260 Sex After Cancer with Dr. Kris Christiansen

*DISCLAIMER* This episode covers adult topics that are not intended for young ears.

 

260. Sex After Cancer with Dr. Kris Christiansen

 

James 1:19 (NIV) My dear brothers and sisters, take note of this: Everyone should be quick to listen, slow to speak and slow to become angry,

 

**Transcription Below**

 

Questions We Discuss:

1. What is common mis-information that you want to set straight as it relates to cancer and sex?
2. If someone is walking their own cancer journey right now, what would you advise them to both do and avoid doing so that they can still enjoy the healthiest sex life possible with their spouse?
3. What hope do you have to share with people who have battled cancer and still desire to connect intimately with their spouse?

 

Dr. Kris Christiansen is a board-certified family physician who specializes in sexual medicine. She attended medical school and completed her residency in family medicine at the University of Minnesota. She practiced full spectrum family medicine for 10 years and then pursued additional training to specialize in sexual medicine. She works as a sexual medicine specialist at two different clinics in the twin cities.

 

Her clinical interests include both male and female sexual dysfunction, and she loves working with individuals and couples to restore an important part of life. Dr. Christiansen is involved with teaching medical students and residents at the University of Minnesota Medical School, and she has presented at multiple local, national, and international medical conferences. She is involved with the International Society for the Study of Women’s Sexual Health (ISSWSH) and serves on committees, collaborates with other experts to publish articles for medical journals, and edits informational articles for the society’s new patient facing website. She is passionate about teaching patients, students, and colleagues about the importance of sexual health and well-being. In her free time, she started her own business called Intimate Focus which provides information and quality products to enhance and restore sexual health and wellness. She also enjoys shopping, hiking, and spending time with her family.

 

Dr. Kris Christiansen's Website

 

Previous Episodes featuring Dr. Kris Christiansen on The Savvy Sauce:

215 Enriching Women's Sexual Function, Part One with Dr. Kris Christiansen

216 Enriching Women's Sexual Function, Part Two with Dr. Kris Christiansen

 

Additional Place to Find More Episodes from The Savvy Sauce Related to This Topic:

One-Stop Shop for Marriage and Intimacy Resources

 

Dr. Kris Christiansen's Recommended Websites for Sexual Health:

The Menopause Society

Mayo Clinic

National Institutes of Health

International Society for the Study of Women’s Sexual Health

American Urological Association

International Society of Sexual Medicine

Sexual Medicine Society of North America

American Cancer Society

ISSWSH International Society for the Study of Women's Sexual Health

SMSNA Sexual Medicine Society of North America 

ISSM International Society of Sexual Medicine

The Menopause Society

 

Find a provider:

For a women's sexual health provider, pelvic floor physical therapist, (non-Christian) sex therapist

ABCST American Board of Christian Sex Therapists (for a Christian sex therapist)

 

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Gospel Scripture: (all NIV)

 

Romans 3:23 “for all have sinned and fall short of the glory of God,”

 

Romans 3:24 “and are justified freely by his grace through the redemption that came by Christ Jesus.”

 

Romans 3:25 (a) “God presented him as a sacrifice of atonement, through faith in his blood.” 

 

Hebrews 9:22 (b) “without the shedding of blood there is no forgiveness.” 

 

Romans 5:8 “But God demonstrates his own love for us in this: While we were still sinners, Christ died for us.” 

 

Romans 5:11 “Not only is this so, but we also rejoice in God through our Lord Jesus Christ, through whom we have now received reconciliation.” 

 

John 3:16 “For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.”

 

Romans 10:9 “That if you confess with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you will be saved.” 

 

Luke 15:10 says “In the same way, I tell you, there is rejoicing in the presence of the angels of God over one sinner who repents.”

 

Romans 8:1 “Therefore, there is now no condemnation for those who are in Christ Jesus”

 

Ephesians 1:13–14 “And you also were included in Christ when you heard the word of truth, the gospel of your salvation. Having believed, you were marked in him with a seal, the promised Holy Spirit, who is a deposit guaranteeing our inheritance until the redemption of those who are God’s possession- to the praise of his glory.”

