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My Clitoris Ghosted Me After Breast Cancer — Here's How I Found Pleasure Again
There's never a good time to get breast cancer, but my 2001 diagnosis came during a life stage that was hardly ideal. I was 28 at the time and a second-year ob-gyn resident, newly married to my college sweetheart. Life was busy, but going great — until it wasn't.
My diagnosis was a shock. I had felt a breast lump myself, but I originally dismissed it because I thought I was too young for breast cancer. Even my fellow physicians thought the same thing. But a few months later, my mom was diagnosed with late-stage ovarian cancer and died soon after. At her funeral, I thought, Maybe I should get that lump checked out. It put me on a path that would dramatically influence my physical and sexual health — and change how I talk to patients now.
My cancer treatment put me into menopause.
Once I had my lump investigated, my fears were confirmed: I had breast cancer, stage 2A estrogen receptor-positive breast cancer, to be specific. My treatment involved a bilateral mastectomy, where both of my breasts were removed, along with six months of chemotherapy.
I was put into menopause three times — one was from chemotherapy, another was medically induced, and a few years down the road, I chose to have my ovaries removed because of my mom's history with ovarian cancer.
But my ob-training did not prepare me for what the average woman dealing with premature menopause or menopause would go through, and my sexual health took a hit for years because of it.
I experienced clitoral atrophy, and didn't even realize it.
There was no discussion at all with my medical team about any of the sexual side effects that I might experience from menopause. I don't think it's because they thought I already knew about this from being a doctor. They either didn't know it themselves or just didn't think it was important to discuss with me. But I was 28 and I was only married for a year. I didn't know what to look out for.
So, I ended up dealing with a diminished sexual response. Meaning, sex didn't feel the same as it used to. I later learned that this was due to clitoral atrophy, which is when the clitoris shrinks or no longer responds the way it should to sexual arousal. Sex was also a little bit more painful due to vaginal dryness from menopause. It took longer to get aroused, too. Frankly, sometimes I would have performative sex to just keep my relationship going.
I didn't even realize that I was dealing with symptoms until years later. I had just gotten used to them and assumed that this was how sex was as you got older.
But in my own work as a menopause specialist, I attended a few conferences that address the latest treatments for women in this life stage. It was from those conferences that I realized, Hey, I need to be aggressive and treat this. I had become lazy about my own sexual health, and it was time to change that.
Treatment made a huge difference for me.
I started with localized vaginal estrogen, which is a treatment that goes into the vagina and is considered safe for the type of cancer that I had. I then started adding in low-dose testosterone to address my low libido — we know that the tissue of the vulva, vagina, and clitoris have a lot of receptors for estrogen and testosterone.
This ended up being the secret sauce that improved my symptoms. I suddenly realized, Oh, this is how sex is supposed to feel? Looking back, I now know that I had clitoral atrophy and vulvar atrophy. But you don't realize what you've lost until you get it back.
Every woman's experience with clitoral atrophy is different.
I now treat patients with clitoral atrophy, and some experience more severe symptoms than I did. Some women have a complete inability to orgasm; Others can experience scarring and adhesions to the clitoral hood, which interferes with pleasure.
My experience with clitoral atrophy is why I now specialize in menopause care. I try to advocate for survivors so they know that it's not normal to have to suffer through this. I should have never had to deal with years of being untreated and under-treated, and neither should they. Unfortunately, clitoral atrophy is a progressive phenomenon. Meaning, it will get worse over time if you do nothing. That's why it's so important for women to speak up when they're struggling.
In my opinion, discussions around sexual health side effects should be a standard part of informed consent in receiving medications for cancer. It's a crime that women have to discover this on their own and be their own advocates. This should be the standard of care.
If you're starting treatment for cancer, you should ask your oncologist about potential sexual side effects of your medication. Don't be ashamed. You can just simply say, "I'm concerned about sexual side effects. What can you do to prevent them from happening?" Just be aware that many times an oncologist or even an ob-gyn will tell you to use a non-hormonal over-the-counter moisturizer and lubricant. Those are helpful, but they won't prevent the underlying issues of loss of collagen and blood flow. We have countless published studies that find we can use low-dose hormones for breast cancer survivors, including women on active treatment.
