The Ovarian Cancer Institute (OCI) was founded on the notion that there is a dire need for novel, more productive approaches to ovarian cancer research. OCI is an innovative collaboration between noted Atlanta gynecologic oncologist Benedict B. Benigno M.D. and internationally-recognized scientist John F. McDonald Ph.D., Associate Dean and Director of the Integrated Cancer Research Center at the Georgia Institute of Technology.

OCI is not your traditional research institute. Dr. McDonald and his colleagues at the Georgia Institute of Technology are taking an “outside the box” integrative approach to ovarian cancer research. Rather than operating in “academic silos” of research specialization, the OCI approach is to combine state-of-the-art molecular biology with new, emerging technologies and expertise in nanotechnology, biomedical engineering and high-throughput computer science to take a multi-discipline approach to ovarian cancer research and is already generating dramatic results.

The goal of the Ovarian Cancer Institute is to find an early screeening test for cancer of the ovary as well as more efficacious and less toxic ways of treating this disease.

To learn more about OCI visit www.ovariancancerinstitute.org or call (404) 300-2997.

Ovarian Cancer Institute Publications:

• http://www.sciencedaily.com/releases/2010/09/100920094618.htm
• http://www.scientificamerican.com/article.cfm?id=ovarian-cancer-test
• http://health.msn.com/health-topics/cancer/articlepage.aspx?cp-documentid=100262394
• http://daily.gatech.edu/digest/08

Throughout my hospital stay and follow up treatment, Dr. Benigno and Sherry were a constant and reassuring presence for me. But even before I met him for the first time, I had taken the time to Google him and see what the internet had to say. I saw that he was one of the best. I was moderately reassured, but it was not until much later during the course of my treatments that I witnessed something I will never forget…

My post-surgical chemotherapy treatment regimen provided me countless hours of observation as my fellow survivors and I struggled with this insidious disease. I clearly recall one day in the chemo-suite as one of the other patients, horribly sick as the chemo took its toll and the disease gained ground, unexpectedly demonstrated a dramatic improvement in her posture. Curious as to what event precipitated this change; I turned to see Dr. Benigno and one of his assistants moving through the room simply interacting with patients and caregivers. I was immediately struck! What a remarkable gift to be able to grant someone so sick a brief reprieve from their illness. This ability to give hope became a driving force in my life and as such I have committed myself to returning to school to obtain a Master’s of Medical Science degree in order to become a Physician Assistant. My life has changed.

Even though I have the most remarkable oncologist directing my treatment, I had an even more important motivation – my daughter, Sydney. With the holidays upon us and the family members here from Texas, the house was a buzz of anxious energy. Yet, Sydney remained steadfast. Her only concerns were ‘where is mama?’ or ‘when is mama coming home?’ By no small miracle, I was home on Christmas Eve. Sydney met me in the driveway! She found it of great interest that mama had a big boo-boo, a cancer boo-boo. At barely two years of age, my daughter was already learning about cancer and the effects it has on those closest to her. I went through six rounds of the initial chemotherapy – Taxol and Carboplatin followed by 12 rounds of maintenance chemo – Doxil. For Sydney, she knew that mama was sick and she began to recognize when others were sick as well. She pointed out a child in a St. Jude commercial on television and told me, “Mama, that baby is sick.” She knew. But it wasn’t really her recognition of the outward signs that amazed me. It was her approach that carried me through some of the darkest days. Instead of being shocked about mama’s now bald head, she found great pleasure in splatting it with the palms of her hands. She loved my bald head and didn’t care that I resembled a boiled egg with a face! It was in those moments when I realized how truly blessed I was for such unconditional commitment and love. I had the ultimate cheerleader, the ultimate motivation for beating this disease. Yes, I had an incredible gynecologic oncologist – the best in the world as far as I’m concerned, but more importantly, I had this amazing little girl at home who needed me. Failure was not an option, no matter the cost to me. She doesn’t really know it yet, but she’s my hero. She represents my hope for a better tomorrow, for the determination of a few – even the little ones with their limited understanding – to find a cure.

I have been asked countless times by others what advice I would give to others diagnosed with cancer. There is really no simple, succinct answer. The sooner that you accept the fact that you will be forever changed by this journey, the sooner you can begin to heal. For me, focusing on what is really important sometimes helped. At other times, I allowed myself to feel those scary feelings that were ever brewing just under the surface. Allow yourself to feel those things but do not allow yourself to remain in those dark places. Get out of the house, meet friends for coffee or dinner. Do things that you will bring a degree of normalcy to your life. By remaining focused and committed to doing what you have to do, the warrior within you will thrive and you will be forever changed by the journey none of us ever intended to take.

I feel so fortunate that I was led to Dr. Benigno as he is at the forefront of treatment and saving the lives of women. He and his incredible team are compassionate and responsive. They understand our needs and fears and I know with Dr. Benigno and his team, I’m doing the most I can to ensure I live the healthiest, most fulfilling life possible.

Survivorship has given me an incredible opportunity that few people get. It has taught me to appreciate and enjoy life, my family, my friends, and everything around me. It has given me an understanding of what’s really important in life and the chance to reprioritize. I see God at work, I have become more spiritual and been able to serve Him and help others. Survivorship has given me the chance to see my beautiful children grow up and to have an even stronger, more loving relationship with my husband of 29 years.

I truly believe a positive attitude, keeping my life and schedule as normal as possible, laughter and exercise helped in my speedy recovery. I didn’t let the disease and chemo consume every thought, every day. I tried to keep busy with work, activities and walking… cancer wasn’t the focus of my life.

I also said this same prayer every day… Lord, give me the strength (both physical and mental), wisdom, dignity, grace and a sense of humor to get through all of this. And along the way, let me use this experience to help others.

Oh, and the hair thing. The worst part of this was before my hair actually fell out. Hearing the words “You’re going to lose your hair” was the hardest, and the tearful breakdown happened right in Benigno’s office with Sherry. By the time my hair fell out, it really wasn’t a big deal. I learned hair really wasn’t as important as I once thought! With the wigs, getting ready took half the time and I had many different looks, it was great. It took 4 ½ months after I finished chemo for me to shed my wigs and let the world see my new, short, really curly grey hair! Now, one year later my hair is better than it was before – of course – color and highlights help!

In two hours she told me the good news: my heart, kidneys, liver, blood pressure and everything were in tip top shape. My workouts at the gym for years had paid off! The bad news was that she had found a mass in my ovary and she thought I had ovarian cancer.

During the morning tests she had spent her time calling all her doctor friends to see who they would go to, or would take their wives to if they had OC. She said Dr. Benedict Benigno was the unanimous answer and that I was meeting with him in two hours if I wanted to. I was in shock. I cried in her arms. And then I called my son, David, and his wife, who met with me at Dr. Benigno’s office that afternoon. He spent over an hour with us filled with compassion, lots of information, some laughter, and a feeling that I was so very fortunate to be in his care.

