Laura A. Katz MD, a board-certified obgyn talks about life, women's health, motherhood and the "sensitive subjects."
I am a board-certified obgyn and aesthetics specialist, a mother and a wife. I have been in solo practice for over 20 years. I am also a musician and a beginner tapper. My colleagues and friends thought that I should start blogging to share my thoughts with the world. Here's to hoping that my blog will make you laugh, make you think, and sprinkle in some helpful info in between.
So, as I understand it, the end is near for my cancer treatments. This week is supposed to be the week. The last chemo. Wow. Just to say it out loud is really something. It doesn’t even seem real. Could it really be true? Of course, when I speak in terms of the end, it is not really the end. The next five years of my life are pretty well mapped out with follow ups and scans and appointments. It is really at the end of those five years that it is really “over,” not just at the end of chemo. There will always be that little forever shadow monkey on my back that things could take a turn for the ridiculous again.
I would be lying if I said that I am not excited about the prospect of chemo being over. But, weirdly, at the same time, I am a bit terrified as well. No more chemo?! While that means, hopefully, no more of the awful side effects after they all wear off. It also means no more internal liquid defense system. It also means that there could be more opportunities for the cancer to creep back into my life. Hmm. How will I know if it is coming back? In the interest of respecting the post traumatic stress aspect of being a survivor, I made a promise to myself not to panic at every little twinge or symptom that I experience after treatment is over, but should I? Or should I be hypervigilant? I don’t really know the right answer.
I am looking forward to feeling like myself again, to having stamina, to being able to exercise, to being able to have hair again (hopefully completely different and thick and amazing), and to feel, dare it say it, sexy again. But, I hear that that is going to be an additional wait as well. I have been told that it can take up to six months before patients feel back to baseline. This kind of statistic just makes me anxious because I suspect that it will be a natural tendency for everyone, including myself, to expect me to pick up right where I left off before treatment as far as work and life in general. I have a gift for putting extra pressure on myself and I am sure this will be no different. Well, at least I am consistent in that regard…lol
Basically what I am saying is that I am kind of all over the place right now. I have no idea how to feel. Part of me is ready to throw caution to the wind and literally have a party( socially distant of course) to celebrate the end of this chapter. The other part of me realizes that there is a whole lot of other stuff to consider before the party can begin.
Picture the scene: Your partner gives you the let’s get frisky look. They start petting you in the way you are normally into. The sexy dance has started. The lights are dimmed aaaaaaand……nothing. You are laying there all bald and post chemo( well it has been a few days but you get the idea), fresh off your latest chemo hot flash, tired, bloated and not the least bit sexy….in your mind. You just aren’t up for it. It’s not you. It definitely isn’t your partner. It’s the freakin absence of sexiness that sometimes comes with cancer and chemo. I tell ya, the changes in appearance alone are a real confidence killer at times. My husband is the most amazing partner and best friend on the planet and regular me can’t get enough of him. But, cancer me is another story.
Cancer and cancer treatment can have a very significant impact on a woman’s sexuality in many ways. Disfiguring surgery may be required that can significantly affect your self esteem and confidence. Treatments can sometimes put you into premature menopause with hot flashes, vaginal dryness, pain with intercourse and decreased libido. Certain pelvic cancers require such extensive surgery, radiation, etc that a woman is left without proper function of her sexual organs permanently.
I get it, this sounds all doom and gloomy. The good news is that not all women are left with permanent sexual dysfunction after cancer. Sometimes the effects are temporary and things go back to normal when treatment is over. I am seriously hoping that I fall into this category.
Fortunately the data shows that if a woman was able to have satisfactory sexual experiences before cancer, she will be able to again. The American Cancer Society has a whole section of helpful tips and information for women who are having sexual issues resulting from cancer treatment. Some of these are in fact very helpful. The bottom line of all of them is that sometimes you have to get creative and you have to reinvest in your own self-love and confidence. Sometimes the same techniques for sexual satisfaction that you used before will not be successful anymore. You might not even have the same parts anymore. You may have to use more lubricant when you didn’t have to before. You may have to explore different things that excite you. You may require a vibrator for extra stimulation. You may need to try different positions. You may need to employ more fantasies into your sexual relationships. You may need dilator therapy to re-stretch the vaginal canal. These are just a couple of examples.
There is an interesting set of exercises recommended by the American Cancer Society for patients feeling anxious about sex and the way that their appearance has changed and adjusting to those changes. They suggest looking in the mirror, dressed at first, and noting the changes in your appearance: your surgical scars, ostomies, missing parts, etc. Then notice what you try to avoid looking at. Then while dressed, try to find three things that you like about your appearance. Once you are comfortable looking at yourself as a stranger might see you, then change the exercise and repeat it with you being dressed “sexy” for your partner. Finally, repeat the exercise nude with the same steps until you are able to look at yourself and adjust to the changes and feel comfortable. Don’t stop until you can give yourself 3 compliments like you did in phase one of the exercises.
