Menopause

Getting Sex Back

In this post, I am going to tell you how I got my sex life back after surgically-induced menopause. I’ll start by saying that if you are a member of my family, you may want to stop reading.  I’m not planning to be too graphic, but I will definitely be writing more about my sex life than anyone who ever eats at a dinner table with us will feel comfortable knowing about.  But other readers – you may want to pay attention. If someone had shown me this post two years ago, I would’ve been so relieved to have it!  I hope you feel the same.

So yeah, my husband and I are having sex again, and it’s really really good.  By “again,” I mean pretty much weekly for the first time since we were married almost six years ago.  By “good,” I mean I can have multiple orgasms, and I’m 100% sure he’s enjoying himself, too. I think about sex now while we’re not having sex, and I look forward to it again after many years of not caring about it at all.

Let me go back before the hysterectomy/BSO just a bit.  Our sex life declined only months after our wedding for a variety of reasons.  We moved, had trouble settling in, my husband was unemployed, we had no money, and we fought a lot. Soon after we resolved all of that, I became pregnant, and I think we were both freaked out by the idea of having sex with our baby “in there,” so there was very little sex after the first trimester. In the third year, I suffered from debilitating postpartum depression and anxiety, and when I recovered, I essentially suffered from PTSD.  It took me nearly a year of therapy to realize that I was terrified of having sex: sex could lead to pregnancy, and pregnancy could lead to the dark abyss of PPD/A, and there was no way I was going back there. Also, I had begun to experience pain during intercourse after my pregnancy (three gynecologists were unable to diagnose it). Even though the pain was only during intercourse, I became turned off to the the idea of sexual activity of any kind. The cocktail of anti-depressants and anti-anxiety medications I was taking didn’t help my waning libido.

For a while, we just took care of our kid; eventually we moved again, and I think we became kind of used to not having sex.  It was only six months after we moved that I was diagnosed with DCIS, and within a month, I had a bilateral mastectomy with DIEP reconstruction – it was about three months until my body felt normal again and we tried to have sex.  It was clearly nothing worth reporting about; I was ok with my new body, but that same post-pregnancy pain was still there.  Then I had the hysterectomy and BSO.  As if things could get any worse – they just went downhill from there. I lost all of my libido. Before the hyst/BSO, at least I still was still turned on by Don Draper – not Jon Hamm – just Don Draper, but by this time, even the Mad Man himself couldn’t excite me. And when my husband and I did try to have sex, it was a complete disaster.

We clearly had problems with our sex life before the hysterectomy/BSO, but I believe that the steps we took to fix the problems are those that could help anyone suffering from mental blocks, pain during intercourse, and lack of libido — all effects of surgically-induced menopause — regardless of what your sex life was like before the surgery.

So, how did we fix the problems?  Well, I can tell you easily what he did – he was patient and understanding. He didn’t pressure me. At a certain point, on the advice of my therapist, I told him that sex was off the table until I could figure out what was going on with my body and my head. That way I didn’t have to feel guilty that he had an expectation of sex and I wasn’t fulfilling it. He gave me all the time I needed. Years. And here’s what I did with that time.

Internal Hormone Therapy: I started at my gynecologist’s office. I had convinced myself that all of the issues around sex were caused by the hysterectomy/BSO – both mentally and physically.  My gyn suggested two things: vaginal estrogen and a sex therapist. Despite a diagnosis of DCIS, I had already been on an oral estrogen because of my depression and mood swings, but my mother had suggested that I ask for vaginal estrogen to help with dryness (which results in pain with intercourse).  My understanding is that vaginal estrogen can be safe for women who have BRCA mutation or have had breast cancer (those who are usually told not to take oral or transdermal estrogen) because it’s basically local – it doesn’t go into your whole system.  So my doctor prescribed Vagifem.  The Vagifem creates lubrication and it does help with libido (I have no idea how it does that, but I could tell within the first two weeks of using it that I some “special feelings” down there).  But it did not help with the undiagnosed post-pregnancy pain, and it didn’t help with my new fear – the vaginal cuff.  I was terrified that my husband’s penis would rip through this wall; it was a block that I was having difficulty getting over.  Nevertheless – the sex therapist – I rejected this advice. Why?  Well, I have been in therapy pretty consistently for about 20 years, so I suspected this was something I could figure out eventually on my own and with my current therapist.  I also really really really wanted to continue to blame the whole thing on lack of hormones because of the BSO – I didn’t want to admit that we’d had some problems with sex before the surgery.  I wasted over a year going down denial river.  Then….