He set up more tests, and after gathering the information suggested that I start three months of chemotherapy the following week to shrink the tumors before the hysterectomy and de-bulking surgery, which he scheduled tentatively for the last week in December, pending how I responded to the chemotherapy. My CA-125 was initially 4385. My surgery was December 29, 2009.

Before surgery the CA-125 dropped to 209. After several rounds of chemo it was in the teens, and has hovered between 3 and 7 ever since. I completed the 6 rounds of chemo following my surgery, and was found to be in remission in June. We decided to do 12 months of maintenance chemo starting in July, as a preventative measure. I was staged at 2A since the cancer was well contained and the surgery was so successful. I had a chest port and a tummy port for the IP chemo treatments for the next five months. I was so grateful to have the ports. It made the infusions go so smoothly.

The nursing team in Dr. Benigno’s office, and at the infusion centers were what made my life so comfortable. All my questions were answered and I was never made to feel I was asking for too much information. Compassion, excellent knowledge, and laughter have made this a more than tolerable journey. There have been spiritual learning’s around every corner. People who have “coincidentally” crossed my path have taught me so much. It sounds crazy to say I am grateful for this situation. I obviously would not wish it on anyone, but the gifts it has brought to me, the friends and family who have shown up 150%, have given me such gratitude for my life and loved ones.

Dr. Benigno has given me my life. He is one of the brightest, most knowledgeable, experienced, funny, and compassionate doctors I have ever known (and I work with doctors in my consulting practice).

His one-liners are priceless. They break the tension and set the stage for healing. This past year for Dr. B. and his staff was a challenging one, with two moves for his office, and a shift in some of the procedures they had used for years. I marvel at the way they handled the changes and stress that always comes with change.

His office and nursing staff are superior, both in their knowledge and nursing skills, but also their intuitive way of knowing what the patient needs. As I said above, all my questions are always answered or followed up on after research, and I am never made to feel I am asking too many questions. They have been supportive on some of the integrative and nutritional approaches I have researched, and have supported me in making decisions for becoming proactive in my healing. The cancer support groups have been invaluable for me and my healing.

Survivorship has definitely brought more joy, love, and peace into my life. I am grateful for everyday, and am especially grateful I am in remission. The friendships, family, and relationships I want in my life are the authentic, honest and caring ones that nurture in both directions. This situation has invited me to really live in the present, and to be aware of what is meaningful, fun, and important in life. My long time spiritual core has grown even deeper, and for that I am grateful. I have no fear of death, and have a passionate zest for life and the many things I still want to do. On a humorous note, I think God really wanted me to get a haircut! So, the slow grow has begun!

My advice to you is to keep joy, love and laughter in your life. Rest when you are tired. Exercise whenever you can as it helps fight fatigue and to give energy. Rest when you are tired (again!). Write, and journal. It helps to manage your stress and research is indicating that if you do it for four consecutive days each month it can enhance your immune system. Review your nutritional approaches. There are some excellent classes at the Cancer Support Groups on nutrition and yoga, exercise, chemo side effects, and especially the women you will meet there, and become friends with along the path.

Ask for help. This was very hard for me. Being single, my friends, married and single, just showed up. One set up a food brigade, and others signed on to go to my chemo sessions with me, as well as my two sons. But it was hard to ask for help and that is one of the biggest lessons I have been learning.

Know that you are not a statistic. We are all different and the approaches to our treatments are different. For me, humor and intellectual stimulation are healing, so that has been a big part of my process. I started a monthly women’s book club that would come to my home, and it kept me connected with friends, and kept my mind alive and alert. Yoga and the gym (in moderation) have been powerful for me, especially meditation and yoga.

Also, Dr. Bernie Siegal’s CD “Meditations for Enhancing Your Immune System” helped me through my initial chemo sessions, preparing for surgery, and the following chemo sessions to this day. I listen to it and other CD’s regularly, and it keeps my attitude positive and proactive. The friends I have made, and continue to make with other women going through this challenge, are priceless. We support each other in ways no friend or family member can. Be sure to participate in the support groups. We are all here for you! Also, crying can be healing, and can open the channels to more love and laughter. I would be happy to talk with you if I can be helpful in any way.



The clinicians at University Gynecologic Oncology (UGO) recognize the importance of addressing the impact your cancer treatment has on sexuality and your quality of life. As you confront a diagnosis of cancer and begin treatment, you will experience a multitude of emotions including fear and anxiety. You may face dramatic changes in your lifestyle. Understandably, your main concern after learning you have cancer is to keep your body and spirit together. It is normal that these concerns would interfere with your usual interest in sex. According to Dr. Benedict Benigno, “It is so important to involve the partner in this process because they often have misplaced fears about ‘catching’ cancer or worries about their exposure to radiation if our patient is receiving that method of treatment. Partners also have real concerns about the changes in the woman’s health and ability to engage in sexual activity without causing additional pain or distress.” At UGO, we address the unique concerns women and their partners face during and after gynecologic cancer treatment. As you begin to adjust to your “new normal” and reclaim your vitality, it is important to restore intimacy and sexuality in your life. Throughout your journey of survivorship, remember that regardless of your desire or ability to engage in sexual activity, it is important to have individuals in your life who share their love and support with you.

Cancer Treatment and the Sexual Response Cycle

At first, cancer patients’ personal concerns are mainly focused on healing and survival. As time goes on, patients and their caregivers begin to integrate cancer treatments and their side effects into a new practice of daily living. Patients attempting their previous approach to sexual activity are often met with unexpected changes in sexual interest, function, or response and may find the experience so uncomfortable they hesitate to try sexual activity again. Understanding how cancer treatments can affect the sexual response cycle helps to prepare oneself for these changes and possible limitations.

The Sexual Response Cycle

The sexual response cycle is described as a series of four progressive phases that include desire, excitement, orgasm, and resolution. The first phase, desire, or interest in sex, takes place on the mental level by having sexual thoughts and feelings. This is followed by sexual excitement, or arousal, where the brain sends signals through the nervous system triggering a physical response to sexual stimuli leading to an increase in heart rate, breathing, and blood pressure. Stimuli traveling along the spinal cord to the pelvic area causes increased blood flow to the genitals, vaginal swelling and lengthening, and lubrication. The female hormone, estrogen, is responsible for keeping the vaginal tissue supple and allowing lubrication to occur. Orgasm occurs at the peak of sexual excitement and is marked by intensely pleasurable rhythmic contractions in the lower pelvis. After orgasm occurs, the resolution phase begins with a sense of release and relaxation.(1,2)