 

Ephesians 1:15–23 “For this reason, ever since I heard about your faith in the Lord Jesus and your love for all the saints, I have not stopped giving thanks for you, remembering you in my prayers. I keep asking that the God of our Lord Jesus Christ, the glorious Father, may give you the spirit of wisdom and revelation, so that you may know him better. I pray also that the eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his glorious inheritance in the saints, and his incomparably great power for us who believe. That power is like the working of his mighty strength, which he exerted in Christ when he raised him from the dead and seated him at his right hand in the heavenly realms, far above all rule and authority, power and dominion, and every title that can be given, not only in the present age but also in the one to come. And God placed all things under his feet and appointed him to be head over everything for the church, which is his body, the fullness of him who fills everything in every way.”

 

Ephesians 2:8–10 “For it is by grace you have been saved, through faith – and this not from yourselves, it is the gift of God – not by works, so that no one can boast. For we are God‘s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.“

 

Ephesians 2:13 “But now in Christ Jesus you who once were far away have been brought near through the blood of Christ.“

 

Philippians 1:6 “being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.”

 

**Transcription**

 

Music: (0:00 – 0:09)

 

Laura Dugger: (0:10 - 1:22)

Welcome to The Savvy Sauce, where we have practical chats for intentional living. I'm your host, Laura Dugger, and I'm so glad you're here. 

 

Leman Property Management Co. has the apartment you will be able to call home, with over 1,700 apartment units available in Central Illinois.

 

Visit them today at lemanproperties.com or connect with them on Facebook. 

 

Today's message is not intended for little ears. We'll be discussing some adult themes, and I want you to be aware before you listen to this message.

 

Not many people specialize in the same thing as our returning guest for today, Dr. Kris Christiansen. She specializes in sexual medicine, and today she's going to provide clarity, information, and direction for how to maximize sexual pleasure with our spouse after one receives a cancer diagnosis. Here's our chat.

 

Welcome back to The Savvy Sauce, Dr. Christiansen.

 

Dr. Kris Christiansen: (1:23 - 1:30)

Well, thank you so much, Laura. We had so much fun last time, and I'm looking forward to this conversation again today.

 

Laura Dugger: (1:31 - 1:57)

Likewise. I feel the same way. And it really wasn't that long ago that you were on The Savvy Sauce two times, so I'll make sure and link to both of those episodes in the show notes for today.

 

But hopefully everybody's already well acquainted with you, and that's why we're just kind of diving right into our topic today. So, for starters, how did this topic of sex after cancer become an interest of yours to study?

 

Dr. Kris Christiansen: (2:00 - 2:32)

Well, so Laura, my job as a sexual medicine physician is that I work with both men and women and helping them with their sexual lives when they have problems or whatever. So, cancer is often a big part of that. So, through my journey with work, I've just developed a significant interest in learning how to really care for people to help restore this important part of life.

 

Laura Dugger: (2:33 - 2:52)

Absolutely, because a lot is taken away when somebody gets that awful diagnosis, and so I'm very grateful for people like you who are experts. But is there any common misinformation that you would like to set straight as it relates to cancer and sex?

 

Dr. Kris Christiansen: (2:55 - 6:42)

Well, interesting you say that, because there is so much misinformation out there just about sex in general. And then when we throw cancer in on top of that, it just makes it even more complicated. So, I think a common fear that people experience when they get that diagnosis that they hope they never hear, the C word, is that it's going to have a significant impact on their sexual intimacy.

 

And you know what, it can, but that doesn't mean that that chapter in life is closed. We just have to remember that sexual intimacy is much, much broader than just intercourse. So, if we can refer to this as PIV sex, penis in vagina sex, many people view it as kind of an all or none thing.

 

If they can't have vaginal intercourse or that PIV sex, then they don't want anything at all. Unfortunately, that just rules out or shuts out so much of sexual intimacy that God has intended for us. We may not be able to engage in the same activities for a time or even long term, but that doesn't mean that we can't connect.

 

So, if we try to remember that intimacy, sexual intimacy is all about giving and receiving pleasure, then there are so many more opportunities. So, we have to get beyond the fact that sexual intimacy, sexual intercourse is just vaginal intercourse because it's not. It's giving and receiving pleasure.

