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Your Body After Cancer Treatment
Fatigue
Pain
Lymphedema: Arm or Leg Swelling
Problems With Your Mouth or Teeth
Weight Changes
Trouble Swallowing
Bowel and Bladder Control
Menopause Symptoms
Intimacy and Sexuality
Other Health Problems
Scar Tissue: Here and Here
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Although your treatment has ended, you are still coping with how
it affects your body. It can take time to get over the effects of
cancer treatment. Each person's schedule is different. You may
wonder how your body should feel during this time and what may be a
sign that cancer is coming back. This section talks about some of
the problems that can occur when treatment is over. Some of the most
common effects people report are:
- Fatigue
- Pain
- Lymphedema, or swelling
- Problems with their mouth or teeth
- Problems with weight and eating
- Loss of bladder or bowel control
- Menopause symptoms
- Changes in their sex lives
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"If I could get over the physical part, if
it would stop hurting, I think I would be fine."
Rose, lung cancer survivor, 70
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What you experience may be related to the type of cancer you had and the
treatment you received. It is also very important to remember that no
two people are alike, so you may experience changes that are very
different from someone else's, even if they had the same type of cancer
and received the same treatment.
"I can walk and keep busy," said one testicular cancer
survivor, "but it gets very tiring. If I sit in a chair and really
want to read or watch something, I'm gone in about 30 seconds, and it is
a deep sleep."
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Some cancer survivors report that they still feel tired or worn out
after treatment is over. In fact, fatigue is one of the most common
complaints during the first year after treatment.
Rest or sleep does not "cure" the type of fatigue you may have after
cancer treatment, and doctors do not know its exact cause(s). The causes
of fatigue are different for people who are receiving treatment than
they are for those who have completed treatment:
- Fatigue during treatment can be caused by cancer therapy.
Other problems can also play a part in fatigue, like anemia (having
too few red blood cells), poor nutrition, not drinking enough liquids,
and depression. Pain can also make fatigue worse.
- Researchers are still learning about what may cause fatigue
after treatment.
How long will fatigue last? There is no "normal" pattern. For some,
fatigue gets better over time. Others, such as those who have had bone
marrow transplants, may have less energy for years after their final
treatment.
Some people feel very frustrated when fatigue lasts longer than they
think it should and gets in the way of their normal routine. They also
may worry that their friends, family, and coworkers will get upset with
them if they complain of fatigue often.
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Talk to your doctor about what may be causing your fatigue and what
can be done about it. Ask about:
- How any medicines you are taking or other medical problems you
have might affect your energy level
- How you can control your pain, if pain is a problem for you
- Exercise programs that might help, such as walking
- Relaxation skills
- Changing your diet or drinking more fluids
- Medicines or nutritional supplements that can help
- Specialists who might help you, such as physical therapists,
occupational therapists, nutritionists, or mental health care
providers
How do you fight fatigue? Here are some ideas that have helped
others:
- Plan your day. Be active at the time of day when you feel most
alert and energetic.
- Save your energy by changing how you do things. For example, sit
on a stool while you cook or wash dishes.
- Take short naps or rest breaks between activities.
- Try to go to sleep and wake up at the same time every day.
- Do what you enjoy, but do less of it. Focus on old or new
interests that do not tire you out. Try to read something brief or
listen to music.
- Let others help you. They might cook a meal, pick up something at
the store, or do the laundry. If no one offers, ask for what you need.
Friends and family might be willing to help but may not know what to
do.
- Just say "no" to things that do not matter as much to you now.
This may include housework and other chores. By using the energy you
have in rewarding ways, you can live a fuller life.
- Think about joining a support/education group for people with
cancer. (See
Joining a Support Group.) Talking about your fatigue with others
who have had the same problem can help you learn new ways to cope.
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You may have pain after treatment. In some cases, it is caused by the
treatment itself.
Types of pain you may feel following cancer treatment include:
- Skin sensitivity where you received radiation. This type of
pain is quite common and can last for many months. "I am so
sensitive [there] that I cannot put on anything tight," one breast
cancer survivor noted.
- Pain or numbness in the hands and feet due to injured nerves.
Chemotherapy or surgery can damage nerves, which can cause severe
pain. (This is called neuropathy.)
- Painful
scars from cancer surgery.
