Experiencing Pain During Intimacy Post-Cancer Treatment

“It really hurts to have sex,” I confided to my doctor. “Like, a lot.”

There I was, seated in a hospital gown on the examination table at my family doctor’s office in Santa Fe, New Mexico. This was the same place where I had gone for both my pregnancies and, not too long ago, where I had received a breast cancer diagnosis.

“I’m so sorry,” she replied empathetically. “I can only imagine what it’s like to go through menopause, especially when it happens so suddenly for you.”

She had been the one to break the news of my cancer. I remember finding a small lump on my right breast and rushing to her office. Our appointment coincidentally fell on Halloween 2017, and she had come dressed as Snow White, complete with face paint and a wig.

“You’re one of the lucky ones,” she reassured me as tears streamed down my face. “You won’t need chemotherapy, and you’ll be okay.” She was correct — I was fortunate. Early detection had saved me, and with breast cancer, that’s everything.

My treatment plan involved a mastectomy, reconstruction, and a decade of targeted hormone therapy aimed at eliminating estrogen in my body to reduce the risk of cancer returning. The goal of these treatments was to speed up the onset of menopause for pre-menopausal women. It worked. Within weeks, I transitioned from a healthy, menstruating 37-year-old to a hot-flashing, bone-aching, post-menopausal cancer survivor. I faced issues like vaginal irritation, which I discovered later was a condition known as vaginal atrophy. Ironically, my post-operative breasts appeared more youthful than ever, while my vagina felt far older. It was a confusing contrast.

“It hurts,” I continued to express my frustration. “All the time, but especially during sex.”

“Menopause makes intercourse highly uncomfortable, often nearly impossible,” she stated bluntly. “Have you considered vaginal rejuvenation? A colleague of mine in Albuquerque offers a laser treatment that I think could really benefit you.”

Later that day, back home, I began researching laser vaginal rejuvenation. I stumbled upon a credible women’s health website that featured a picture of a smiling woman in her 60s, in a pink button-up shirt, looking content post-treatment.

The type of treatment I was looking into involved a fractional CO2 laser aimed at revitalizing the vaginal tissues and providing hormone-free relief for vaginal atrophy. Vaginal atrophy, for those unfamiliar, is severe vaginal dryness commonly associated with menopause. While some women benefit from estrogen creams for this issue, the research on the safety of these creams for women like me, who actively reduce estrogen levels, remains inconclusive—it’s something I’m not comfortable trying.

I was eager to share my findings with my husband. Given that we were occupied with raising two toddlers and recovering from my health struggles, tackling sexual dysfunction hadn’t bubbled to the top of our priority list yet. We did identify two significant drawbacks to the treatment. The first was the cost. The laser treatment required three sessions spaced apart, totaling around $3,000, and insurance didn’t cover it unless you had a flexible spending account, which I didn’t.

The second was the inherent risk. Most sources I reviewed downplayed the risks associated with the treatment, but there is always a chance of pain during the procedure and, in rare instances, even burns. Despite these concerns, I felt fortunate that I could afford to try this option.

A few weeks later, I was on my way to Albuquerque for my first session, taking in the desert landscapes. Upon arrival at the small gynecological practice, I was greeted by a cheerful young receptionist. When I quietly mentioned I was there for vaginal rejuvenation, she asked me to repeat myself, giggled nervously, and then consulted with a coworker before apologizing for her earlier reaction, saying she hadn’t heard of that treatment before. I made a mental note—that menopause would eventually catch up with her too.

Once in the exam room, a nurse applied numbing cream, and I eyed the laser machine in the corner. It resembled equipment you’d find at a dentist’s office. Then my gynecologist, an older, gentle woman, came in and expressed her enthusiasm about performing the treatment. My nerves kicked in as I asked how many procedures she had done. “Only a few,” she admitted. A wave of panic washed over me as I lay back, remembering an old advertising tagline: “You’ve come a long way, baby.”

The first treatment proceeded smoothly. I experienced some mild vaginal bleeding for a few days, which was expected as the laser created tiny micro-abrasions in the vaginal wall to improve blood flow and regenerate new blood vessels. The procedure itself was awkward but not painful; immediately afterwards, I noted my vagina felt markedly better—pain-free.

My gynecologist encouraged me to have sex between treatments to maintain the benefits. Feeling optimistic, I was excited to jump back into bed with my husband, but when the moment arrived, I discovered to my dismay that penetration was still painful.

“I’m sorry,” I said regretfully to my husband after our attempt at intimacy. “It hurts too much.” Tears of frustration flowed freely. I wondered if I would ever feel whole again in this way.

I raised these concerns at my next appointment. The gynecologist advised me to wait until completing all three treatments before drawing any conclusions. However, the results from the second and third sessions were underwhelming. While the initial benefits were promising, they didn’t alleviate the pain I was experiencing during intercourse.

Six months post-diagnosis, I found myself once again recounting my experience to my doctor. We both agreed that there’s a significant gap in medical research and funding regarding women’s health. Many women face the burden of painful conditions but lack access to affordable treatments. Too often, they either normalize their pain or hesitate to speak up.

So, did vaginal rejuvenation resolve my painful symptoms? No. Would I try estrogen cream? No, not at this point. But then I reflect on the waiting room at the cancer center, and I realize I can accept my situation, albeit reluctantly. The real question persists—why isn’t there an effective treatment for vaginal dryness, akin to the little blue pill for erection issues? It seems unjust.

Before I left, my doctor wrote me a prescription for Lidocaine, a numbing cream. “Apply this twenty minutes before sex; it really helps,” she suggested. With a faint smile, she seemed to say, “Welcome to menopause— we’ve come a long way.” But, have we?

There exist a few non-estrogen treatments for vaginal atrophy, and maybe someday I’ll explore them. For now, my partner and I are discovering what “successful intercourse” truly entails for us. It seems clear that penetration is only one way to connect—there are many other enjoyable experiences to be had.