 

And however people want to connect or comfortable connecting, that they can still enjoy a very fruitful sex life. The other thing that is misunderstood and misconceptions is estrogen, vaginal estrogen, especially. Because, well, all women who enter menopause and you're in menopause for the rest of your life do experience some changes.

 

And it's so common that women experience the genital urinary syndrome of menopause. That's vaginal atrophy, or when the tissues get drier and thinner and there can be tearing and pain as well as bleeding and decreased sensation, decreased sensitivity. These things are common with aging, but oftentimes cancer treatments emphasize that or accelerate it or make it even worse.

 

And vaginal estrogen is really, really safe. It does not cause cancer. And most of the studies show that even in women who have breast cancer, that it doesn't cause recurrence.

 

So vaginal estrogen, being so safe, can really save our vaginas. And we're talking about vaginal health and bladder health. It's not just about sex, but it helps keep our bodies functioning properly and minimizing pain and discomfort.

 

So, if a woman is diagnosed with breast cancer and she's on treatment, then obviously we have to talk to the oncologist, make sure they're okay with that. But we get more and more studies showing it's safety and it's definitely effective and can help keep our tissues young.

 

Laura Dugger: (6:42 - 7:25)

This is really helpful and brand new information to me. So someone, like you used that example, if they have breast cancer diagnosis and there's different types, but if they're doing the treatment where perhaps they go into early menopause or they have a hysterectomy or remove their ovaries and they even have an estrogen blocker so that they're not producing estrogen, for that type, you're still saying as long as you're working with the oncologist for that personal client, even in those situations, vaginal estrogen, which would be, I'm assuming, more of a cream or something you insert to the vagina, is that right? That that would be safe?

 

Dr. Kris Christiansen: (7:25 - 10:55)

So, where it gets a little gray is if the woman is taking an aromatase inhibitor, which is the estrogen blocker. So, it pretty much wipes all estrogen out of her system. There's a little more risk there.

 

So most definitely we need to double check with the oncologist. But it often comes down to quality of life. I have a patient who, she was diagnosed with breast cancer, I believe, in her early 60s.

 

And she came to me at the sexual medicine clinic and she was just miserable. I mean, when we think of vaginal dryness, you think of, okay, it's annoying. You use a lubricant, right, and it's going to be just fine.

 

In the beginning, yes, that's the case. But this genital urinary syndrome of menopause, GSM, gets worse with time, especially with those anti-estrogen treatments. And for this poor woman, she couldn't exercise.

 

She loved to go hiking. She loved to go skiing. And just any kind of movement was painful.

 

And we don't think of that. We kind of take it for granted. But for some women who really experience severe side effects of the breast cancer treatments and causing dryness and irritation, it affects everything.

 

And for her, we tried all the non-hormonal things first. They didn't work. And her oncologist gave us the blessing saying, you know, we tried it.

 

This is really important to you. Let's give it a try. And so, we've monitored her, and the vaginal estrogen hasn't caused any problems.

 

So, a couple points on that. With the vaginal estrogen, yes, it comes as a cream. There's a tablet, which is like a little pill with an applicator that you insert in the vagina.

 

There are vaginal inserts. They look like little caplets that you just insert with the finger. There's a vaginal ring.

 

But with the localized treatment, it's meant to just act locally, meaning just on the vaginal tissues. And, oh, package insert. So, you know, here we tell patients, vaginal estrogen is safe.

 

Don't worry. It's not going to cause cancer, heart attack, strokes, or blood clots. But then they go home.

 

They get their prescription. They open up the patient insert, package insert, and it talks about risks and bad things that can happen and side effects. Unfortunately, the FDA says we have to use the class labeling or the side effects that are associated with systemic estrogen.

 

And it automatically gets applied to the localized or vaginal estrogen treatments. So, patients go home, they read that, and they think we're lying to them. But, unfortunately, it's just very misleading because we have plenty of studies to show that vaginal estrogen doesn't cause those terrible things.

 

And it's very safe. So, they just have to trust us. And there are groups and people out there trying to work with the FDA to get that class labeling effect removed because it just scares everybody away from using estrogen, which can be so helpful.

 

Laura Dugger: (10:57 - 11:04)

Wow, that is helpful. Is there any other common misinformation you want to make sure we don't overlook before we continue on?