- Pain in a missing limb or breast. While doctors do not know
why this pain occurs, it is real. It is not just "in your mind."
You deserve to get relief from your pain, and your doctor or nurse can
help you. Wanting to control pain is not a sign of weakness. It is a way
to help you feel better and stay active.
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If you are older, you may not know whether your pain is because of
cancer or because of other health problems, such as arthritis. You might
not think to mention it to either your oncologist or your other doctors,
but you should do so. If you are in pain, tell your oncologist or
another doctor.
With your help, your doctor can assess how severe your pain is. Then,
he or she might suggest one or more of the following approaches. These
approaches have helped others recovering from cancer and may help you.
- Pain relief medicines. In most cases, doctors will try the
mildest medicines first. Then they will work up to stronger medicines
if you need them. The key to getting relief is to take all medicines
just as your doctor prescribes. To keep pain under control, do not
skip doses or wait until you hurt to take these medicines. You may be
afraid that if you use medicines you'll become a "drug addict," but
this almost NEVER happens if you take the correct dose and see your
doctor regularly.
- Antidepressant medicines. Some of these have been
prescribed to reduce pain or numbness from injured nerves.
- Physical therapy. Going to a physical therapist may help
relieve your pain. The therapist may use heat, cold, massage,
pressure, and/or exercise to help you feel better.
- Braces. These limit movement of a painful limb or joint.
- Acupuncture. This is a proven method that uses needles at
pressure points to reduce pain.
- Hypnosis, meditation, or yoga. Any of these may help your
pain. A trained specialist can teach you these approaches.
- Relaxation skills. Many people with cancer have found that
practicing deep relaxation helped relieve their pain or reduced their
stress. (See Practicing Relaxation to
Help Relieve Pain and Stress and
Relaxation Exercises.)
- Nerve blocks or surgery. If you do not get relief from the
other approaches in this section, you may want to ask the doctor about
these. Nerve blocks or surgery often help if you have persistent,
limiting pain, but they may put you at risk for other problems. They
may also require you to stay in the hospital.
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| NOTE: Health insurance does not
always cover these approaches. Find out whether your policy covers
the approaches your doctor recommends. |
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Here are some tips to help you describe your pain to your doctor:
- Use numbers. Talk about how strong the pain feels on a scale of 0
to 10, with 0 being no pain and 10 being the worst pain you could
have.
- Describe what the pain feels like. Is it sharp, dull, throbbing,
steady?
- Point out the exact places it hurts, either on your body or on a
drawing. Note whether the pain stays in one place or whether it moves
outward from the spot.
- Explain when you feel pain. Note when it starts, how long it
lasts, if it gets better or worse at certain times of day or night,
and if anything you do makes it better or worse.
- Describe how your pain affects your daily life. Does it stop you
from working? Doing household chores? Seeing your friends and family?
Going out and having fun?
- Make a list of all the medicines you are taking (for any reason).
If you are taking any for pain relief, how much do they help?
- Talk about any side effects from your pain control medicine, such
as constipation or other changes in bowel habits, or feeling groggy or
"out of it." Many of these problems can be solved.
- Talk about your goals for pain relief. Do you want no pain at all
(which can sometimes be hard to achieve), or is your goal to feel well
enough to do specific activities?
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Keep a pain
diary. A diary can help you track changes over time. It can also show
how you respond to any pain control medicine or other treatment you
receive. (A large version of the
Pain Diary may be found in the Additional Resources.)
Relaxation can help you feel better--both mentally and physically.
For most of us, though, it is not easy to "just relax." Relaxation is a
skill, and it needs to be practiced just like any other skill.
Many people wait until they are in a lot of pain or feel a lot of
stress before they try to relax, when it can be hardest to succeed. Then
they might try to relax by overeating, smoking, or drinking--activities
that are not helpful and might even be harmful.
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- Take the time to learn helpful relaxation skills and practice
them often. You can try the
exercises in the Additional Resources, take a class, or buy a
relaxation tape or CD.
| Finding Humor and Laughing As Much As You Can |
"Is [cancer] life-threatening? Yes, but
why die mad? So I joked about it all the way through, and I
think it helped me."
