FAQ – Sexuality

Your vagina might be dry because the floor of the pelvis is tense which results in a reduced flow of blood. The process of the vagina becoming wet is like sweating, the blood flow has to be strong so that secretions can be pressed through the vaginal wall. Your blood flow is increased by arousal, i.e. a perceived desire for sex. The movement of the pelvis also increases blood flow. But this needs varying lengths of time and sometimes you have the feeling you are ready for your partner’s penis but in fact that is just something your mind feels; the pelvis is in fact not ready for it yet. This is when it is important to pause and take your time until the pelvis is ready too. But if you are frightened of experiencing pain or you are unsure about how things will work and whether your partner will like it etc, your pelvis will tense up whether you want it to or not. And then the blood flow decreases and the vaginal entrance also narrows. Another reason can be a hormone deficiency that dries out the mucous membrane of the vagina, just like with dry skin. This is particularly the case if the ovaries do not produce any hormones, for example during or shortly after chemotherapy. Even hormone replacement therapy might still not be enough for the vagina. Therefore, it can sometimes be useful to strengthen the mucous membrane using a special cream or suppositories that are inserted into the vagina. Lubricants can also help to alleviate penetration. But even then, you still need the pelvic floor to be relaxed so that moistness can be increased again. This is why it is important to talk to your doctor about what could help and particularly what you need in your specific situation. The one thing that is certain is that there is a solution, which may vary from one person to the next! So pluck up the courage to talk about it and don’t give up!

To have an erection, you need a certain genital maturity (even though young children can actually have an erection). This is mainly controlled by the release of testosterone and often happens spontaneously during puberty. So a frequent morning erection is a natural reaction of your body. However, when testosterone levels drop during chemotherapy and sometimes afterwards, these spontaneous erections may not occur as frequently and may in fact stop altogether. It is different, however, if you want an erection because you want to have sex. So even if you feel aroused, in other words you want to be intimate and more with a partner, your penis might see things differently. An erection is a reflex which happens automatically with intimate touching and / or thoughts, but it can be suppressed and effectively controlled. So if your head takes over and decides that it is not currently a good idea to have sex, you may not have an erection at all or it may disappear again suddenly. This is not something you are conscious of: it often tends to happen subconsciously, When, for example, you are worried about “not getting it up again” or are putting yourself under pressure as you feel it is time you had sex again, etc., you lose the tension in your pelvis, the blood flows out of the erectile tissue again and the penis becomes flaccid or floppy. So an erection is also a matter of the mind. But not entirely. How long an erection can be maintained varies from person to person. This is also influenced by how well you are feeling in general, whether you are tired or feeling under the weather, or perhaps struggling with pain, etc. Therefore, it is important to consider what reason your mind might have for not wanting to have sex and what you possibly need to feel ready to have sex again. If you had a very active sex life before you were ill and you found it very easy to have an erection and keep it going, you have to accept that a lot has happened to you. The whole of your body has changed and first has to recover and find itself again. And that is something that needs time and patience! So don’t overdo it, don’t put yourself under too much pressure. Take things easy and try to find your way back to intimacy gently, slowly, by enjoying touching at first without building up pressure that this automatically means you have to have sex. There is no medication that will make you have an erection, it has to happen “spontaneously” and can then be prolonged if necessary. So if the main problem is that your erection fades quickly, there are medicines you can take to help slow that down. But all medicines can have side effects, so it is important to discuss the risk to you with your doctor beforehand.

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