 

Dr. Kris Christiansen: (11:05 - 11:29)

Well, I made a few notes here. No, I don't think so. Except that media, television, and all that other stuff that we see out there is so misleading when it comes to sexual intimacy.

 

Because sex in real life doesn't look like what you see in the movies. Yeah.

 

Laura Dugger: (11:30 - 11:45)

Great, great point. And so, when somebody does get, like you said, that dreaded C-word diagnosis, what's a common path that they may experience as it affects them sexually?

 

Dr. Kris Christiansen: (11:48 - 14:00)

Well, so, the different cancers are so different and treatments are so different that it's hard to generalize for everybody. But, you know, first thing most people experience is fear. What's this mean for me?

 

What's this mean for my life, my family? Am I going to be around in five years? So, it's that fear.

 

And the initial part of that journey is often involved with meeting with lots of doctors, having all the tests, trying to figure out what's going on, what we're going to do. And sexual intimacy often isn't part of that first steps that they take. So, but when things kind of finally settle down, then those questions start popping up.

 

What does this mean? It's important to talk with your cancer journey, your cancer team, the oncology team to find out what's going on. And it's important to ask all these questions because doctors really aren't very good about asking about sexual health and what that means to you.

 

Oncologists, generally speaking, they want to treat the cancer and their job is done when the cancer is treated, under control, gone, whatever. And they've done a good job. However, so many of us are just left afterwards saying, okay, thanks, cancer's gone, but now what?

 

And so, it's a matter of really trying to figure out what's important over time, learning what's going to work and what's not. And know that there are people out there to help you and that want to help you if it's not going as planned. You know, I just want to reiterate that people really need to advocate for themselves and they need to ask questions.

 

And if they're not getting the answers that they want, don't give up because there are people, organizations, information out there that can be helpful. So rather than just worrying about what's next, seek help.

 

Laura Dugger: (14:02 - 14:18)

That's really great advice. And I think this may be an appropriate place to pause and just get some of those recommended places. Because if somebody, this is new to them and they don't know where to turn, do you have any places or websites off the top of your mind that you would recommend?

 

Dr. Kris Christiansen: (14:20 - 15:41)

Well, so cancer.org, the American Cancer Society has a lot of resources on there. When it comes to menopause-type symptoms and such, menopause.org is the Menopause Society, which has a lot of information. And a website called PROSAYLA, it's P-R-O-S-A-Y-L-A.com, is a website that's managed by ISHWISH.

 

We've got all these acronyms. The International Society for the Study of Women's Sexual Health. So that is my go-to.

 

Okay, so that's the organization where there's so much research and science and such happening. And the PROSAYLA.org or prosayla.com, either one works, is a website where there are several articles written by experts in the field. So, these are articles backed by science.

 

It's not just somebody's opinion or somebody's blog. And I know there's an article on there about sex or cancer and sexuality. So, some generalities and some other references on that site too.

 

Laura Dugger: (15:42 - 15:51)

Okay, that is super helpful information. We'll make sure and add links to those places as well. Anything else that you want to make sure we don't miss?

 

Dr. Kris Christiansen: (15:52 - 17:36)

Well, when we talk about sexual concerns or sexual problems, we always try to approach it from a biopsychosocial aspect. Because those three different entities all play a big role in what works well and what doesn't. So, from the biological section, that's pain, medications, nerve problems, chronic medical problems.

 

So obviously cancer plays a big role in that. And with cancer treatments and such, pain may be part of that, nausea, fatigue. And so, we just don't feel the same going through these treatments because it's really hard.

 

As far as the psych bubble, I'm usually referencing a Venn diagram here. Psychological, so when we experience anxiety or depression or performance anxiety, that plays a big role. So, we need to take a step back and realize that what happens up here in our brain has a huge impact on how our bodies function physically.

 

And then as far as the social aspect, that's our relationships, our interpersonal relationships with our partner, our spouse, with our family and how things are going on at work. A cancer diagnosis and treatment can affect all of those. And so, it's not just a magic pill to improve your libido because if we don't treat all these other things, people continue to struggle with their sexual function.