It's been 24 years since I had breast cancer, and I'm in really good health. I have no evidence of disease. My sexual health is good, my menopause symptoms are under control, and I feel the best I've felt in years. But it took a lot of time and self-advocacy to get here. Now, I'm doing everything I can to help other women avoid the complicated sexual health journey I had to go through.
— As told to Korin Miller
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women's Health, Self, Health, Forbes, and more.
What Causes Clitoris Itching?
Occasional clitoral itching is common and usually not a cause for concern.
Oftentimes, it results from a minor irritation. It'll usually clear up on its own or with home treatment.
Here are other symptoms to watch for, how to find relief, and when to see a doctor.
During your body's sexual response cycle, blood flow increases to your clitoris. This causes it to swell and become even more sensitive.
Orgasm allows your body to release the sexual tension that has built up. This is followed by the resolution phase, or when your body returns to its usual state.
How fast this happens varies from person to person and can take anywhere from a few minutes to several hours.
How fast this happens varies from person to person and can take anywhere from a few minutes to several hours.
If you don't orgasm, you may continue to experience increased sensitivity for even longer. This can cause clitoral itching and pain.
You may also notice that your clitoris remains swollen after sexual stimulation.
What you can do
Oftentimes, itching or sensitivity will fade within a couple of hours.
If you can, change into a pair of breathable cotton underwear and loose bottoms.
This will help alleviate unnecessary pressure on the area, as well as reduce your risk for further irritation.
If you didn't have an orgasm, try to have one if it isn't too uncomfortable. The release may help.
Contact dermatitis is an itchy, red rash that's caused by direct contact with a substance or an allergic reaction to it.
You may also develop bumps or blisters that may weep or crust over.
Many substances can cause this type of reaction. Those most likely to come into contact with your clitoris include:
What you can do
Wash the area with a mild, fragrance-free soap and avoid any further contact with the substance.
The following may help relieve your itching:
If your symptoms are severe or don't improve with home treatment, see a doctor. They may prescribe an oral or topical steroid or antihistamine.
They're more common in people who have diabetes or a compromised immune system.
A yeast infection can cause intense itching in the tissues around your vaginal opening.
Other common symptoms include:
What you can do
If you've had a yeast infection before, you can probably treat it at home using an OTC cream, tablet, or suppository.
These products are usually available in one, three, or seven-day formulas.
It's important to finish the entire course of medication, even if you begin to see results sooner.
If you've never had a yeast infection before — or you deal with severe or recurring infections — see a doctor or other healthcare provider.
They may be able to prescribe an oral antifungal medication or long-course vaginal therapy.
Lichen sclerosus is a rare condition that creates smooth white patches on the skin, usually in the genital and anal areas.
This condition can also cause:
The exact cause of the condition is unknown. It's thought that an overactive immune system or hormonal imbalance may play a role.
What you can do
If this is your first flare-up, see a doctor for diagnosis.
Lichen sclerosus on the genitals usually requires treatment and rarely improves on its own.
Your doctor may prescribe corticosteroid creams and ointments to help reduce itching, improve the appearance of your skin, and minimize scarring.
PGAD is a rare condition in which a person has continuous feelings of genital arousal that aren't associated with sexual desire.
The cause of the condition is unknown, though stress appears to be a factor.
PGAD causes a number of symptoms, including an intense tingling or itching in the clitoris and genital throbbing or pain.
Some people also experience spontaneous orgasm.
What you can do
If you suspect PGAD, make an appointment with a doctor. They can assess your symptoms and make specific recommendations for relief.
There is no single treatment specifically for PGAD. Treatment is based on what may be causing the symptoms.
Some people have reported temporary feelings of relief after masturbating to orgasm, though this can also worsen symptoms in others.
Clitoral itching is fairly common during pregnancy.
It may be due to hormonal changes or increased blood volume and blood flow. Both of these things contribute to increased vaginal discharge.
Your risk of vaginal infection, including BV and yeast infection, also increases during pregnancy. These can all cause clitoral itching.
If itching and some light, odorless discharge are your only symptoms, then you can probably chalk it up to hormones.
You should see your doctor if itching is accompanied by:
What you can do
In most cases, soaking in a cool oatmeal bath or applying an OTC anti-itch cream can help ease your symptoms.