Sexual Dysfunction Resulting from Cancer Treatments

Treatment for gynecological cancers can cause an interruption during any phase of the sexual response cycle. It is not uncommon to lose your desire for sexual activity when your primary focus is to heal and survive. During treatment, you may experience changes in your body that make you wonder if you are still attractive to your partner. Later on, your desire may be inhibited if there are overwhelming concerns of a cancer recurrence. Fatigue, pain, or other side effects brought on by chemotherapy or radiation interfere with desire and interest in sexual activity.(3) Surgery and radiation treatment involving the vulva and vagina can account for a decrease in sensation, arousal, and sexual response in the genital area. Orgasm will be affected if radiation or surgery involves those structures (especially the clitoris, inner labia, and lower vagina) important to sexual response. (4) Additionally, cancer treatments may abruptly reduce or eliminate the amount of estrogen and other hormones produced by the ovaries leading to symptoms of menopause. As a result, women may sense a loss of desire and have difficulties feeling aroused due to vaginal dryness and the lack of engorgement and sensitivity needed for excitement or arousal. Intercourse may become painful (dyspareunia) because the vaginal tissue is thin and fragile causing one to avoid future sexual encounters. A condition called vaginismus may also occur when vaginal penetration or sexual intercourse becomes traumatic. A natural response to pain triggers the vaginal muscles to contract, making penetration even more distressing. (4,5) It is extremely important to communicate your experience to members of your health care team who will develop interventions to alleviate these symptoms. Using vaginal lubricants and estrogen replacements approved by your clinician will help relieve some of the symptoms associated with estrogen loss. Additionally, we will refer you to physical therapists specializing in the field of pelvic floor rehabilitation and physiotherapy for the treatment of sexual pain disorders. With a careful evaluation of your current symptoms, we will help you and your partner find new ways to have a gratifying sexual experience.

Notes:

1. Berman JR, Berman L, Goldstein I : Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology 1999; 54:385-391
2. Masters WH, Johnson VE:(1966) Human Sexual Response. Boston, Little, Brown.
   Carmack Taylor CL, Basen-Engquist K., Shinn EH, Bodurka DC: Predictors of sexual functioning in ovarian cancer patients. Journal of Clinical Oncology 2004; 22 (5) 881-889
3. Berek JS, Anderson BL: Sexual Rehabilitation:Surgical and psychological approaches. Principles and Practices of Gynecologic Oncology. Second Edition. Ed WJ Hospkins, CA 4. Perez, and RC Young. Lippincott-Raven Publishers, Philidelphia. 1997; 551-566.
4. Green, Marjorie: Sexual Medicine in the 21 Century: Break the silence: Discussing sexual dysfunction. Presentation at Northside Hospital. March 2008. Atlanta, Georgia

Chemotherapy

Changes in Hormones

Chemotherapy can reduce the function of the ovaries and the amount of hormones made by the ovaries. The loss of ovarian function from chemotherapy depends on the woman’s age, the type of chemotherapy used, and the overall dose of chemotherapy exposed to the ovaries. A decrease in estrogen can cause menopausal symptoms, such as hot flashes or flushes and/or night sweats, mood swings, and interruption in the sleep cycle. In addition, estrogen keeps the vagina lubricated and moist and the vaginal tissue supple. Estrogen loss can cause vaginal atrophy, whereby the vaginal tissue becomes dry, thin, and fragile. Over time, a woman may feel like the vagina becomes less elastic and more narrow or shortened. (1, 2) Intercourse can become painful and traumatic to the vaginal tissue. Many women describe a change in their sexual function and desire (libido). As mentioned before, the sexual response cycle requires the presence of estrogen to produce an increase in moisture and blood flow (engorgement) to the genital structures important for sexual arousal and orgasm. A loss of estrogen can interfere with female sexual response and pleasure.(3, 4)

Hormone Therapy (HT) – Estrogen, Progesterone, Testosterone

If symptoms of hormone loss are interfering with the quality of your life, one option that may help provide relief is hormone therapy (HT). HT in the form of oral tablets or patches can be given to women who do not have contraindications, such as estrogen receptor positive cancer, certain stages of endometrial cancer, history of blood clots, or uncontrolled high blood pressure. Depending on the symptoms brought on by estrogen loss, the clinicians at UGO will prescribe a form of estrogen called estradiol. When estradiol is taken as a tablet, or as a gel or patch applied to the skin, it has been found to help relieve vasomotor symptoms and vaginal atrophy. However, if you still have a uterus, these methods of HT must include taking a progestin, in the form of micronized progesterone, to protect the uterus from continuous estrogen stimulation which could cause changes in the uterine lining that may lead to cancer. After careful review of the risks and benefits of HT, your clinician will recommend the lowest starting dose of HT to manage your symptoms with careful consideration given to the presence of other health conditions or lifestyle concerns. Alternatively, when the symptoms of estrogen loss are primarily associated with vaginal atrophy and dryness, an estradiol-containing product in the form of a cream or tablet can be directly inserted into the vagina with the use of an applicator. There is also an estradiol-containing ring that when inserted into the vagina not only treats vaginal atrophy, but also has the additional benefit of treating urinary disorders such as stress incontinence.(5, 6) The vaginal estradiol tablets, creams, or estrogen vaginal ring, have not been found to increase the risk of recurrent breast cancer; (7) however, this is a subject of debate and starting this type of local HT in patients with a history of breast cancer must be initiated with the complete agreement of the breast care specialist.
So far, there is no scientific proof that estrogen or progesterone HT helps improve sexual desire, or libido. Nevertheless, HT does relieve some side effects of cancer treatment, which may allow for more opportunities for sexual interest and motivation. A few small studies have shown an improvement in sexual interest with the addition of testosterone (male sex hormone produced in small amounts by a functional ovary) to the oral estrogen regimen or delivered as a transdermal cream.(8, 9) Talk to your doctor or nurse about options to treat a decreased libido. It is important to rule out factors that could also cause a lowered libido, such as intimate partner issues, depression, or other health problems.

Vaginal Lubricants

Many women find the use of vaginal lubricants helpful when applied directly inside and outside the vaginal area before and during sexual activity. This will replace moisture to the vaginal tissue and allow less friction and trauma during intercourse. We recommend water-based lubricants, such as Astroglide®, Sylk®, Lubrin®, and Zestra®. Avoid vaginal moisturizers that have added flavorings or chemicals. Vaginal lubricants that are longer acting, such as Replens®, help restore vaginal moisture and are applied to the vaginal area a few times during the week. These moisturizers are available at most drug stores. Another good vaginal lubricant is Vitamin E, which is thicker in consistency and very protective of dry, fragile skin.