 

Laura Dugger: (18:01 - 19:46)

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Also, Dr. Kris, are there any certain cancers or treatments that have the most detrimental impact on a person's sex life?

 

Dr. Kris Christiansen: (19:48 - 23:15)

We know that cancers that affect the breast, for women, but men too get breast cancer, and also the genital area have the biggest impact. We've talked a fair amount about breast cancer. Many of the treatments for breast cancer result in early menopause.

 

If a woman is premenopausal when this happens, menopause can have a definite impact. The treatments can cause the pain and dryness and decrease sensitivity. Also, if surgery is involved in a mastectomy, it can affect our own body self-image.

 

From a more physical standpoint too, when we have the mastectomy and those nerves are cut, it decreases the sensitivity. For a lot of women, breast stimulation is really important as part of their sexual play. If now her breasts are gone and she can't feel anything when her husband is touching her breasts, that can be a really hard adjustment.

 

Any cancers that affect the genital area, uterine cancer, ovarian cancer, or anal rectal cancer for both men and women, and prostate cancer for men, those all have a huge impact. In addition to working with a lot of women who have breast cancer and overcoming and improving those areas, I work with a lot of men who have prostate cancer. Those treatments usually result in erection problems and urinary incontinence, which can be hard to deal with.

 

Men who have a prostatectomy, so if they have their prostate removed, then 100% of them are going to have erectile dysfunction in the beginning. It's going to take time for those nerves to recover, and it may take up to two years to see that full recovery. In those first few months when I'm working with men, I'm trying to be their cheerleader, saying, don't lose hope, don't give up, because this is going to get better.

 

It just takes time for those nerves to regrow. In the process, though, it is important to do whatever we can to make sure that that tissue stays healthy. Remember that the penis is actually muscle, muscle tissue, smooth muscle.

 

If we don't use a muscle for several months, atrophy sets in, which is a bad thing. With atrophy, the penis can shrink in size, and scar tissue potentially can set in, and it just makes that recovery less optimal than what it would have been. Trying to maintain the blood flow during those first few months or first year is really helpful.

 

Just to help maintain the blood flow and the oxygen to help keep the tissues healthy, so when the tenders do recover as best as they're going to, we get the best outcome.

 

Laura Dugger: (23:16 - 23:36)

This may be an ignorant question, but then if erectile issues are present during that first time period, but it's crucial to have the blood flow to that area, what can men do to increase blood flow there, even if erection is difficult or impossible?

 

Dr. Kris Christiansen: (23:36 - 25:01)

That's a great question. Taking a medication like Viagra or Cialis. Cialis is my favorite because it stays in the system for a good 36 to 48 hours every time you take it.

 

If you're just taking a low dose every day, it just encourages a little bit of that blood flow every day. Using a vacuum device, which I just happen to have one right here, looks like this. A penis goes inside the cylinder, we create a vacuum or suction, and it pulls the blood flow in.

 

It's not the most sexy thing, but using it and using the vacuum device several times a week just to get that blood flow going is a very helpful way to keep the tissues healthy. Getting an erection with the vacuum doesn't get those arousal-type feelings, so it looks a little weird, but it does work. For men who want to use this for sexual activity, you can get the erection within the tube, and then it comes with these tight rings that are stretched over the edge of the cylinder.

 

Once you get the full erection within the tube, you slide that ring off to maintain the erection.

 

Laura Dugger: (25:04 - 25:14)

That's incredible just to pause and think of God's grace and these inventions and how incredible that there are solutions. Please continue, but I find that encouraging.

 

Dr. Kris Christiansen: (25:16 - 27:39)

There are all kinds of encouraging things, but if you're in the middle of this journey, it can be sometimes hard to keep going when you're not getting the results that you want to. But we believe in a big God, and he created sexual intimacy, and it's a gift. Other ways to help manage erectile dysfunction and a couple other show-and-tell things here.

 

This medication is called Muse. The actual medication is a pellet that comes preloaded in this applicator. You insert it in the tip of the penis, the medication gets absorbed, and 10 minutes later, magic happens.

 

I don't prescribe this very often because it's really, really expensive, a little harder to find. But the advantage to this medication is that it doesn't need the nerves to work, whereas the medications like Viagra and Cialis, they need the nerves. Guys usually kind of turn white when I pull this out.