But if you're experiencing signs of infection, you'll need to see your doctor. They may prescribe antibiotics or other medication.
Your Guide To Understanding Vulvar Cancer
Vulvar cancer is a relatively rare type of cancer that affects the vulva, the external genital organs that protect a female's reproductive system. Early signs include a lump, itching, and bleeding.
The vulva includes the vagina and vaginal opening, the labia majora, labia minora, clitoris, mons pubis, the bulb of the vestibule, and the greater and lesser vestibular glands.
Vulvar cancer most commonly affects the outer lips of the vagina. Typically, the first signs of vulvar cancer will involve changes to the vaginal lips, or the side of the vaginal opening.
Here, find out how to recognize vulvar cancer and what to do if you have symptoms.
Vulvar cancer is most likely to appear in the outer vaginal lips, or labia.
Symptoms can vary between types of vulvar cancer and can develop at different rates.
The first sign usually involves changes to the vaginal lips or the sides of the vaginal opening.
Depending on the type, there may be:
Different types of vulvar cancer may have different symptoms, and some may have no noticeable symptoms in the early stages.
It is essential to seek help if any changes occur around the vulva or vagina. An early diagnosis can significantly improve the outlook.
Cancer that starts in the vulva is called primary vulvar cancer. If it starts in another part of the body and spreads to the vulva, it is called secondary vulvar cancer.
There are several types of vulvar cancer, and the symptoms can differ. The table below shows some types and their features.
If a person visits a doctor with concerns about changes to the vulva, the doctor will most likely:
Depending on the results of the biopsy, there may be further tests:
If a biopsy confirms the presence of vulvar cancer, the doctor will stage it with the help of imaging scans.
Early diagnosis and treatment can often prevent the spread of cancer and improve the outlook.
Surgery
Surgery aims to remove the cancer while leaving sexual function intact. The extent of the surgery will depend on how far cancer has spread.
Here are some types of surgery:
Reconstructive surgery may be possible, depending on how much tissue is removed.
Radiation therapy
Chemotherapy
People may have chemotherapy alongside radiotherapy as part of treatment or palliative care. It can take the form of a cream or lotion to apply to the skin, but the method will depend on the stage and extent of the cancer.
Other therapies
Some drugs target specific functions that appear to boost the development of cancer cells. They can slow or stop cancer from growing by altering these functions.
Biologic therapy is a kind of immunotherapy. It uses either synthetic or natural substances to help the body defend itself against cancer. Imiquimod is an example. It may be applied topically, as a cream, to treat vulvar cancer.
Measures that can reduce the risk of developing vulvar cancer include:
There is no standard screening for vulvar cancer, but people should attend any recommended checkups and be aware of any changes to their bodies. Doing this can help spot the early signs of vulvar cancer.
Survival rates refer to a person's chance of surviving another 5 years or longer after a diagnosis of vulvar cancer compared with someone who does not have a diagnosis.
However, the outlook will depend on the type of vulvar cancer and other factors. The outlook for vulvar melanoma is less positive than for other types, and there is a 50% chance of a recurrence. Overall, the chance of vulvar cancer recurring is 37% within 5 years of an initial diagnosis.
Here are some questions people often ask about vulvar cancer.
What are the warning signs of vulvar cancer?
Symptoms usually appear first on the lips of the vagina.
What is the first stage of vulvar cancer?
At the first stage, cancer only affects the vulva and perineum and has not spread to other areas.
What is the survival rate for vulvar cancer?
For all stages combined, a person with vulvar cancer has a 71% chance of surviving another 5 years after diagnosis, compared with someone without the disease. However, this may be higher or lower depending on the stage at diagnosis, the type of cancer, and other factors.
Vulvar cancer affects the area in and around the female genitalia, including the labia and clitoris. There are different types of vulvar cancer, but they can all involve skin changes, itching, and pain during sex or urination. Treatment options include surgery, chemotherapy, and radiation therapy.
With early detection, the 5-year survival rate is 86%, but various factors can affect this.
Anyone who notices skin changes or other symptoms around the vulva should seek medical advice, as early treatment can help prevent the progression of vulvar cancer.
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