Ari, kidney cancer survivor, age 56
|
Laughter can help you relax. When you laugh, your brain releases
chemicals that produce pleasure and relax your muscles. Even a smile
can fight off stressful thoughts. Of course, you may not always feel
like laughing, but other people have found that these ideas can
help:
- Enjoy the funny things children and pets do.
- Watch funny movies or TV shows.
- Buy a funny desk calendar.
- Read joke books or check out jokes on the Internet. If you
don't own a computer, use one at your local library.
- Go to comedy shows.
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You may even find you can laugh at yourself. "I went by to
help a friend with her computer this summer, and it was really hot,
so I took my wig off," one woman said. "I got ready to go and
I could not find my wig. Well, her toy poodle had gotten it and had
done a number on it, [but] I just stuck it on and went home. My
husband said, 'What happened?' Needless to say that wig has never
been the same." |
Lymphedema is a swelling of a part of the body, usually an arm or
leg, that is caused by the buildup of lymph fluid. It can be caused by
cancer or the treatment of cancer. There are many different types of
lymphedema. Some types happen right after surgery, are mild, and don't
last long. Other types can occur months or years after cancer treatment
and can be quite painful. Lymphedema can also develop after an insect
bite, minor injury, or burn.
People who are at risk for lymphedema are those who have had:
- Breast cancer--if you had radiation therapy or had your
underarm lymph nodes removed. Your risk is even higher if you had
radiation in the underarm area after your lymph nodes were removed.
- Melanoma of the arms or legs--if you had lymph nodes
removed and/or had radiation therapy.
- Prostate cancer--if you had surgery or radiation therapy to
the whole pelvis.
- Cancer of the female or male reproductive organs--if you
were treated with surgery to remove lymph nodes or had radiation
therapy.
- Other cancers that have spread to the lower abdominal area.
The pressure from the growing tumor can make it hard for your body to
drain fluid.
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Your doctor or nurse may be able to help you find ways to prevent and
relieve lymphedema. Ask about:
- Ways to keep your skin healthy. It is important to keep
your skin clean. You should also keep it moist with lotion.
- Exercising to help the body drain the lymph fluid, and what
types of exercise you should not do.
- Treating lymphedema. He or she may suggest:
- Keeping the arm or leg raised above your chest.
- Special massage that can help by moving the lymph fluid from
where it has settled.
- Special bandages and clothing that can help lymph fluid drain.
- Losing weight.
- Finding sources of emotional support to help you cope.
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Other cancer survivors have found these tips helpful:
- Watch for signs of swelling or infection (redness, pain, heat,
fever). Tell your doctor or nurse if your arm or leg is painful or
swollen.
- Keep your arm or leg free of cuts, insect bites, or sunburn. Try
not to have shots or blood tests done in that area.
- Eat a well-balanced, protein-rich, low-salt diet.
- Keep regular follow-up appointments with your doctor.
- Wear loose-fitting clothing on your arm or leg.
- Try not to use that arm or leg to figure out how hot or cold
something is--such as bathwater or cooked food. You may be less able
to feel hot and cold now.
Research shows that many people who have been treated for cancer develop
problems with their mouth and teeth.
Radiation to the head and neck can cause problems with your teeth and
gums; the soft, moist lining of your mouth; glands that make saliva
(spit); and jawbones.
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This can cause:
- Dry mouth
- Cavities and other kinds of tooth problems
- Loss or change in sense of taste
- Painful mouth and gums
- Infections in your mouth
- Jaw stiffness or jawbone changes
If you were treated with certain types of chemotherapy, you can also
have many of the same problems.
Some problems go away after treatment. Others last a long time, while
some may never go away. Some problems may develop months or years after
your treatment has ended.
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Who has these problems?
- Almost all people who have had radiation therapy to the head and
neck
- Most people who have had bone marrow transplants
- About 2 of every 5 people treated with chemotherapy
If you find that these problems persist after cancer treatment ends,
talk to your doctor about:
- What may be causing these problems
- Ways to control mouth pain
See your dentist soon after you are done with treatment. Ask about:
- How often you should have checkups
- Ways to take care of your mouth and teeth
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Keep your mouth moist.
- Drink a lot of water.
- Suck ice chips.
- Chew sugarless gum or suck on sugar-free hard candy.
- Use a saliva substitute to help moisten your mouth.
Keep your mouth clean.