 

For our listeners, I'm holding an insulin syringe and needle. There is such a treatment where you can actually inject a tiny amount of medicine directly into the penis, and it will give you an erection. I tell men that with the pills like Viagra and Cialis, just in general with ED, it works in about 60% of men.

 

We can get this to work, the injections to work, in 90-95%. It's such a tiny needle that men say it feels like a poke or a pinch once they get past that initial shock that they think is going to hurt. The usual response is, oh, that wasn't so bad, and it's very effective.

 

This can work within four to six weeks, so whenever your surgeon says it's okay to engage in sexual activity again, this will work. Then last but not least is a penile implant. That's surgery, and that you have to wait at least a year, if not two, after the prostate surgery.

 

That works in 99.99%. Wow.

 

Laura Dugger: (27:40 - 27:56)

We were focusing a lot on men for that one. Is there any medication or any other injections or anything like that for women, other than the vaginal cream or different ways to get estrogen in the vagina?

 

Dr. Kris Christiansen: (27:58 - 31:15)

Yes, we've got all kinds of treatments. If a woman has breast cancer, or for whatever reason we want to avoid hormones as much as possible, then generally we're starting with a vaginal moisturizer, which is different than a lubricant. A lubricant is just for sexual activity and just to make things slipperier and feel better.

 

That often helps in the beginning, but as the GSM or the atrophy continues, the lubricant isn't enough. A moisturizer, think of like a facial moisturizer or a moisturizer for your hand, in order for it to work, you have to use it regularly, which is probably at least three times a week. These moisturizers can come in forms of a liquid that gets injected.

 

They're little capsules that you can insert. Reveri is a hyaluronic acid suppository, which you insert in the vagina and over time that can be really helpful. One of my favorites is this Rosebud Everyday Balm.

 

It's a really nice balm that you can put on the tissues inside the lips and inside the vagina. It's just really, really soothing. Again, you've got to use these things regularly.

 

It will take a good two months at least to see the full effect, so it doesn't work right away. Just like with the guys where they've got to be patient with the nerves, we have to be persistent and patient with things that can work. A vaginal moisturizer is really helpful.

 

A lubricant for sexual activity. There are over-the-counter and prescription medications that can help with arousal and orgasm. There are two approved medications for the treatment of low libido in premenopausal women.

 

One is Addi, which is a pill that you take every day, also known as the pink pill. Another treatment is Vilece, which is an injection. It comes in a pen, so you never see the needle and really don't feel the needle.

 

You give it to yourself about 45 minutes to an hour before sexual activity. Both of these medications are working on the brain chemistry because the brain is the biggest sex organ in the body. It's the most important sex organ.

 

It works on the brain chemistry and improving the dopamine and norepinephrine and the good sex positive hormones. Like I said, it's only approved for premenopausal women, but many of us do prescribe it for postmenopausal women. We have studies to show that it's safe and it's effective.

 

The drug companies didn't go through with all the rigmarole they had to do to get the FDA-approved indication for that. We've got all kinds of tricks up our sleeve.

 

Laura Dugger: (31:16 - 31:26)

Absolutely. Just piggybacking on that, they wouldn't oftentimes follow through on all those studies, would you say primarily because of financial restraints?

 

Dr. Kris Christiansen: (31:27 - 31:41)

Totally. To get a medication approved for female sexual function, it's multi-million, if not a billion dollars. Studies and everything that needs to be done, it's crazy.

 

That's why these meds are so expensive.

 

Laura Dugger: (31:42 - 32:14)

Then you also mentioned earlier bringing in the quality of life. There are so many options to consider, but such a personal basis. I had another question that arose.

 

You kind of were answering that because this one works with the brain chemistry. I'm thinking the body parts may be functioning and you can do different things to have an erection or be aroused with your genitalia, but how is desire affected with cancer?

 

Dr. Kris Christiansen: (32:16 - 35:03)

It's huge, unfortunately. Again, if we go back to that biopsychosocial model and for everything to work well, everything's got to be working well. If we have pain, of course that drives down desire.

 

We use the analogy of putting your hand on a hot stove. Pain with sex can hurt just as badly as that. I have women tell me it's 10 out of 10 pain feels like shards of glass.