Other Side Effects:

• Irregular periodsThe effect chemotherapy will have on a woman’s period (menstrual cycle) is unpredictable. It is common for a young woman who has not reached menopause to notice her periods have become irregular or stop all together. Depending on a woman’s age, the dose and type of chemotherapy given, it may be several months before the menstrual cycle returns. (10) However, it is still possible for some women to become pregnant during chemotherapy. Exposing immature eggs (oocytes) within the ovaries to certain types of chemotherapy can cause birth defects. It is extremely important to use a birth control method during chemotherapy and continue birth control for at least 6 months or more after stopping treatment. Be sure to speak to your doctor about when it is safe to have unprotected intercourse.
• InfertilityChemotherapy can cause damage to the developing eggs in the ovaries leading to infertility. Women of child-bearing age facing cancer-related infertility may have feelings of despair and sexual impairment.(11) Recovering the ability to become pregnant after chemotherapy depends on a woman’s age and the dose and type of chemotherapy. Younger women (less than 30 years of age) are more likely to resume their menstrual cycles and have their ovaries produce eggs again. Higher doses of chemotherapy appear to have a more damaging effect on the ovaries compared to lower doses of chemotherapy. Certain chemotherapy agents, especially the “alklating agents,” have a more toxic effect on the ovaries causing an increased chance for permanent infertility. (10,12) Before your treatment begins, talk to your clinician to gain an understanding about your treatment and the potential for infertility. Depending on your type of cancer and stage of disease, there may be fertility-sparing options. Discuss the types of chemotherapy that will effectively treat your disease and still remain fertile, while providing the best chance for survival. (13) A referral to a reproductive specialist or endocrinologist will help you choose treatment options that protect your fertility. Visit www.fertilehope.org to view fertility resources for cancer patients and survivors who are facing treatment that may cause risk of infertility.
• NauseaChemotherapy, like other drugs, has chemicals that can trigger nausea and/or vomiting. This side effect may occur anytime while receiving chemotherapy or during the next several days. Currently, there are medications, called “anti-emetics”, that help by blocking the signal to or from the emetic center in the brain that triggers vomiting. It is helpful to start anti-emetic medications before receiving chemotherapy in order to prevent symptoms before they become troubling.(14) If these traditional medical treatments do not relieve your symptoms, you may consider acupuncture, which has shown to be helpful in relieving symptoms of nausea, (15) This is also the time to let your partner know what comfort measures you find helpful, such as a cool moist cloth to the face and neck or a gentle massage to the back, legs, or feet.
• FatigueFatigue is the body’s biological response to stress. Besides the stress you feel about the reality of cancer being in your life, your body is stressed from cancer treatments and the continuous energy expenditure required to repair and rebuild cells during and after treatment.(16)The fatigue associated with cancer treatment is different for every person and changes throughout the day. In addition, cancer-related effects such as anemia, depression, and pain can contribute to the experience of fatigue.(17) Fatigue can be so intense that it interferes with the ability to accomplish the activities of daily living. It becomes distressing not to be able to accomplish your routine social and family responsibilities. Discuss your symptoms with your clinician to help identify any underlying and treatable causes for fatigue such as sleep disruption, drug side effects, or anemia. While undergoing treatment, you will find a pattern to when you experience fatigue. Try to prioritize and arrange intimate occasions for times you anticipate feeling least fatigued. Communicate with your partner about how they can be supportive. Regular exercise and good nutrition help improve fatigue.
• MucositisMucositis occurs as a results from the effects of chemotherapy on the mucosal surface inside the mouth. The oral tissue becomes inflamed and local bacteria invade leading to ulcer formation inside the mouth and gums.(16) This causes pain and difficulty eating meals and other social activities. You can help prevent worsening mucositis by maintaining good oral hygiene and alerting members of your health care team of any symptoms of redness, inflammation or oral pain. There are mouth rinses, oral pastes, and lozenges that help treat inflamed, painful oral lesions.
• Vaginal mucositisVaginal mucositis results in redness, inflammation, and irritation of the mucosal tissue of the vagina. These symptoms can also be a sign of a yeast or bacteria infection so it is very important to see your clinician for evaluation and treatment. In the absence of a vaginal infection, vaginal mucositis is helped with the use of vaginal lubricants and Vitamin E suppositories. It is also helpful to avoid vigorous intercourse for a few days following chemotherapy.(18) Some women feel a stinging sensation in the vaginal and vulvar area after the male partner ejaculates. Using a condom is helpful to prevent sperm from coming in contact with the inflamed vaginal tissue.
• Hair Loss (alopecia)Many types of chemotherapy will temporarily cause hair loss. For many women, losing their hair is the most distressing aspect of chemotherapy; knowing this is temporary does little to change the emotional impact of this event. For many women, their hair provides a strong sense of feminine identity. Hair loss not only changes their appearance but it also affects their self-concept. A patient once remarked, “When I lost my hair, I thought I became invisible.” To make matters worse, our cultural links social value with physical health and beauty. This is evident in the media where advertisements promote a multitude of anti-aging remedies and young, air-brushed models with long, luxurious hair. Until these cultural stereotypes change, we can work at ways to help you feel more confident about your appearance. Programs, such as Chemoflage, www.chemoflage.com, are specifically designed to help cancer survivors deal with the emotional and physical “fall-out” from cancer and chemotherapy. Experiment with colorful scarves and wraps until your hair grows back. So far, there aren’t any good remedies to prevent hair loss as a result of chemotherapy, but there are natural hair wigs that may be partially reimbursed by insurance with a prescription from your health care provider. There are also plenty of women who wear their baldness with pride as a sign of life and a symbol of survivorship.

Northside Hospital offers a a health and wellness resource and support program through The Wellness Community, www.thewellnesscommunity.org where cancer survivors in support groups help women recognize their personal attributes and inner beauty as a means to redefine their self-concept.

Notes:

1. National Cancer Institute: Sexuality and Reproductive Issues. Bethesda, MD, National cancer Institute, 2002
2. Nelson, HD. “Management of menopause-related symptoms”. Agency for Healthcare Research and Quality. 8/2008 .
3. Goldstein I, Alexander JL: Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. Journal of sexual medicine 2005; 2 Suppl 3:154-65
4. Kovalevsky G: Female sexual dysfunction and use of hormone therapy in postmenopausal women. Seminars in Reproductive Medicine 2005;23(2):180-7
5. Freeman S: Bioidentical hormones: Replacing fallacies with facts. Women’s Health Care. 2008; 7. No (2):7-13
6. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society” North American Menopause Society. 9/2008 http://www.menopause.org/aboutmeno/consensus.aspx.
7. Green, Marjorie:vSexual Medicine in the 21 Century: Break the silence: Discussing sexual dysfunction. Presentation at Northside Hospital. Atlanta Georgia March, 2008.
8. Lobo RA, Rosen RC, Yang HM, et al:Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Fertility and Sterility; 79 (6):1341 – 1352
9. Davis SR, Guay AT, Shifren JL, Mazer NA: Endocrine aspects of female sexual dysfunction. J Sex Med. 2004; 1(1): 82-6.
10. Schilsky RL, Lewis BJ, Sherins RJ, et al: Gonadal dysfunction in patients receiving chemotherapy for cancer. Annuls of Internal Medicine 1980; 93:104-113
11. Carter J, Rowland K, Brown C., et al: Gynecologic cancer treatment and the impact of cancer-related infertility. Gynecologic Oncology. 2005; 97 ( 1 )91-94
12. Meirow D, Nugent D:The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update 2001; 7(6):535-43
13. Gershenson DM, Miller AM, Champion PO, et al:Reproductive and Sexual function after platinum-based chemotherapy in long-term ovarian germ cell tumor survivors: A GOG group study. Journal of Clinical Oncology 2007 25 (19): 2792-2797
14. Kriss M: Preventing emesis and nausea now and in the future. Presented at the Third Annual Supportive Oncology Conference Sept. 2007. The Journal of Supportive Oncology 2008; 6, (2 ): 73-79.
15. Shen J, WengerN, Hays RD,et al: Electracupuncture for control of myeloablative chemotherapy-induced emesis.JAMA 2000; 2755-2761
16. Murphy B: Radiotherapy and chemoradiation after effects: Widespread and often persistent. Presented at the Third Annual Supportive Oncology Conference, Sept. 2007. Journal of Supportive Oncology 2008; 6 (2):62-63.
17. Dimsdale JE, Ancoli-Israel S, Ayalon L, et al.: Taking fatigue seriously, II: variability in fatigue levels in cancer patients. Psychosomatics 2007; 48 (3): 247-52
18. Krychman ML, Carter J, Aghajanian CA, et al: Chemotherapy-induced dyspareunia: A case study of vaginal mucositis. Gynecologic Oncology 2004; 93: 561-563

