and want to share as much as I can.

#Healthandwellness #Treatmentandsideeffects