Man! It’s hard to feel sexy when you have cancer.

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!

Dr. Katz

Soo..when should you take your kid to the gynecologist?

Well i am glad you asked! Being a gynecologist myself, I am ALL OVER this one with wise tips and safe knowledge. First let me say that yes, I have seen all the newsflash and articles about teens suffering through unnecessary exams too early. Yes yes. I have read them all. I am also well-versed in all the national recommendations. Having said that, let me break this down according to my perspective and explain how I go about the practice of adolescent gynecology.

I want to first start off by saying that, to my knowledge, no teen has suffered at my office that I know of….or at least they have not spoken up. Usually they leave the office relieved that it wasn’t as awful as their friends, google, or the random promiscuous acquaintance said it would be.

Ok let’s clarify some current national recommendations on pap smears. The USPSTF( United States Preventative Services Task Force) recommends screening for cervical cancer in women ages 21 to 65 years with a pap smear every 3 years or, for women age 30 to 65 who want to lengthen the screening interval, screening with a pap smear and hpv testing every 5 years. Women over the age of 65 with adequate prior screening do not require further screening. Women who have had a hysterectomy with the removal of the cervix and who do not have a history of high grade dysplasia also do not require further screening. Now that we have all that settled there are a few caveats and things to clarify. First, these recommendations are based on statistics, costs( how expensive it is to identify and take care of someone with cervical cancer versus how much it costs to screen everybody) and epidemiology( how long it would take abnormal cervical cells to progress into something serious. Second, these recommendations often come from a panel of folks who may or may not have seen actual patients in a clinical setting in a very long time. Third, these recommendation ONLY refer to the pap smear guidelines. This can be very confusing for women because when they hear no pap smear required, they tend to think that means no exam is required. I cannot speak for other offices, but in my office, the pap smear is a mere 30 second portion of the entire head to toe exam that I perform on my patients and is by no means the end all be all. This is, in my opinion, potentially very dangerous because there are many gynecologic conditions that do not present with symptoms until late stage and increased severity. If the average woman gets no check up and just waits for symptoms, she could already be facing a life-threatening condition that could have otherwise been picked up on and treated. Ovarian cancer symptoms can be as vague as some bloating and decreased appetite. Vulvar cancer can present with just a minor itch. Without significant contortionist abilities, a head lamp, and some Superman x ray vision, I find it difficult to believe that the majority of women could accurately self- diagnose at an early stage. I recommend at least getting an exam every year…all pap smear recommendations aside. The other thing that I find difficult to swallow about these recommendations is that they seem to be attempting to weigh what a human life is worth. It feels like we are saying,” It’s just too expensive to watch out for all of you long term and actually use our technology to catch everything early, so we are just going to hedge our bets and go for the cheapest option because it will likely end up in our favor. For that handful or more of patients that get missed, oh well. I would challenge any actively practicing physician to look a patient whose preventable diagnoses was delayed and hide behind these recommendations with no regret.

Now, back to the teenagers. Let me preface again before we go on that what I am about to say is based on fact and my personal opinion combined. I will try to be very clear on which part is which. Here is what I tell parents when they ask when they should bring their teenage daughters to me. I first recommend that a patient start visiting me when she first starts having a period. This is a good time to have an honest, CLOTHING ON, discussion with the adolescent about her body, what to expect, evaluate whether she is having any menstrual difficulties, etc. If applicable, we can also have an open discussion about sexual pressures and peer pressure. I also use this as an opportunity to offer myself as an unlimited resource for any future questions she might have. This visit does not necessarily involve getting an exam. These kinds of visits can be carried out on an annual basis, accounting for good decision-making, until the patient reaches 21 and screening can begin. However, we all know that age of first intercourse in the United States is getting lower and lower. I have 12 and 13 year olds in my practice that are already experimenting with sex. A lot of the time, the parents either do not know or are not prepared or comfortable to deal with this situation and therefore the patient goes unchecked, high risk behaviors evolve out of lack of resources and information, and lots of potential problems arise. I truly feel that if these patients were to have the opportunity to establish with me, I could help tackle some of these issues and at least attempt to help keep the patient safe. If I have an adolescent patient that is engaging in high risk behaviors( multiple partners, unprotected sex, etc), I may want to do an exam for several reasons. First, even tho I realize that some sexually transmitted infections can be screened with urine and blood, there are some that cannot. For example, I cannot determine if a patient has genital warts that need to be treated without an actual examination. Second, it is my personal opinion that there is a certain amount of responsibility that should accompany the decision to be sexually active and part of that should include the patient being actively involved with being healthy like getting an exam rather than peeing in a cup and waiting for results. I think that when we foster a disconnect between our teenagers and their decisions, it only compounds the potential for disaster. Third, this subgroup of teenagers is at higher risk of HPV and eventually cervical cancer. I realize that, according to statistics and epidemiology, it is likely to take years and years for this HPV or cervical dysplasia to develop into something serious like cancer and that it has a chance of resolving on its own. I also realize that part of the logic in these recommendations is that the teenage population would be more at risk for having unnecessary procedures for conditions that may resolve spontaneously in time. I assure you that I am very cognizant of not doing just that in my practice. Even understanding all that, do we really want to just throw the dice and wait and not even involve the adolescent in her own gynecologic well- being until she is 21? I just have a hard time with it. Welp, those are my thoughts on the subject. Have a fantastic day!

Dr. Katz

“My mom’s a gynecologist, so she knows.”