Gynecological Cancer Surgery

Vaginal surgery

The treatment for pre-cancerous changes in the vagina, called vaginal intraepithial neoplasia (VAIN), and cancer of the vagina depends on the degree of invasion and size of the lesion. A laser beam may be used to remove the lesion or a topical cream called Efudex® (fluorouracil) may be applied to destroy the abnormal cells on the surface of the vaginal tissue. For a larger, invasive vaginal cancer, you may undergo a partial vaginectomy, or surgical removal of part of the vagina. This may cause shortening and/or narrowing of the vagina. The vaginal tissue allows for gradual stretching or lengthening with the use of vaginal dilators or sexual intercourse on a regular basis. Using water-based vaginal lubricants and topical estrogen cream will help ease the process of lengthening or stretching the vaginal walls. (1) Sensation in the remaining vaginal tissue and vulvar structures will remain the same. After any surgical treatment, follow the recommendations from your clinician about when to resume sexual intercourse, giving ample time for the vaginal tissue to repair and heal.

Vulvar surgery.

The surgical treatment for vulvar intraepithelial neoplasia (VIN) and cancer of the vulva depends on the size and depth of the lesion. If the lesion is small and not invasive, laser beam therapy or local surgical removal, or excision, may be utilized. Recovery from laser treatment usually has no effect on sensitivity or sexual function. Be sure you understand when it is safe to resume sexual activity, allowing the treated area time to heal.
A large or invasive cancer may require a wider resection, or vulvectomy, whereby either a portion of the vulva or, in the case of a total radical vulvectomy, the entire vulva is removed. These procedures may include removal of the inner and outer labia and clitoris. Because these structures are important in sexual arousal and response, it may make it harder for a woman to reach orgasm. The radical procedures will include removal of the underlying fat layer. Skin grafts are often used to replace the layers of skin removed during surgery. To some degree, the appearance and structure of the vulvar area will be altered. A recent study found that older age and the size of the vulvar excision were two factors that had the most negative impact on sexual function. (2) Every effort will be made to preserve the vulvar structures important to sexual response as well as the appearance and shape of the vulvar area. However, there may be a loss of sensation in the genital area. Women who receive radical surgery may need reconstructive surgery and sexual rehabilitation in the future. Resuming sexual activity should be done gradually and you and your partner will need to be open to trying new techniques and positions. (3) If not already provided, ask a member of your health care team a booklet, for a booklet produced by the American Cancer Society, Sexuality and Cancer, which gives detailed instructions and illustrations on how to approach new ways of sexual expression.

Hysterectomy.

Cancer of the uterus and cervix are often rtreated with surgical removal of the uterus (hysterectomy) and, depending on the extent of the disease, could involve surgical removal of the tissue surrounding the cervix and upper vagina (radical hysterectomy). Your surgeon may remove the ovaries and surrounding lymph nodes in the pelvis. After a radical hysterectomy, some women report that they feel the length of the vagina has shortened, but with time and increased sexual activity the problem resolves. Recent research shows that women who have a simple or radical hysterectomy can expect the same level of sexual response and satisfaction as women who have not had the procedure. (4) For pre-menopausal women, removal of the uterus will remove the potential to carry a pregnancy. If the ovaries are not removed, a surrogate will be needed for child-bearing. However, if the ovaries are removed, a pre-menopausal woman can experience a dramatic estrogen loss and the resulting effects of atrophic vaginitis and painful intercourse. Post-operative hormone replacement therapy may be recommended in this situation. See Hormone Therapy (HT). Women who require treatment with hysterectomy followed by radiation therapy may experience more problems with sexual function.(4) See Radiation.

Oophorectomy.

Surgical removal of both the ovaries due to cancer is usually done with a hysterectomy and removal of the omentum and any other build-up of tumor in the abdomen and pelvis. The amount of estrogen your ovaries were producing at the time of surgery will influence how you experience estrogen withdrawal. Lower estrogen levels as a result of surgical menopause are linked to hot flashes, night sweats, sleep disturbances, sexual discomfort and lowered sexual pleasure.(5) Additionally, removal of both ovaries will cause infertility. Whether you are currently in a relationship or not, it is very important to discuss the impact your cancer has on sexual function and fertility. Women of reproductive age who are concerned with building a family should meet with their oncologist and a reproductive endocrinologist before cancer treatment to determine if any fertility-sparing options are possible, such as leaving one ovary and/or the uterus. In your case, harvesting eggs from the ovaries for freezing in order to fertilize a surrogate at a later date may be an option. You may also be a candidate for hormone replacement therapy.
Generally, it is best to avoid intercourse within the first six weeks after pelvic surgery. Your clinician will recommend the best time to resume sexual activity depending on the type of surgery you had and how well you are healing. It is very important to report any bleeding or pain during or after intercourse, and only resume sexual activity after the cause of the problem has been identified

Ostomy

An ostomy, or stoma, is a surgical opening in the skin and connects to a hollow internal organ (colon, ureters, bladder) to allow drainage through the new opening, known as the stoma, into a drainage bag or appliance. Sometimes, in order to completely remove all the tumor mass in the abdomen and pelvis, or to bypass an obstruction, the surgeon must create a temporary or permanent colostomy or urostomy. At first, the presence and function of a stoma may be unacceptable to you. Your clinician and nurses will help you become confident in self-care of the stoma while you adjust to physical changes and modifications for sexual activities. You will become aware of timing food intake to produce less output during intimate moments. There are also sashes and clothing made to protect the ostomy appliance from friction or rubbing. You can order a custom made ostomy pouch cover on line at www.bengalspot.com/ostomy1/OstomyCovers.htm. See the resource page for more ostomy support websites. It takes time to adapt to a new style and approach to intimacy, but most ostomates report that the stoma is not a barrier to intimacy. A word of caution: UGO clinicians warn that stoma sex is not a good idea. The stoma opening is actually the internal surface of the bowel and can easily be traumatized and lead to pain, bleeding and infection. Don’t go there!