Myofascial Release and Pelvic Floor Therapy: In January, I began to have spasms in my abdomen that I knew was from the muscle that had been cut during the flap procedure for my mastectomy (two years earlier). I went to see my plastic surgeon, and he prescribed physical therapy.  I sought out a family friend who is a physical therapist, and she introduced me to a progressive treatment she is now doing – myofascial release (yes, the website is credibly cheesy looking).  As she performed MFR on various parts of my body to release pain, and as it began working, I told her about the pain I had during intercourse. She explained that she could also do MFR internally – through my vagina. She also taught me how to do it to myself in between sessions using dilators and other therapy tools.  After about five months of MFR on my entire body and only about two months of pelvic floor therapy, I was able to have intercourse with no pain for the first time in more than five years.  But I still  wasn’t enjoying sex (having orgasms); my libido was still low, I still had a fear of the vaginal cuff (regardless of countless affirmations by medical professionals that the cuff was indeed healed and the chances of it tearing were practically nil), and so I knew I still had mental blocks that I needed to work out.

Mental Health: Although my PTSD is a moot point now (I can’t get pregnant, so there’s no worry there), I was still having problems in my head that weren’t allowing me to enjoy sex, even though I’d received treatment for the physical pain. I won’t get into a lot of the details about all of the particular issues, but this is just to say that therapy did help me, even though it wasn’t specifically a sex therapist I turned to. The way my therapist helped me the most was that he suggested scheduling sex. After not having regular sex for nearly five years, working a more-than full-time job, keeping a household, raising a preschooler, going through a cancer scare and a year of surgeries, the death of my mother-in-law – it’s really easy to make an excuse for why “not tonight, honey.” My therapist suggested that sex on our calendar would help us stop making excuses. It might not seem like the most romantic of solutions, but we had to start somewhere.

Scheduling Sex: We decided to schedule sex on Sunday nights and do our best to keep to the schedule regardless of how tired we are or even if we aren’t in the mood. Sex is a good way to start the week – connected and happy. For the last two months or so, we have more or less kept to the schedule. This has had several positive effects. After going years without regular sex, it’s helped me to see the value of sex as a regular part of our relationship, even if it’s not spontaneous (and now that it’s better, it has become, on occasion, spontaneous, too). It’s helped me to get over my fear of the vaginal cuff tearing. And of course, I think it’s helping both of our moods a lot.  But having sex on the schedule can make it seem like just another task we do every week, like Thursday night garbage and Saturday morning laundry.  So we’ve had to spice it up.

Discussion of my “new” sexual needs: Over the last few years, after two breast surgeries and a hysterectomy/BSO, my body is different both inside and outside.  So it makes sense that the sexual activities I enjoyed before I gave birth four years ago no longer help me achieve orgasm; it took me a while to realize that I have new needs.  I know I was in denial about this – mostly because it meant admitting that I am a menopausal woman, which is something that has been incredibly hard for me to come to terms with as someone who is not yet 40 (at least, not for another year and 8 days); it’s something that makes me angry and sad every day. While this isn’t the case for all  women, for me, being menopausal means that having an orgasm isn’t easy anymore, and that my husband and I both have to work harder for me to enjoy sex. So, importantly, I had to be open with my husband about my new needs. As I sort of expected, he has been very willing to respond to my new needs.  The results – not only can I achieve multiple orgasms now, but I think about sex and look forward to sex.  Sunday is definitely fun day.

I know this is lengthy and detailed, but ever since I had the hyst/BSO, I have looked for advice like this – for someone to tell me how to reclaim my sexual identity after all of my biologically female parts are now gone.  I hope this helps someone else do just that.

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Too Soon for High Hopes?

I think I might have kicked Evil Crazy Bitch (ECB) to the curb!  Well, I didn’t do it.  The Vivelle Dot seems to be doing it.  In fact, I’m hesitant to even “say” this aloud, but I might feel even better than I did before this whole thing!  When I wrote yesterday, it had been about 18 hours on the patch.  By 24 hours, I felt like a new me.  Some of it was probably the adrenaline rush I get before teaching or giving a presentation at work, and then the endorphin rush I get when it goes well.  But by the time I got home from work last night, I felt pretty awesome.  I was in a good enough mood to return phone calls I’d been avoiding.  My mom said something frustrating on the phone, and I just ignored it.  My husband did two annoying things, and I just went on playing with our son.  The little guy and I ran around in circles on the grass barefoot, chasing each other, falling down on purpose, lots of tickling and unabashed toddler belly laughs – I think someone should have filmed it as a commercial for estrogen patches.

So, I don’t want to jinx myself, but I thought I should report that I do feel pretty good!

Today I will see the hormone specialist to check in with her.  And, I will also see the surgeon this afternoon.  I plan to ask him about that strange pathology report as well as some of my physical symptoms (uncomfortable twinges when goin’ #1 and unable to ‘push’ when goin’ #2).

My Other Personality

Today is three weeks since I had all of my reproductive organs removed, thus the end of my hormone production.

