Welcome to the YSC Ask The Expert series. We ask a leader in the field to respond to YSC constituents' questions on a specific topic during a month-long Ask the Expert residency. This month we are highligting all of our 2007 experts. To view previous Ask the Expert features, please visit the Ask the Expert Archive Page.

Ask the Expert Highlights

A selection of answered questions from recent Ask the Expert columns.

Sexuality and Intimacy

Question for Dr. Shiffman:

I've been in medically induced menopause (zoladex shots) for 2 1/2 years. Aromasin sucks any remaining estrogen out of my body. The quality of my sex life pre-treatment was very good. Now it's horrible. Not only do I not have any desire, but sex is actually painful. When I urinate afterwards the pain is very intense. I dread it. This is taking quite a toll on our marriage.

I've tried many different kinds of KY and astroglide, and even replens. My GYN says I have vaginal atrophy. She suggested a vaginal suppository (haven't tried that yet) but doesn't have any other suggestions. She's not comfortable prescribing a vaginal cream due to the studies that imply systemic absorption. Are there any other solutions? I don't want to live the rest of my life like this.

The question of pain during intercourse or penetration after menopause is a common one. There are several issues that need to be addressed. The first is the pain…having repeated painful sexual encounters (and sometimes only one) leads to anxiety (read, fear) in anticipation of the next painful encounter, increasing the likelihood that you will not be receptive to penetration, and it is more likely that it will be painful.

Dr. Schiffman:

My recommendation is: STOP having intercourse. Then, treat the cause of the pain.

After menopause, especially surgically or chemically induced menopause, you should plan to use a water-based, non-glycerin lubricant all the time. Most of these lubricants can be ordered on-line, but the suppository-type (which keeps you lubricated for several days) requires a prescription. Lubricants alone may not address the issue of vaginal atrophy, the thinning and inflammation of the vaginal walls.

You may need to use graduated vaginal dilators to help stretch the vagina, but in a controlled way. Graduated dilators are like dildoes of gradually increasing widths, and require a prescription. The treatment starts with the smallest dilator and lots of lubricant. You relax the introitus, the muscle at the entrance of the vagina (this muscle is the one you use to stop the flow of urine midstream, and you can practice learning to relax that muscle), then insert the dilator. The theory is to gradually increase the size of the dilators until you get to penis size, and then introduce your partner. With the partner, I recommend the woman take the superior position (on top), so she has control of putting the erect penis inside her.

The goal is to get comfortable with penetration, keep the woman in control, improve communication, then add sexual fantasy or other specifics, and hopefully, end up with more spontaneity and comfort during intercourse. Clearly, this kind of treatment is probably best done with the guidance of a sex therapist.

See more questions and answers on Sexuality and Intimacy.

Breast Cancer Treatments and Fertility

Question for Dr. Partridge:

Many women undergoing breast cancer treatment (myself included) are given Lupron shots or another ovarian suppression drug with the idea that if we put our ovaries to sleep during chemo they will be less likely to be damaged. My oncologist said that there were no conclusive studies about this, but it was a theory that many oncologists found persuasive. What studies are there on this topic?

Dr. Partridge:

Your oncologist is correct. There are currently two ongoing randomized clinical trials evaluating the use of ovarian suppression with medications during breast cancer chemotherapy for the preservation of menstrual functioning and the results these are not yet available. There have been several small, preliminary studies some of which are promising. However, some do not reveal likely benefit and many reproductive endocrinologists (fertility specialists) do not feel that it is likely to work. Therefore, at this point in time, we do not know that it works. (Please refer to a recently published guideline put out the American Society of Clinical Oncology entitled: "American Society of Clinical Oncology recommendations on fertility preservation in cancer patients" for details on the actual studies reported to date)

See more questions and answers on Breast Cancer Treatments and Fertility.

Clinical Trials

Question for Dr. Sledge:

Why is it that most studies seem to be "after the fact" (i.e. I read about a surgical study after I have had surgery) and I can't find studies to enroll in to look at things in my life "now" (that is- 6 years out) such as bone health, hot flashes, etc.?

Dr. Sledge:

Early breast cancer studies focused on questions such as response to new treatments and survival following treatment. It is only in recent years that investigators have begun to devote significant time to what we now call survivorship issues such as bone health, hot flashes, sexuality, and related quality of life issues. The Eastern Cooperative Oncology Group ( a nation-wide cancer study group) has a large ongoing trial that will eventually involve over 1000 women focusing on the survivorship issues of young women, and the Southwest Oncology Group has a separate trial looking at fertility issues associated with chemotherapy.

[Quality of Life in Female Breast Cancer Survivors and Their Spouse, Partner, or Acquaintance]

[Goserelin in Preventing Ovarian Failure in Women Receiving Chemotherapy for Breast Cancer]

See more questions and responses on Clinical Trials.

If you have a suggestion for a topic for the YSC Ask the Expert section, email ask-the-expert@youngsurvival.org.

View previous Ask the Expert features on the Ask the Expert Archive Page.