Pelvic Exenteration

Very rarely, in advanced gynecological cancers, the only remaining curative treatment is a pelvic exenteration. This surgical involves removal of the uterus, ovaries, vagina, bladder and rectum. Women who undergo pelvic exenteration will need extensive sexual rehabilitation and will experience significant challenges with sexual function. Reconstructive surgery can restore a similar shape and form of the pelvic structures. A “new” vagina can be created for intercourse, but sensation and sexual function will be altered. (1) Your clinicians and nurses will ensure that you and your partner receive the rehabilitation needed to regain a sense of intimacy after extensive surgery.

Notes:

1. Berek J S, Anderson BL: Sexual rehabilitation: Surgical and Psychological Approaches. Principles and Practices of Gynecologic Oncology. 2nd Ed. Edited by W.J. Hoskins, C.A. Perez, and R.C. Young. Lippincott-Raen Publishers, Philadelphia@1997. 556-567
2. Likes WM, Stegbauer, C, Tillmanns T, Pruett J: Correlates of sexual function following vulvar excision. Gynecologic Oncology 2007; 105 (3): 600-603
3. Schrover LR, 2007. Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner. American Cancer Society.
4. Frumovitz, M, Sun C, Schover L, et al: Quality of life and sexual functioning in cervical cancer survivors. Journal of Clinical Oncology 2005; 23 (30): 7428-7436
5. Liavaag AH, Dorum A, Bjoro T, et al.:A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors.:A therapeutic approach. Gynecologic Oncology 2008; 108: 348-354

Radiation

Radiation is often used to treat gynecologic cancers, either alone as a primary treatment or with chemotherapy or surgery. Radiation acts to damage the DNA within the cancer cell and stops its ability to reproduce and multiply. When chemotherapy is added, tumor cells become more sensitive to the destructive process of radiation. Radiation can also be used to shrink the size of the tumor before surgery or used after surgery to decrease the chances of the cancer recurring. (1)

External Beam Radiation

Endometrial and cervical cancers are often treated with external and/or internal radiation sources. External radiation uses an X-ray machine to direct beams of radiation through your body to the tumor. The radiation oncologist will use a computerized scanner to identify the exact shape and size of the tumor within the body so the beams of radiation can be directed to target only the cancer cells within the contour of the tumor and spare the surrounding structures.

Internal Radiation Therapy

Internal radiation therapy, or “brachytherapy,” places sealed radioactive sources within the pelvic organs in very close contact with the tumor. This form of radiation therapy delivers a “high-dose-rate” (HDR) treatment to the cancer site in or near the uterus or cervix. One type of HDR, intracavitary brachytherapy, utilizes a thin, long, curved applicator tube, called a “tandem,” that is inserted up the vagina through the opening of the cervix into the uterus. The radiation is then released through the tandem to the inside of the uterus where the cancer first began to grow, but does not damage the healthy organs and tissue in the pelvis. Another type of HDR brachytherapy places radiation implants, called “ovoids,” into the top of the vagina where the radiation can be released in direct contact with the cancerous tissue in the cervix.(2)
In cases of primary vaginal cancer, or a recurrent cancer from another site that metastasized to the vagina, HDR brachytherapy can be applied directly to the surface of the vagina in the form of a cylinder. Your radiation and gynecologic oncologists will determine what treatments are best for your type of cancer and will use methods that limit radiation exposure to healthy pelvic organs.

Female Sexual Dysfunction as a Result of Radiation Therapy

Women treated with radiation therapy have more problems with sexual function and response including decreased vaginal lubrication and painful intercourse. During the sexual response cycle, there is a natural increase in blood flow and lubrication to the vaginal tissue. Radiation affects the blood vessels and tiny glands near the surface of the vagina causing the tissue to become thick and firm with layers of scar tissue forming around the vaginal walls. Intercourse can become painful because these changes decrease the ability of the vaginal tissue to expand and moisturize. (3,4)
Dr. Tracy McElveen, radiation oncologist at Northside Radiation Oncology in Atlanta, Georgia, describes how irradiated vaginal tissue “becomes thicker and less compliant.” Because of the loss of elasticity and without any effort to maintain the vaginal opening, “the vagina tends to become narrower and shorter.” Vaginal dilators are recommended to maintain the depth and width of the vagina. Your radiation oncologist or a member of your health care team can provide you with dilators. Dr. McElveen encourages beginning dilator use on a daily basis with the use of water-based vaginal lubricants. “It is best to start early in the treatment process, before the effects of radiation begin to tighten and narrow the vaginal walls. Continue using the dilators frequently until the right size and comfort level are reached.” Women will need to continue using dilators or engage in intercourse frequently (about 4 times per week) to maintain the shape and depth of the vagina. See Instructions for use and care of vaginal dilators. Unless you have risk factors and cannot use estrogen replacement, local hormone therapy (HT) can also be applied directly to the vaginal tissue to help with vaginal atrophy resulting from estrogen loss.

Notes:

1. Perez, CA, Hall EJ, Purdy JA. et al: Biological and physical aspects of radiation oncology. In Hoskins, W.J., Perez, C.A., Young, R.C. eds. Principles and Practices of Gynecologic Oncology. 2nd Ed. pp.309-313 .Philadelphia :Lippincott-Raven.
2. Perez, CA, Hall EJ, Purdy JA. et al: Biological and physical aspects of radiation oncology. In Hoskins, W.J., Perez, C.A., Young, R.C. eds. Principles and Practices of Gynecologic Oncology. 2nd Ed. pp.321-335. .Philadelphia :Lippincott-Raven. pp.321-335
3. Jensen PT, Groenvold M, Klee,MC, et al:Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. International Journal of Radiation Oncology, Biology, and Physics. 2003; 56(4):937-49
4. Bergmark K, Avall-Lundqvist E., Dickman, P W, et al: Vaginal changes and sexuality in women with a history of cervical cancer. The New England Journal of Medicine. 1999. 340 (18): 1383-1389

Use and Care of Vaginal Dilators

1. Follow the recommendations from your gynecologic oncologist or your radiation oncologist about when to begin using the vaginal dilators. If you recently had pelvic surgery, it is important to allow for the vaginal cuff to heal, which could take up to six weeks. During this time, sexual intercourse or the use of vaginal dilators should be avoided. If your treatment involves radiation only, or is combined with chemotherapy, you should begin using either the vaginal dilators 3-4 times per week, or begin having intercourse as soon as comfort allows.
2. Radiation changes can occur gradually over several years and it is important to consider long-term use of vaginal dilation.
3. Wash your hands and the dilator with warm soap and water before using.
4. Apply a water-based lubricant like Astroglide or KY Jelly onto the dilator.
5. Lie down on your back, bend your knees and place your feet flat on the bed.
6. Hold the dilator as if it were a tampon and glide the rounded end of the lubricated dilator into the vagina up to the point where there is resistance or discomfort.
7. Place your knees together and gently straighten your legs while keeping the dilator in place. When you are lying completely flat, place the legs together and leave the dilator in the vagina for up to 10 minutes, or as tolerated. During this time, try to relax and you may remove and re-insert the dilator as often as necessary for comfort.
8. Wash the dilators with soap and water after each use, dry with a soft cloth and place back in the box or protective casing. Inspect the dilators before the next use for any rough edges or scratches that could cause vaginal tissue trauma.
9. It is not unusual to experience a small amount of bleeding or spotting after the use of the dilators. If you experience heavy bleeding or pain, call a member of your health care team or your radiation oncologist.