This title is a direct quote from my now 15 year old to another child when she was correcting her on the proper terminology for body parts, at the ripe old age of 4 or 5. To be fair, she may have butchered the term gynecologist a bit and made it her own, due to pronunciation difficulties. Nonetheless, the message was the same. As I think about it, I am quite sure that growing up with a gynecologist as a mother has presented an intricate balance of advantages and disadvantages…for both sides. It has definitely made life interesting, to say the least. I remember thinking, before I had children, that it was going to be sooooo amazing to be a gynecologist mom. I couldn’t wait to have daughters so that I could be the best information resource ever about all things “sensitive.” I was convinced that we would share so openly about sex and biology and all things gyn that my kids would never want for knowledge and certainly would come to me with ANY questions or concerns they might have. Well, this hasn’t exactly turned out the way I had hoped.

Let’s start from the beginning. From the time my kids were little, there simply wasn’t room for any body part baby talk in our house. There were no weewees or hoohoos. There were penises and vaginas, right from the start. I was determined to give them the proper terminology, thinking I was starting off right in removing the taboo. After all, I wasn’t teaching them swear words or anything, just basic biology terms. What’s the harm right?

Well, I need to tell you a little story about how this semi-backfired almost immediately. We were sitting in a restaurant one day. It was my husband, myself, our oldest and my two year old. The meal was meh, but the conversation was nothing if not interesting. Right in the middle of her mashed potatoes, my 2 year old suddenly bolts up out of her chair and announces very plainly to us and the whole restaurant in general(cue squeaky high-pitched two year old voice)..” Mommy, my vagina hurts real bad and I can’t sit here any more.” You could have heard a pin drop. The silence was deafening, except for the sounds of every single head in the restaurant snap-turning in my daughter’s direction with a look of horror on their faces. It was as if she just quoted a line from a soft porn movie, complete with cusswords. My oldest was trying to stifle a laugh into her pot pie. My husband was sitting there open-mouthed. My 2 year old was grinning, very proud of herself for getting all the words right. I knew it was up to me to handle this. I stood up immediately and said,” It’s ok folks. It’s ok. I am a gynecologist and I can take care of this.” I turned to my two year old and asked her if she wanted to switch seats. She did willingly. I then asked her if she felt any better. She looked at me and said,( cue toddler voice again) ” Oooooh yes. My vagina feels muuuuccchhh better now. Thank you Mommy.” She then sat down, smiling and proceeded to start in on her mashed potatoes again. Meanwhile, the rest of the room did not seem nearly as relieved that the problem had been solved. Ever the fixer, I felt like I had to address the again. I said,” It’s alright now. She feels better. Problem solved. Everyone please go back to enjoying your meal.” Needless to say we never ate there again.

My now 15 year old took a completely different spin on it. She learned and embraced all those terms with relish early on. In fact, she would correct every child that she came across who dared to use improper terminology for their body parts….all the time! As a matter of fact, she was so keen on all of her little friends knowing the right words to say, that even if the subject of body parts did not come up in polite conversation, she would bring it up so she could have the opportunity to “educate” them. This did result in more than a few phone calls from the school. It was as if we had turned the tide on the terms wee wee and hoo hoo and now they had become the bad words.

My youngest was also always fascinated with what her Mommy did, especially the part about delivering babies. She thought that was really something special.(and hopefully still does) However, I did not really grasp just how special she thought it was until one day when I got a different kind of phone call from school. Mind you, at the time, both of the girls were attending a private Lutheran school, so they were getting their daily dose of religious education right along with their ABCs. I got a phone call at work saying that I needed to come to the school as soon as I could, but that it wasn’t an emergency. I hung up confused, of course and tried to head there as soon as I could. I arrived at the school and headed right to the preschool day care room. As soon as I walked in I noticed a long line of little girls leading up to the play tent in the corner. I asked the daycare teacher what was going on. She smiled at me and said, “Oh you’ll get a kick out of it.” She motioned me over to the tent and there was Katy, dressed like the virgin Mary, delivering each little girl’s baby one by one. She saw me and immediately smiled and informed me that she was delivering their babies just like me. Everyone still had their clothes on and each baby was a doll, but the main objective was still clear. She was very proud. I thought it was pretty clever that she combined her admiration for me and the Virgin Mary all in one. However, all of the other parents did not exactly share my sentiments and thus, the baby tent had to go.

All in all, I still think I did the right thing in teaching the proper terms to my kids. I think we have to stop thinking of body parts as taboo for little children. It is only natural to be curious about them. Psychologists say this starts naturally as young as the toddler age. I think that if we contribute to removing the taboo from the words themselves, it might be a first step in being more comfortable talking to our kids later in life about their sexuality and arming them with useful information and resources instead of shouting about abstinence only or leaving them to fend or themselves.

Yes, i went there. I started talking about teenagers and sex. This leads to yet another tricky aspect of having a mom as a gynecologist. My girls went very quickly from being fascinated with what I do and happy to receive whatever tidbits of wisdom I wanted to impart to being mildly horrified and unwilling to engage in the sharing extravaganza that I had in mind. I learned very quickly that, despite all my efforts to the contrary, they had no problem coming to me with concerns or questions on behalf of their friends, but that it was just too embarrassing to talk too much in depth on a more personal level. Nevertheless, I still continued, and will still continue to encourage open conversation whenever possible. Whatever my girls decide to do, I have armed them with resources and information to help them make safe decisions. Teenagers in general are known for poor decisions and getting guidance from google, their friends, snap chat, and tik tok, but I am hoping that my guidance will help pave the way to better ones. I will always be hoping.

Well, that’s all for now. Gotta get to work. Have a fantastic day!

Dr. Katz