The last week has been a bit like having a split personality disorder.  There is the normal me who hangs out with family, reads, writes, goes places, generally enjoys life (although is pretty well medicated on anti-depressants and anti-anxiety meds; but they work, I feel, to make me the person I could be if I didn’t have a brain chemistry defect).  Then, there is evil crazy bitch (ECB).  ECB has reared her ugly head four times in the last week or so.

Episode 1:
Toddler won’t go to sleep.  Husband and I argue a bit over how to get him to sleep.  He finally gets to sleep.  Husband says to me something about not yelling at him (husband) while trying to get toddler to sleep.  ECB shows up, screams profanity at husband, scares husband into leaving room, texts husband not to ever come back to room.  Husband sleeps on couch.  ECB/I sob for about an hour, then toss and turn all night feeling simultaneously sympathetic and furious toward husband.  I wake up as myself and we have a completely normal morning.

Episode 2:
Husband perceives that I say something to him in a not nice tone.  Husband says, “That wasn’t really a nice tone to say that in.”  ECB appears, screams profanity at husband, scares husband into moving as far over to the other side of king size bed where he hides until we both fall asleep.

Episode 3:
Mother tells me I am talking too loud on my cell phone while in the car on the way to Whole Foods.  ECB begins to scream at mother about years of criticizing.  Father cuts in and tell ECB and mom to stop.  ECB/I sob behind sunglasses while walking through Whole Foods, avoiding mother and father.  Silence in car on the way home from Whole Foods.  ECB/I sob for another hour or so alone at home.  I come out of bedroom as myself later to cook for the FORCE picnic we head to that afternoon.

Episode 4:
Husband and I take son to playground.  I criticize husband’s parenting in a rather mild way.  Husband walks away from me and son, sits on bench, pouts, and gives me silent treatment.  I ask husband what’s wrong.  He continue silent treatment.  ECB tells son that we’re leaving the playground now, storms off to the car leaving husband to collect confused toddler, sobs the whole way home, continues to sob for a half hour alone in bedroom, gets in car and goes to Starbucks to eat/drink copious amounts of chocolate.  I return home as myself about an hour later.

Seeing a pattern?  None of these are things that would normally upset me.  I mean, I’d be annoyed that my mom criticized me or that my husband was giving me the silent treatment, but I’d deal with it, usually by talking it through, and then it would be over in minutes.  These are episodes that last at minimum two hours, with uncontrollable sobbing (during which I think, “What have I done?  Why did I do this to myself?   What if I’m like this from now on…. forever?”).  And then, after I get ECB out of my system, I return to my normal self.  At that point, I usually agonize a bit – do I need to apologize for ECB?  Is ECB really my fault?  

I have an appointment with the hormone/menopause specialist, Dr Balk, on Wednesday.  My mother insisted I need help sooner than that  (a conversation that necessitated all of my power to restrain ECB) and I did just talk to the nurse.  Dr. Balk doesn’t see patients until Wednesday, but the nurse will call her to see if she thinks there’s anything we could start now.  Both the nurse and I seemed to agree that waiting until Wednesday so that I can have a full conversation with Dr Balk directly would be better.

Also, this morning there was a slight pink tinge on the toilet paper I used after I peed.  I’m not expecting that to be anything of any importance since I was told spotting could be normal, and that’s not even really spotting.  But, in the spirit of recording what’s going on, there you have it.  Pink TP.

What Hysterectomy? (graphic pic)

That’s kinda how I’ve felt the last few days.  I’ve been going about most of my normal life, just a little less active with my son, and with only a bit of pelvic pressure (if you’ve been pregnant, then it’s pretty similar to the point when the baby drops, and you realize you have something sitting on your pelvis just inching its way out).  I have definitely had to pee more frequently.  And, if I get up and down a lot within a short time span, I do notice more of a pulling sensation.  My bellybutton is still one gross scab.

Scabby belly button five days after laparoscopic hysterectomy

Scabby belly button five days after laparoscopic hysterectomy

So, like my mother-in-law says, “hurry up and wait.”  That’s how I feel  about the surgical menopause symptoms that I’m dreading – I’m just waiting for the ice to crack, the other shoe to fall, the abyss to take me in.  But otherwise, I feel pretty normal.

Some Release

Today feels better.  I’ve managed to release both gas and solids.  So, while I can still feel the soreness (like pms cramps) and a bit of pain in my navel incision, at least I don’t feel like I’m about to give birth at any moment.  And the scale says I’m back down a pound, which is somewhat of a relief.  I’ve read that “swelly belly” can come and go depending on activity level and such, but I’m hoping that mine was just digestive-related.

It’s now been three days since my hysterectomy.  I have not had any hot flashes or noticed any mood changes.  According to my doctors, it could be anywhere between a few days to a couple of weeks before all of my hormones are really gone.  But I’m very anxious, just sitting around sort of waiting to see what sort of reaction I’m going to have to all of this.