Editor’s Note: This information is not a substitute for medical care. Always inform your healthcare team of any concerning symptoms you are experiencing, and consult with your provider before starting new treatments, therapies, or health routines.
It was 2012, and I was seated in business class expecting a mundane three hour flight to meet a client. My seat mate I will refer to as “Sally.” Sally was digging through her purse in a bit of a tizzy. Finally, she found her magic pills. Sally turned to me and said, “I can’t believe no one ever tells us what happens during menopause, I want to warn you of the terrible things it can do to you.” She continued to tell me there are 34 symptoms, some are not too bad, but there are a few that sounded REALLY bad. Holding her pill bottle, she goes on, “These are bio-identical hormones—I don’t care what the risks are. I don’t have hot flashes and my vagina hasn’t closed shut.” What the …???? Hun, your vagina can completely close? Eeek. Mental note, get the magic pills when I enter menopause, maybe in twelve years or so.
Menopause came much sooner than that. I very quickly found that I had vaginal atrophy. Sigh. After my second breast cancer diagnosis in under two years, the aromatase inhibitors (“AI”) put me in early menopause. It took only two days for the hot flashes to start; insomnia kicked in and every cell in and out of my body felt crispy, including my vagina (vag for short).
When I felt “recovered” (whatever that is) from my recent treatments and had been on AI’s for six weeks, my partner wanted to start having intercourse again. The first attempt triggered my PTSD. I was being ripped in half, my skin torn and bleeding. Sally was right, menopause is awful. In a state of disbelief, we tried again a week later—maybe a new lube will fix things. Same result, me screaming for my partner to stop, then crying inconsolably.
I felt broken—cancer had taken so much from me. Now it was going to ruin my marriage. These side effects were directly impacting my relationship and my emotional state. Having hormone positive breast cancer precludes me from taking Sally’s “magic pills.” That night I laid awake contemplating stopping the AIs and accepting the risk of a shorter life to have a marriage. Neither choice was good.
The next morning, we decided to talk about our intimacy issue with my Oncologist (“Onco”) during the next appointment. We needed information about why intercourse is so painful and what we can do. I really didn’t know what the response would be. The problem with intimacy is not isolated to me; many women in my support groups and online groups suffer from sexual disfunction.
My Onco recommended Pelvic Floor Therapy (PFT). I had heard of it, but I wasn’t sure what it entailed. It didn’t sound fun. He told me my Rx for therapy would be ready when I checked out. That type of therapy was for incontinence and for older people, right? I am not even fifty, so I don’t know why I would try.
It took a few weeks before I put on my big girl pants and found a physical therapist who specialized in PFT. No excuses now, as the office was close to my house. I filled out pages of questionnaires, mostly relating to incontinence and bowel problems. I didn’t have any of those symptoms. I will refer to my PFT as LM. She was confident with a very calm, warm disposition. LM had taken the time to read all the twelve pages of questions I had answered. This allowed us to get right into the assessment.
LM started with some initial physical tests to check the mobility of my pelvis, hips, and spine. I didn’t score high on those tests; nothing moved the way it should. Next, LM examined the 22 inch abdominal incision created during my reconstruction. The scar tissue was very tight and restricted my movements. Lastly, there was an internal exam. LM summed up the issues she could address for me—balancing my hips to put my pelvis on the correct plane, adjusting my spine mobility so my pelvis could move unrestricted, and working out the muscle knots inside my vag. The last one was surprising to me, but our vag is just a bunch of muscles that can get tight. Of course, there was homework to do—stretch my iliac muscles and use my dilator 10 mins every day with no vibration.
When I started PFT, I was depressed and scared about my relationship. I was mad at cancer. Being in a negative mindset created the belief that I wouldn’t have remarkable results from PFT. It took a few visits to mentally get used to the vag muscle releases. The changes to my body were good, and I responded very rapidly. Sticking to the PFT schedule—three visits per week—was key. My body really benefited from the therapy. The entire experience was very positive. Today, my body can handle intimacy better than before PFT.
PFT can help other conditions women with breast cancer suffer from such as bladder and bowel control, along with abdominal organ support. It isn’t just the AI triggered menopause or systemic therapies that cause our physical modalities. The emotional stress of dealing with breast cancer and the postural changes from surgery all affect the pelvic floor.
I want to bring awareness to other breast cancer patients, survivors, and those in between, that PFT can effectively help with sexual disfunction. Many comprehensive cancer centers will have practitioners on site. In your community you can also find physical therapists who specialize in PFT. You will need an Rx from your oncologist or family doctor to start the therapy.