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To be able to enjoy sex and intimacy, lots of things need to work together. The brain, body, mood and behaviour all need to be in sync, and then if you add a partner into the equation (although you don’t have to) and what is happening around you in life generally, it's a wonder anyone ever manages a successful sex life! So after cervical cancer it’s no surprise that one or all of these areas may have been affected.
This isn't always the case and things may be great and better than before – but I guess if you’re reading this, you are looking for tips on how to help improve something. So what might have changed…
You may think differently now and that little voice that we all have in our head may be working overtime. Sometimes it may be kind and other times pretty critical. How you think of yourself and of your body may have changed, which could be causing a barrier to you connecting with yourself or a partner. It's hard to be kind to you sometimes, but it’s really important to not be too hard on yourself.
Take time out to rediscover yourself and know that you are still the same person. Sometimes it’s little things, like taking an extra five minutes for yourself in the shower but being aware of the water on your body and how it feels and how the towel feels as you dry – reconnecting your brain with your body.
How you think and feel will be interlinked and affect each other. Improving how your body works and how you interact with a partner may improve how you feel and, in turn, how you think.
Lots of things may have changed with your body. Your vagina may have changed due to radiotherapy or surgery. You may have gone through the menopause previously or as a result of treatment, and hormonal changes can affect many different things. Think of the seven dwarfs of menopause – itchy, bitchy, sweaty, sleepy, bloated, forgetful and psycho… you may experience some or all! Check if it's appropriate for you to have hormone replacement therapy (HRT).
The main changes in your vagina mean that the tissues aren't as supple and they're more fragile than they were. Using a vaginal moisturiser every few days (hormonal or non-hormonal) can help, a bit like your daily routine for face care. You should be able to get this from your GP free on prescription.
Lubrication is a must at the times when you plan on inserting something into your vagina – whether that's a dilator, vibrator, dildo or penis. Using a combination of oil and water-based lube can be good for some. Put the oil-based lube on your vulva/vaginal opening, then then the water-based lube on the thing you are inserting. This is a slide/glide technique. Silicone lube is also good. Lots of companies offer samples, so try a few and find one that suits you. Remember, do not use oil-based lube if you use condoms or silicone toys. If you're in a couple encounter, try using lube in foreplay.
Another tip (bear with me with this one!) – if we think something is going to hurt we protect ourselves, so our pelvic floor muscle contracts which closes the vagina. If you try to squeeze your pelvic floor tightly (as if you’re stopping yourself from having a wee) but at the same time push out your abdomen, you'll find you can't keep your pelvic floor tight. So next time something is going into your vagina, push out that tummy and it may help.
Often when things aren’t so good sexually, people withdraw from intimacy and sexual contact to avoid the situation. In sex therapy, we often put our client on a sex ban. The aim is to take away the fear of being sexual to allow the intimacy and confidence to rebuild. Re-discovering your body and, if you have one, your partner’s body and closeness over a period of time often helps with arousal and wanting to be close and intimate. In a way, it's about giving your head and body time to re-connect. It may sound simple, but it can takes a lot of work and, if there are two of you, lots of talking.
Enjoying your body on your own or with someone else doesn't have to involve vaginal penetration – sex and intimacy is so much more. But for many of you reading this, using dilators may be part of day to day life. Many of my clients find developing relaxation and mindfulness techniques, combined with lubrication and the tummy push I talked about above, helpful in successfully using dilators. For some, it also helps to find a dilator set that suits them, as there are lots of different types around.
If your problems persist and start to cause you emotional distress or problems within your relationship, you may be eligible for psychosexual therapy (PST) through the NHS. It's best to ask your GP or clinical nurse specialist (CNS) if there is a service locally. The best way to seek PST privately is through The College of Relationship and Sexual Therapists (CORST) It has a list of accredited therapists in your area. Before you decide on a therapist, it makes sense to check that they understand the treatments you have had and how that may impact on your body, as well as the psychological impact.