Complementary and Alternative Medicine (CAM) Therapy .

Complementary and Alternative Medicine (CAM) therapies have become increasingly important to our patients and as clinicians we are gaining more insight into their use as we broaden our options to treat cancer. First, it is important to understand the meaning of “complementary” and “alternative” therapies. Complementary therapies refer to treatments which are “added to” the standard, science tested, medical regimen and carry little risk of interfering with the accepted medical treatment plan. Yoga, meditation, massage, biofeedback, guided imagery, and music and art therapy are all examples of complementary therapy that have proven benefits and provide an enhanced sense of well-being. For example,, acupuncture has shown to be helpful in relieving symptoms of nausea (1), hot flashes, pain, and neuropathy.(2) Complimentary therapies also help patients by giving them a sense of participation and control in the treatment plan. See Resources.
Alternative therapies refer to treatments that may be used “instead of” the scientifically approved medical treatment plan. We remain open to alternative practices when there is sufficient peer-reviewed data showing a possible benefit. UGO participates is clinical trials throughout the nation and is involved with research aimed at the discovery and approval of new treatment methods for gynecological cancers. There is a great deal of information available on the internet regarding alternative cancer therapies and it is important to review these treatments with your physician before starting alternative therapies. For example, there is an abundance “safe alternatives” to medical hormone therapy. The clinicians at UGO provide bio-identical hormones (estradiol, micronized progesterone) which are supported by scientific evidence and approved by the Food and Drug Administration (FDA) for symptom relief from estrogen loss. Bio-identical hormones are hormones created chemically in a laboratory that are an exact match to the hormones produced naturally by the ovaries. There are other alternative products identified as “botanical” or “bio-equivalent” hormones that are compounded in pharmacies or in health food stores, or marketed over the internet. The terminology can be confusing, especially when products such as soy, black cohash, red clover, and phytoestrogens extracted from plants claim to be safe alternatives to treat symptoms of estrogen withdrawal. These products have not been studied by the FDA, and there is no control over how the botanical was prepared or tested. We can’t be sure about their safety or effectiveness, and there are unknown interactions with chemotherapy or other prescription medications.(4) Furthermore, there are scientific clinical studies that have shown no benefit to the use of soy products for the relief of hot flashes. (5)
Currently, the National Institutes of Health is supporting research of herbal remedies for the treatment of symptoms of estrogen loss. It is important to discuss your interest or use of any CAM therapy with your clinicians at UGO to be sure the CAM therapy does not create a harmful interaction with the recommended medical treatment.

Notes:

1. Shen J, Wenger N, Hays, RD, et al: Electroacupuncture for control of myeloablative chemotherapy-induced emesis. JAMA 2000; 2755-2761
2. Johnstone AS, Polston GR, Niemtzow RC, Martin PJ:Integration of acupuncture into the oncology clinic. Palliative Medicine 2002; 16: 235-239
3. Freeman, S: Bioidentical hormones: Replacing fallacies with facts. Women’s Health Care 2008; 7: 7-16
4. Complimentary & Alterntive Medicine: An alternative approach. Changes. The North American Menopause Society 2007;97-102
5. Quella, SK, Loprinzi D., Barton JA, et al: Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central cancer treatment group trial. Journal of Clinical Oncology 2000;18; 1068-1074

Psychological and Social Changes

Women usually experience some form of physical alteration from cancer treatments. It takes time to adjust psychologically to the presence of new surgical scars, or a change in the shape, sensation, and appearance of the genitalia. Hair loss causes a dramatic, and often undesirable, change in appearance. The changes brought on by cancer and treatment affect a woman’s self concept and any undesirable change can feel like a threat to feminine identity. If a woman perceives herself as unattractive, she will feel less confident with sexual activity. Furthermore, concern with body image and self-concept can inhibit engaging in new relationships. It becomes very difficult for a younger woman to disclose a cancer diagnosis to a potential partner. It is very important to understand that although your body has changed as a result of cancer treatments, there are many ways to have a satisfying intimate experience with your partner. Modifications need to be made in the approach to physical pleasure, but imagine it as an opportunity to broaden your sexual repertoire. See recommendations for symptom management.

Social Changes

Most relationships will change temporarily. The role within your family changes depending on what is being experienced during cancer treatment. Side effects such as fatigue, nausea, neuropathy, or joint discomfort may keep you from performing and enjoying the usual activities with your partner and others. The disruptions in your life brought on by cancer treatment will in turn cause others to alter their role and accept new responsibilities. Initially, shifts in roles and responsibilities can cause anxiety and concern about the stability of your relationships. In fact, you may feel resentful of someone who temporarily takes over the role of caring for your children, especially if parenting gave you a sense of fulfillment and identity. You may experience isolation from colleagues at work who seem to avoid you and the use of the “C-word”. Much depends on the depth and stability of these relationships before diagnosis. With respect to intimate partners, if the relationship was strong before the cancer diagnosis, couples will find a way to bond and cope just as they would with any other major life event.

Emotional Changes

For most people, confronting a cancer diagnosis generates a broad range of feelings. At first, there is the distress and shock of receiving the diagnosis, often succeeded by fear of the consequences to your life and to the lives of your family and loved ones. You may experience a sense of loss and grief brought on not only by the physical changes and decreased stamina, but also because of the changes in the ability to perform sexually and express yourself as you had before your diagnosis. As time goes on, the fear may be about whether the cancer has responded to treatment and concern about the possibility of a recurrence. It is not unusual to become depressed and develop a negative view of the future. Its normal to feel overwhelmed by these emotions. Talk to your clinician or a member of your health care team about your feelings. Individual psychotherapy or group therapy can help you address these feelings and develop coping strategies. Most often, the best support comes from group meetings where you can share your feelings with other female cancer survivors. See Resources.

Recommendations and Interventions

To improve desire and arousal:

Sensate focus technique:

Sensate focus helps individuals and couples develop a heightened sense of self awareness through touch. Begin with touching areas of the body that are not usual sources of sexual arousal and gradually moves through stages to include other areas of the body. This helps the cancer survivor not only re-discover pleasurable areas of the body but also identify what may not feel comfortable.(1, 2, 4):

1. Avoid touching the breast or genital area; instead, begin by touching areas such as the hand, arm, and back. If you are with a partner, take turns giving and receiving touch, and communicate what feels pleasurable or uncomfortable.
2. Communicate and expand on what kind of touch feels pleasurable.
3. Begin to move on to mutual genital touching when both partners feel ready.
4. Move on to the intimate acts that lead to orgasm, although this is not necessarily the goal of therapy.

