Cancer is, obviously, a big deal. But something that you may not know about it is that one of the most common and painful side effects of cancer treatment is vaginal dryness. Many women who are receiving chemotherapy or who are taking drugs such as Tamoxifen, Raloxifene, and aromatase inhibitors as part of a cancer treatment course may find themselves living with discomfort. The problem can be especially troubling due to the fact that estrogen therapy is usually not an option for these women.

But it’s not all just day-to-day discomfort. Vaginal dryness has another unfortunate side effect: It can make sex incredibly painful. Within a short window of only three to six months, vaginal dryness can lead to painful sex, according to Dr. Murray Freedman of the Medical College of Georgia at a recent North American Menopause Society (NAMS) meeting in Washington, DC. The reason is atrophic vaginitis, the medical term for thinning of the walls of the vagina and skin of the intimate areas around it that can lead to vaginal narrowing and dryness with an increased tendency to urinary symptoms.

“Keeping sexually active helps maintain the vaginal wall tissues,” says Dr. Machelle Seibel, a Massachusetts menopause expert and professor at the University of Massachusetts Medical School. Dr. Seibel continues, “Unfortunately sex can hurt, and women with this condition suffer a great deal, especially cancer patients who typically can’t use a hormone cream. Those that can use estrogen locally derive a great deal of benefit because it can reverse the atrophic changes. But some estrogen will be absorbed into the bloodstream, causing many oncologists to withhold it. That's why it's important to discuss non-hormonal treatments with your doctor."

Read Suzi's Sexy Secrets: 7 Smart Health Choices for a Long and Happy Life

During the NAMS plenary session entitled "When Sex Hurts," Dr. Raquel Arias of the University of Southern California discussed treatment options and various types of non-estrogenic interventions for vaginal atrophy and dyspareunia in women with breast cancer, such as lubricants, Replens moisturizer, and acidifying gels.

Don’t be mistaken: Not all lubricants and vaginal moisturizers are equal. K-Y, Astroglide, or even a little olive oil can temporarily relieve discomfort during sexual intercourse, but will do little to heal chronic dryness or restore vaginal pH or the structure of the tissue. But there is something that  I can wholeheartedly recommend: Replens. Replens is a long lasting moisturizer and a good non-hormonal alternative to estrogen for easing vaginal dryness and alleviating painful sex. Be on the lookout for symptoms including irritation, itching, burning and soreness; these may be indcations of thinning vaginal tissue. If left untreated, this condition can lead to vulvar vaginal atrophy and—you guessed it—painful sex.

“The most important thing to realize is that atrophic vaginitis is the most common symptom of natural menopause and is extremely common in breast cancer survivors. A variety of treatments for atrophic vaginitis are available. Talking with your doctor early is the best way to manage these symptoms, because otherwise, the problem will get worse over time,” adds Dr. Seibel.

As a recent Wall Street Journal article stated, "The battle is over estrogen." Although women often loath mentioning it, eliminating estrogen also creates sexual issues, particularly vaginal dryness. With time, "the hot flashes get better, but the vaginal dryness gets worse," says Mary Jane Minkin, a professor of obstetrics and gynecology at Yale University School of Medicine.

As a cancer survivor, I sure have firsthand experience with this issue. So, please pass my sexy secret along.

With love,

Suzi Kirsh