- Brush your teeth, gums, and tongue with an extra-soft toothbrush
after every meal and at bedtime. If it hurts, soften the bristles in
warm water.
- Use a mild fluoride toothpaste (like a children's toothpaste) and
a mouthwash without alcohol.
- Floss your teeth gently every day. If your gums bleed or hurt,
stay away from the areas that are bleeding or sore, but keep flossing
your other teeth.
- Rinse your mouth several times a day with a solution of 1/4
teaspoon baking soda and 1/8 teaspoon salt in one cup of warm water.
Follow with a plain water rinse.
- If you have dentures, clean, brush, and rinse them after meals.
Have your dentist check them to make sure they still fit you well.
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If your mouth is sore, remember to stay away from:
- Sharp, crunchy foods, like taco chips, that could scrape or cut
your mouth
- Foods that are hot, spicy, or high in acid, like citrus fruits and
juices, which can irritate your mouth
- Sugary foods, like candy or soda, that could cause cavities
- Toothpicks (they can cut your mouth)
- All tobacco products
- Alcoholic drinks
If you have stiffness in your jaw:
- Three times a day, open your mouth as far as you can without pain,
then close it. Repeat 20 times.
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"I cannot believe I have cancer, and I'm
gaining weight!"
Sara, breast cancer survivor, 43
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Research shows that some cancer survivors who have had certain kinds
of chemotherapy or who have taken certain medicines have problems with
weight gain--and the added pounds stay on even when treatment ends.
Breast cancer survivors who have had certain types of chemotherapy gain
weight in a different way--they may lose muscle and gain fat tissue.
Unfortunately, the usual ways people try to lose weight may not work for
them.
Some cancer survivors have the opposite problem: they have no desire
to eat, and they lose weight. Some men say that weight loss is a bigger
concern for them than weight gain. It makes them feel less strong--and
like "less of a man."
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Your doctor or nurse can help you deal with weight gain. Ask about:
- Doing strength-building exercises for your arms and shoulders, if
you have lost muscle and gained fat tissue
- Talking to a dietitian or nutritionist who can help you plan a
healthy diet that won't add extra pounds
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Here are some tips that have helped others improve their appetites:
- Start with small meals. Five small meals a day may be easier to
manage than three larger ones. Try to have a smaller breakfast than
usual, then have a healthy snack in the middle of the morning.
- Focus on favorite foods. If the thought of eating still lacks
appeal, try the foods you really liked before treatment. They can help
jump-start your appetite.
- Pamper yourself. Make mealtime a special time. Even if you only
have a nutritional supplement drink, serve it in a chilled glass or
mug. Add some fresh fruit, juice, or other flavor boost to make it
taste better.
- Find ways to make your meals look nice. Choose foods of
contrasting colors; serve the meal on a pretty plate; use a colorful
napkin.
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Some people who have had radiation
therapy or chemotherapy to the head or neck areas may find it hard to
eat because they have trouble swallowing. People who have had radiation
to the breast or chest or those who have had surgery involving the
larynx may also have this problem. As one lung cancer survivor said,
"I had a really hard time swallowing and chewing because of the chemo. I
just couldn't do it. I lived on soup and soft rice for weeks and weeks."
If you have trouble swallowing:
- Eat soft, bland foods moistened
with sauces or gravies. Puddings, ice cream, soups, applesauce, and
bananas and other soft fruits are nourishing and usually easy to
swallow.
- Use a blender to process solid
foods.
- Ask for advice from your health
care team, including your doctor, nurse, nutritionist, and/or speech
pathologist.
- Tilt your head back or move it
forward while you are eating.
- Have a sip of water every few
minutes to help you swallow and talk more easily. Carry a water bottle
with you so you always have some handy.
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Bowel and bladder problems are among the most upsetting issues people
face after cancer treatment. People often feel ashamed or fearful
to go out in public. "Going back to work was the hardest thing,"
one prostate cancer survivor noted. "I felt so foolish having to go
to the bathroom all the time. And it was a complete surprise. My doctor
never told me I would have this problem."
This loss of control can happen after treatment for bladder,
prostate, colon, rectal, ovarian, or other cancers. Your surgery may
have left you with no bowel or bladder control at all. Or perhaps you
still have some control, but you make lots of sudden trips to the
bathroom.
