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Breast cancer can impact a woman’s life in many ways, but there’s one unique challenge that her doctor probably isn’t talking about: her sex life.

“About 90 percent of patients will have some sexual issues following treatment,” says Dr. Lauren Streicher, author of Sex Rx: Hormones, Health, and Your Best Sex Ever, and Director at the Center for Sexual Medicine and Menopause and Associate Clinical Professor of Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University.

Most women aren’t prepared for the sexual issues they face following treatment, including painful intercourse due to changes in vaginal tissue, vaginal dryness, and the loss of libido as a result of the fatigue, stress, and anti-depressants many patients start to help cope. Women who’ve had a unilateral or bilateral mastectomy can experience a crushing blow to their self-confidence following surgery.

“It was like missing the topping on a cake- I was incomplete,” says breast cancer survivor Michelle Kolath-Arbel of how it felt -after a one-sided mastectomy- to look in the mirror and no longer see her nipple.

While some sexual challenges may improve after completing treatment, other issues, like pain during intercourse, can be permanent- which is why offering women solutions is important.

“The biggest challenge is that often, doctors are not addressing these issues, and patients don’t know to expect these problems,” Dr. Streicher says. “Since the conversations aren’t being had, patient questions often go unanswered.”

Fortunately, there are a number of options that can help:

1. The right lubricant. Painful intercourse is the most common sexual issue following breast cancer treatment, due to physical changes in the vaginal tissue. Many women are advised to stop hormone therapy when diagnosed, which Dr. Streicher says can lead to vaginal dryness. Something as simple as the right lubricant can help.

2. Vaginal estrogen. Low-dose vaginal estrogen creams can help alleviate dryness by applying locally, eliminating the need to expose the entire body to hormone therapy.

3. Laser treatment. Dr. Streicher offers the MonaLisa Touch, a minimally-invasive laser treatment, to women seeking a non-hormonal option to restore vaginal health. Treatment is usually able to rejuvenate the vagina to what it was prior to diagnosis.

4. Ready-made realistic nipples. Pink Perfect produces realistic, custom-made adhesive silicone nipples for women around the world who’ve undergone unilateral or bilateral mastectomies. Nipple tattoos, once a common solution, can fade around the 18-month mark due to lack of iron in the ink, which can’t be used on cancer patients who will need followup MRI’s. Pink Perfect’s waterproof silicone nipples are a great option instead, offered in eight different colors and can be worn in the shower, ocean, or swimming pool. They were created by breast cancer survivor Michelle Kolath-Arbel, who says the nipples helped her get her self-confidence back. “I was able to dress (and undress) regularly, wear swimsuits again, and share intimate moments without having to worry that something was missing.”

Dr. Streicher sees women every day who are searching for solutions to their sexual problems following breast cancer. During Breast Cancer Awareness month, let’s talk about these options to help women enjoy sex after breast cancer. It’s time.

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