postpartum depression

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.

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.

Shocking Discoveries

I am shocked by what I learned from Dr. Balk this morning – according to her, women who’ve had postpartum depression are 4 times as likely to suffer depressive symptoms during menopause. I have asked every doctor I’ve met about this, and all have said there’s no evidence or no connection or no studies that have been done.  So now I’m about a hundred times more terrified.  However, after telling Dr. Balk about my postpartum depression, she really believes that the episode was more psychological than hormonal – that it was triggered by several emotional events combined with an ineffective anti-depressant.  She suspects that I might be just fine after the surgery and have no real emotional reaction to the menopause because I’m well medicated now.

I’m also shocked by how irresponsible I’ve been lately.  Today I went through my purple folder looking for the forms I needed for my PCP, Dr. Stern, to sign before my surgery on Monday – as in, five days from now.  Turns out I was supposed to see her, get my blood work, and have a CT all at least two weeks before surgery.  And, I was supposed to stop taking fish oil, also two weeks before surgery.  I have done none of these things.  So, I had the blood work done, the CT is scheduled for tomorrow, and I’m going to stop taking the fish oil now!  I’m sort of shocked to discover how lackadaisical I’ve been about preparing for this surgery.

The most shocking discover of my day, though, was what I found while digging through my purple folder as I sat in my PCP’s waiting room.  Behind my blood work order was a diagnosis sheet – it’s what I get after every appointment with any doctor explaining what happened at the appointment.  This one said, “ovary cancer” and had a diagnosis code for CA-125 blood work.  I felt myself lose all of the breath in my lungs – was there something someone wasn’t telling me?  I then realized that the diagnosis sheet wasn’t mine.  It was for another woman.  The nurse must have grabbed it with my own diagnosis sheet and not realized they were stuck together.

Surprisingly, my breath didn’t come back, and instead I felt tears come to my eyes.  Sonya Gall, a complete stranger, has ovarian cancer.  She was in the doctor’s office at the same time as me – perhaps this was when she first learned her diagnosis.  Or maybe she was there for treatment.  Regardless, I was surprised by how sad I felt for Sonya.  I sat there staring at the paper, not knowing what to do with it.  Throwing it away seemed like a bad omen for her (sort of the way I feel about throwing away photographs).  So I tucked it back into the folder where it will stay, part of my collection of documentation about this journey.

Belly after DIEP (graphic pics)

I always thought of my belly as two parts – top belly (from navel up to breasts) and bottom belly (from navel down to crotch). As a teenager and college student, whenever I gained weight, it was in my bottom belly. My top belly always stayed rather flat. As I gained weight throughout college, I eventually hit 160 pounds. I stayed at that weight for several years, convinced my body liked it there and I couldn’t ever gain more weight than that. Something happened though in my mid 20s (moving to New York, drinking a lot, and access to lots and lots of amazing food) and I did start to gain weight. Top belly began to grow. In fact, top belly grew larger than bottom belly. My weight began to fluctuate between 200 and 220 pounds; any time I lost or gained weight, top belly and bottom belly would shrink or grow but never be the same size. I couldn’t seem to get below 200, and I stayed that way until this surgery. Even after I had a baby at 35, bottom belly went back to being smaller than top belly. I did lose all of my baby weight (really, it was the only benefit of post-partum depression, during which I didn’t eat solid food for three months). Going into DIEP, I weighed 212 pounds.

Many many women talk about the benefit of DIEP is their new flat stomach. Clearly these women have a little paunch in their bottom belly and no fat in their top belly. As a fat girl, I knew that there was no way I was coming out of this with a flat stomach. I searched the internet endlessly trying to look for post-DIEP pictures of overweight women, to no avail. So, here, I present to you my new belly, which I call “whole belly.”

Whole belly post-DIEP

Whole belly post-DIEP

Whole belly post-DIEP

Whole belly post-DIEP

You can see, essentially what’s happened is that bottom belly was removed. Top belly was pulled down to meet the incision where bottom belly was. Thus, the result is just one whole belly (which used to be top belly) with a drop-off. I will say that top belly used to protrude even further than my breasts, and at least now it’s flat enough that my breasts protrude more than my stomach. So that’s a plus.

So now what? This clearly looks weird (and possibly there’s some swelling that might go down and some shifting that might still occur). Though I think it can be masked in clothes, it’s not ideal. My feeling is that if I work to lose weight (and thanks to DIEP, I am already down to 192 pounds) then whole belly will shrink as a whole. Of course, if I gain weight, then whole belly will grow as a whole. Eventually I will look like one of those men who belts his pants below his jolly full Santa Claus stomach. That image alone is enough to help me cut cookies out of my diet for a while.

The goal is, use the weight loss from the surgery as a springboard to continue to lose weight. Get whole belly down to semi-flat belly (along with wide ass and thunder thighs). Parlay whole belly into whole new me.