The opposite problem can happen when a medicine you are taking for
pain causes constipation.
It is very important to tell your doctor about any changes in your
bladder or bowel habits. Ask your doctor or nurse about:
- Help in dealing with ostomies. There are services and support
groups to help people deal with these changes.
- Problems with constipation, which can be treated.
- Doing Kegel exercises and other
physical training programs.
- Medications that may help.
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After chemotherapy, some women stop getting their periods every
month--or stop getting them altogether.
Some cancer treatments (and the medicine tamoxifen) can cause changes
in women's bodies and reduce the amount of hormones the body makes.
These changes can cause your periods to stop, as well as cause other
symptoms of menopause (also called "the change" or "change of life").
Over time, some women will start getting their periods again (this is
more likely for younger women), but others will not.
Some common signs of menopause are:
Irregular periods. One of the first signs is a change in your
periods. They may become less regular. They could be lighter. Some women
have short times of heavy bleeding. Sometimes, they stop all of a
sudden.
Hot flashes. Hot flashes are often worse at night and can
disrupt sleep. This can cause mood changes and make it hard for you to
make decisions.
Problems with your vagina or bladder. Tissues in these areas
become drier and thinner. You may be more likely to get infections in
your vagina. As you get older, you may also have urinary tract problems
or problems holding your urine.
Lack of interest in having sex. These changes may make it hard
for you to become sexually aroused.
Fatigue and sleep problems. You may feel tired or have trouble
getting to sleep, getting up early, or getting back to sleep after
waking up in the middle of the night.
Memory problems, and other problems such as depression, mood
swings, and irritability. Some of these, especially memory problems,
may be related to growing older. There may be a connection between
changes in your hormone levels and your emotions.
Other changes in your body. You may notice your waist getting
bigger, less muscle and more fat around your body, or thinning and loss
of elasticity in your skin.
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| It Is Important to Know That:
If you were still getting your period when you started treatment,
and
you are having menopause symptoms after treatment,
you still may be able to get pregnant.
|
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See a gynecologist every year. Ask about:
- Medicines or supplements or other approaches that can help you
manage menopause symptoms
- Tests you should have (such as a bone density test to see if you
are at risk for osteoporosis)
- Ways you can reduce your chance of getting:
- Osteoporosis. Menopause can put you at risk for losing
bone tissue, which can weaken your bones and make them easier to
break.
- Heart Disease. Menopause can also lead to higher
cholesterol in your blood, which can increase your risk of diseases
that affect your heart and blood vessels.
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Here are some tips that have helped others deal with menopause
symptoms:
- Quit smoking.
- Exercise--both weight-bearing and muscle strengthening.
- Eat wisely. A balanced diet will provide most of the nutrients and
calories your body needs to stay healthy.
- Through exercise and diet, try to maintain a healthy weight.
- Drink plenty of water.
If you are having hot flashes, try making a diary of when they happen
and what may start them. This may help you find out what to avoid.
Otherwise:
- When a hot flash starts, go somewhere that is cool, or carry a
small fan with you.
- Sleep in a cool room; this may keep hot flashes from waking you up
during the night.
- Dress in layers that you can take off if you get warm.
- Use cotton sheets, and wear clothing that lets your skin
"breathe."
- Try having a cold drink (water or juice) at the beginning of a
flash.
- Try not to eat a lot of spicy foods. Limit the alcohol and
caffeine you drink.
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"I knew about the impotence. What I did not
know about ... was the total lack of interest, which really caused
some problems between [me and my partner]."
Mitch, prostate cancer survivor, 73
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You may have changes in your sex life after cancer treatment--many
people do. About half of women who have had long-term treatment for
breast and reproductive organ cancers and more than half of men treated
for prostate cancer report long-term sexual problems. Many cancer
survivors say they were not prepared for the changes in their sex lives.
Sexual problems after cancer treatment are often caused by changes to
your body--from surgery, chemotherapy, or radiation, or by the effects
of pain medicine. Sometimes these problems are caused by depression,
feelings of guilt about how you got cancer, changes in body image after
surgery, and stress between you and your partner.
What types of problems occur? People report four main concerns:
- Losing interest in sex. Some may struggle with their body
image after treatment. Even thinking about their partners seeing them
without clothes is stressful. Others are worn out or in pain, and sex
is the last thing on their minds. Chemotherapy and some cancer
medicines can also reduce sex drive.