The last thing to address regarding the impact of cancer on sexuality is the anxiety that goes along with it. It takes time to realize even when treatment is over that you are actually better and that life can go on, including sex. Clear communication is the absolutely paramount here. Talk openly with your partner about your fears and issues. Don’t leave them in the dark and just reject them. They can’t possibly understand what is going on in your head unless you tell them. Get therapy if you need to. Talk openly with your doctors. You be the one to bring it up. I can tell you right now that most physicians are not comfortable enough to make sure to address sexual issues at any time, much less with their cancer patients. This will be something that you really need to take charge of and advocate for if you want things to change and improve. As much as we try to deny it at time, our sexuality and sexual health are key components to our relationships and overall health. Sex is just as important for cancer patients as it is for every day folks. So, do what you can to preserve it. It’s for your health!
I feel like this statement has a wide general application in life. It applies to every path, every goal, and every challenge. Just think about it for a second. Every time we set out to accomplish something, we set out with full steam and limitless energy at first. Then, about half to three quarters of the way to our goal, we hit that proverbial wall. Our resolve waivers. Our energy supply decreases. We feel sure, at the moment, that there is no way we can finish. We wonder why we started in the first place. Interestingly, the perceived obstacle at the moment isn’t even that significant at the time. Often, it is just a slight twist on what we were already dealing with, a slight change in variables. And yet, it can be enough to stop some people in their tracks. I have a theory here.. I think this happens because we all need a break sometimes. We need to let the steam out of whatever pressure cooker that we have created for ourselves at the moment. In and of itself, this break can be healthy and allow us time to regather the strength to head back toward completion of our goal. We need to give ourselves permission to take these brakes.. The trick is to not take too long and get back on track once the break is over. I guarantee you, finishing what we started will be worth it.
Cancer plus pandemic has forcibly reduced my level of human contact over the last year. Whether it was due to government regulations or physical restraints from my illness, the effects were the same: less people were physically in my life at any one time. At first I fought it. I felt angry and restricted, especially when I was still healthy. Then when I got sick, I still felt resentful every time I had to be left behind when my family went somewhere or left out of a favorite activity. After awhile though, it started to feel easier to bow out of things, easier to just stay home and sit with my dogs, watch TV, and have no expectations. It started to become too comfortable. It is still too comfortable. Traditionally I am a social person who needs people, who savors life and interaction. Now, it seems like I have to force myself to leave the house and carry out any kind of responsibility. Now granted, I have the plethora of chemotherapy side effects like pain, neuropathy, and intense gastrointestinal distress that legitimately get in the way sometimes. That is true. However, I find myself wondering if I will still have reluctance to gather even after those excuses are out of the way. This is concerning. The words lazy, lackadaisical, and apathetic have never before graced my daily life vocabulary. I don’t really like them setting up residence now, but I am not sure what to do about it. I don’t really think that it is fear anymore that is keeping me inside. I think it’s something worse: apathy. I am just over it. I am just over all the panic and the restrictions, but at the same time I am out of the energy to discuss them, fight them, or act against them. What I need is a strategy for emergence that makes sense for me, my sanity, and my particular set of circumstances and limitations, not anyone else’s. Here’s hoping that I develop a good one and I hope you do too.
Boy I tell ya. Every time I think I have my crap together, it seems like I am destined to have a mini emotional breakdown. It’s as if that temporary sense of peace and satisfaction sends out an invisible beacon, calling for something else to happen to tip the emotional scale against me. Of course I know that’s not true, but it feels true. Logically, there are a ton of reasons for me and everyone else in the world to have recurrent crying spells and emotional breakdowns. Nothing feels the same anymore. The long term isolation and restrictions have us overly craving any decisions that could be called ours, even down to the day to day minutia. When one thing doesn’t go our way, we are devastated, even if it is something otherwise insignificant. Our feelings bruise more easily. I promise you. There are some days that I could cry if someone looks at me the wrong way. It seems like people are ready to point fingers and blame everyone and everything else for how they are feeling. We are further imprisoned by our unreasonable expectations of those around us lately, which only sets us up for more failure and disappoinent. In my case, my plate is heaped full between the pandemic, it’s effects on my business, and now cancer on top of it! I get it! We are all frustrated and hurting in different ways. It’s understandable and it makes sense! We need to move forward but until we can, we still have to be accountable for ourselves, our actions, and our feelings. We still have to make an attempt to do things that make sense.. We may still weep and fret along the way,, but it is the only way we will be able to eventually get to where we need to be.