For detailed instruction, go to http://health.discovery.com/centers/sex/sexpedia/sensate.html

Mindfulness technique:

Mindfulness is a form of meditation that creates a heightened awareness of the experience in the present moment. This technique can be used to help women dealing with sexual difficulties related to decreased libido and lowered arousal. A woman can easily self-direct the meditation with the following instructions (3):

1. Sit in a comfortable position, eyes closed or focused somewhere several inches from the face.
2. Hold your posture upright through the chest and shoulders.
3. Allow your body to set the rhythm of breathing.
4. Relax and let yourself receive the thoughts and sensations as they come to you without judgment.

A very helpful, interactive demonstration can be viewed at www.youtube.com/watch?v=3nwwKbM_vJc

For those who are dealing with cancer, the mindful state may begin with negative thoughts and overwhelming concerns about the future. Dr. Benigno often describes this technique to his patients:
“If you find yourself deliberating in the thought, remind yourself, ‘this may be important, but I will reserve time to think about it later.’” Reconnect to the moment, and release the thought into an imaginary box. Later in the day, allow 15 minutes to open the box and engage in thinking about the thoughts and concerns that were troubling you, and place the thoughts again in the box until the next reserved 15 minutes. You can also use the mindfulness technique less formally at any moment, especially when becoming open to matters of sexual intimacy. Practicing mindfulness can help overcome barriers to sexual intimacy such as decreased libido, worries about body appearance or sexual performance, or fatigue. Plan a time to be with your partner when you anticipate feeling your best. Take a few minutes for relaxed breathing and consider what is most important to your survival and well-being is being at peace in the present moment. Acknowledge thoughts as they enter your mind, and release them with each breath. As you become calm, allow yourself to become fully aware of the sensations of touch, taste, and smell. Engage in what you have learned about “sensate focus.” Focus on these sensations and let the present moment unfold without the intrusion of negative thoughts and fears. Using the mindfulness technique and sensate focus can be very powerful and validating tools for women surviving gynecological cancer who can improve their arousal and response to sexual stimuli. (4)

Other interventions for decreased libido and arousal:

1. Talk to your partner about your feelings and show them what they can do to help you feel better. Intercourse does not always mean intimacy. Be clear about what loving and caring behaviors will give you comfort when you are not feeling sexual.
2. Stimulate the senses and visit sex shops for books and erotica. While you are there, pick up a dildo or vibrator for vaginal conditioning.
3. Go for a massage or a day of pampering at the spa.
4. Set aside a time for intimacy when you think that you will be feeling your best. Create a sensual mood with candles, music, and fine wine.
5. Plan a date night or weekend getaway.

For decreased arousal, painful intercourse, or impaired orgasm:

1. Talk to your clinician about the possibility of hormone therapy that includes estrogen.
2. Used water-based vaginal lubricants.
3. Experiment and broaden the options for sexual positions that avoid deep penetration.
4. Review your medications with the health care team. Certain types of anti-hypertensive and anti-depressive medication can interfere with or delay your ability to reach orgasm.
5. The Eros Therapy device has been found to be helpful for some women who have had difficulty with sexual arousal and orgasm following cancer treatment. Talk to your doctor or nurse about prescribing this device.
6. Consider counseling or sex therapy. See Resources.

Notes:

1. Bober, S: Reclaiming your sexuality. Caring 4 Cancer. 2008; Fall: 46-48
2. Sensate Focus Exercises. Sexual Health Center. Sinclair Intimacy Institute. 2002. 10/2008. http://health.discovery.com/centers/sex/sexpedia/sensate.html
3. Kabat-Zinn J. 1993. Mindfulness Meditation: Health benefits of an ancient Buddhist practice. Mind/Body Medicine, eds. Goleman D, Gurin J. New York 1993
4. Brotto, L. A., Heiman, J.R. Mindfulness in sex therapy: Applications for women with sexual dysfunction. Sexual and Relationship Therapy. 2007; 22 (1)

Resources for Gynecological Cancer Survivors:

Counseling in the Atlanta Area:

Talmadge and Talmadge, PC. Associates for couple, individual, and sex therapy.
34 Lenox Pointe, NE
Atlanta. GA 30324
404-261-9325 404-266-8521
www.talmadgeandtalmadge.com

Scott Colbert, PhD
1050 Crown Pointe Parkway
Suite 360
Atlanta, Georgia 30338
404-822-3286
www.colbertcounselingcenter.com

Support group with other gynecologic oncology survivors:
www.thewellnesscommunity.org
www.gaovariancancer.org/support.htm

Finding a sex therapist:

Ask your clinician for a referral to a qualified mental health professional who holds an advanced degree (MD, PhD, MSW, MS, MA, MFC) or a certified sex therapist associated with The American Association of Sex Educators, Counselors and Therapists at www.aasect.com. Call and speak to the therapist over the phone about the issues that concern you and your partner. Ask about the therapist’s experience and approach treating sexual dysfunction. Avoid unlicensed individuals who claim to be sex surrogates or individuals who offer sexual services or advice for money.

Complementary and Alternative Resources

Directions for Mindfulness and Sensate Focus Techniques:

www.youtube.com/watch?v=3nwwKbM_vJc
http://health.discovery.com/centers/sex/sexpedia/sensate.html

Acupunturist:
David Hobbs LAc, Dipl. CH NCCAOM
www.inspireatlanta.com

Jie Wang, TCMD.
Chinese Medical Clinic
drwangcmc@yahoo.com
www.georgiachinesemedicalclinic.com

Reiki:
Alice Fink
Key Energy
www.keyenergy.org
404-580-6094

For beauty, friendship and laughter:

www.chemosavvy.com
www.sego-wecarefoundation.com
www.lookgoodfeelbetter.org
www.chemoflage.com

Fertility Issues:

www.fertilehope.org
www.livestrong.org

General Information/Education:

www.cancer.gov/cancertopics/pdq/supportivecare/sexuality
www.hystersisters.com
www.gaovariancancer.org
www.thewellnesscommunity-atlanta.org
www.womenandcancermag.com
www.Caring4Cancer.com

Ostomy support sites:

www.ostomyinternational.org/facts/sex
www.uoa.org

Sexy custom ostomy pouch covers:

www.myheartties.com
www.bengalspot.com/ostomy1/OstomyCovers.htm
www.ostomy-medical-supplies.com/ostomy_.Bathing_Suits.html

Physical therapy specialists in pelvic pain or pelvic floor dysfunction:

Physiotherapy Associates
www.physiocorp.com

Vaginal dilators:

www.owenmumford.com/us/range/41/amielle-care.html
Syracuse Medical Devices,Inc. 315-637-9275

• Visit www.cscatlanta.org for more information

• Café Au Lait
  2300 Holcomb Bridge Road, Suite 410
  Roswell, GA 30076
• ph: 770-641-9607
• For more information contact Ovarian Cancer Survivor Janet Kempe, cell: 770-617-1642 or email jkempe@lycos.com