- Not being able to have sex as you did before. Some cancer
treatments cause changes in sex organs that also change your sex life.
- Some men can no longer get or keep an erection after treatment
for prostate cancer, cancer of the penis, or cancer of the testes.
Some treatments can also weaken a man's orgasm or make it dry.
- Some women find it harder, or even painful, to have sex after
cancer treatment. Some cancer treatments, like chemotherapy,
surgery, or radiation, can cause these problems; sometimes, there is
no clear cause for these problems.
- Having menopause symptoms. When women stop getting their
periods, they can get hot flashes, dryness or tightness in the vagina,
and/or other problems that can affect their desire to have sex.
- Losing the ability to have children. Some cancer treatments
can cause infertility, making it impossible for cancer survivors to
have children. Depending on the type of treatment you had, your sex
and age, and the length of time you've been out of treatment, you may
still be able to have children.
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Your doctor may be able to help you deal with these problems, but he
or she may not bring up the subject. You may need to "break the ice"
yourself. If you think you might have trouble getting started, bring
this document with you and show this section to your doctor or nurse.
Often, sexual problems will not get better on their own. To get help
with many of these problems, it is important to talk to your doctor. Ask
about:
- Any medical problem that may be causing changes in your sex
life. You may be able to get treatment for the problems you are
having. These may include:
- Erection problems. Medicines, counseling, finding ways to
please yourself, surgery, or other approaches may help.
- Vaginal dryness. Dryness or tightness in the vagina,
which can be caused by menopause. Ask whether using a water-based
lubricant during sex, using vaginal dilators before sex, and/or
taking hormones or using a hormone cream are options for you.
- Ways you can gain muscle control by doing Kegel exercises.
You can help strengthen muscles in your genital area by doing these
exercises. Practice by controlling your muscles to stop the flow of
urine. You can do these exercises even when you are not urinating.
Just tighten and relax the muscles as you sit, stand, or go about
your day.
- Concerns about having children, and what you can do.
Discuss family planning concerns with your doctor. If you are a
woman, ask if you still need to use birth control even if you are
not getting your period.
- Seeing a sex therapist. He or she may be able to help you
talk openly about your problems, work through your concerns, and
come up with new ways to help you and your partner.
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Most people can still enjoy sex and intimacy after cancer treatment,
even if they need to make changes. Here are some ideas that have helped
other people.
- Create a sensual mood. Lighting, music, scent, or a
romantic meal for two can help.
- Have a "date." If possible, set aside special time for just
the two of you.
- Touch each other. Kiss, hug, and cuddle even when you
cannot have the kind of sex you are used to having.
- Change positions. A new position may increase your
comfort.
- Find other ways to be sexual. For example, you may enjoy
feelings in parts of the body that were not touched as often before.
Think about ways to give yourself pleasure.
- Go
slowly at first. If you have painful scars, you may have to get used
to having the scar touched little by little.
- Ask for more foreplay if you need it. Some women say they
need more time for foreplay to relax and get ready for sex. Some men
say they need a new type of caress to reach orgasm. Their climax may
be stronger if they stop and start a few times when they get close
to climax.
- Find ways to feel more sensual. Wear pajamas or a
nightgown that hides your scar and makes you feel attractive. Think
about all the ways you please your partner.
- Be positive. Your thoughts can play a big role in your
sex life.
- Tell your partner about your worries or fears.
For some survivors, the long-term effects of cancer and its treatment
may be made worse by the effects of aging, or by other health
conditions, such as diabetes or heart disease, that you may have had
before cancer. Breast cancer survivors who have had surgery may find
everyday activities like reaching or stretching painful; health
conditions such as arthritis can make these activities even more
difficult. Colorectal or prostate cancer survivors may find that the
aging process also affects their bowel or bladder control.
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It is very important that you tell your doctor about:
- All your health conditions
- All the medicines you are taking for these conditions
Some cancer treatments may cause future health problems. Sometimes
these problems don't appear right away; some don't appear until years
after treatment.
Ask your doctor:
- Whether your treatment can put you at risk for short-term or
long-term problems
- What those problems are
- What you should do to take care of your health
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