 

Obviously, that's not pleasant. If we compare that to putting your hand on a hot stove, why in the world would you want to do that? We've got to take care of the pain.

 

When it comes to pain, it becomes imprinted in the brain and the body responds by just amplifying that pain. You've got more pain and you have less desire. Part of GSM or surgery or chemotherapy and other treatments, radiation, can affect the nerves.

 

We don't get those positive sensations and the arousal anymore. There's arousal in the brain as well as arousal in the genital area. If we're not getting that positive feedback that this just isn't fun anymore, it's hard to get enthused about engaging in that.

 

Sex therapy can be really helpful. Sex therapy isn't going to fix thin tissues, but a sex therapist is very skilled and trained at working with people and working with couples on trying to process this, working through the process and the changes that are happening. Sometimes it is a permanent change in sexual function, so there's grief involved.

 

Helping to process through some of that is really important. But again, if we take a step back and remember that sexual intimacy is more than just PIV sex, that there are all kinds of ways to be able to give and receive pleasure, as long as each person is comfortable with this. And moving beyond the thinking that, well, if I can't have intercourse, I'm not going to have anything at all, then that may mean you might not have anything at all for the rest of your life.

 

That makes me sad. We just have to take a step back, work through some of this, because it's a journey, it's a cancer journey, it's an aging journey, and try to make the most of it.

 

Laura Dugger: (35:04 - 36:32)

I want to make sure that you're up to date with our latest news. We have a new website. You can visit thesavvysauce.com and see all of the latest updates. You may remember Francie Hinrichsen from episode 132, where we talked about pursuing our God-given dreams. She is the amazing businesswoman who has carefully designed a brand-new website for Savvy Sauce Charities, and we are thrilled with the final product. So, I hope you check it out.

 

There you're going to find all of our podcasts, now with show notes and transcriptions listed, a scrapbook of various previous guests, and an easy place to join our email list to receive monthly encouragement and questions to ask your loved ones so that you can have your own practical chats for intentional living. You will also be able to access our donation button or our mailing address for sending checks that are tax deductible so that you can support the work of Savvy Sauce Charities and help us continue to reach the nations with the good news of Jesus Christ. So, make sure you visit thesavvysauce.com.

 

What are some of those examples for someone if they can't have PIV sex anymore? What are ways that you encourage continuing to build intimacy and a knowing of one another and offering and receiving pleasure?

 

Dr. Kris Christiansen: (36:34 - 41:17)

Well, starting with making sure each person is on the same page as far as what they're comfortable with. Okay? Communication is key.

 

To be able to talk about what you want, what you desire, what your needs are, and listening to your partner say that same thing, trying to make no judgments and not forcing anybody into anything, but just so that we can help understand each other. And when it comes to actual giving and receiving pleasure, whether that's with manual stimulation, with your hands, with your fingers, or if you have a massager, oral stimulation, using a vibrator. And a vibrator can be really helpful for women in menopause, women dealing with cancer treatments, and also for men if they need a little extra help with the stimulation because their nerves aren't working so well.

 

A vibrator, using it together in the context of giving and receiving pleasure can help, just help with the response, help with the enjoyment, and make it a little more fun, as long as everybody's okay with that. Using a lubricant is really important. And a good lubricant, you want to use a good lubricant because some of the more common ones, unfortunately, have ingredients in them that can actually hurt or irritate.

 

And like KY and Astroglide, sorry to name names here, but they're basic water-based lubricants, have either glycerin, parabens, or propylene glycol in them, and those can irritate, so we want to try to avoid those. A silicone-based lubricant doesn't have those preservatives, and it stays slippery longer. Where we have to be careful with that is that if you're using a silicone tool, otherwise known as a vibrator, you don't want to use those together because it can ruin the tool.

 

And if the man is struggling with ED, using too much, especially of a silicone lubricant, can make it too slippery. And too slippery is not so good for him. Oil-based lubricants, they're very nice, except if you're using condoms, it will degrade the condom and create other problems, potentially.

 

Other ways to stimulate, manually, orally, and when women have pain with intercourse, I'm going to bring in another show-and-tell here, the pain is often coming from the vulva, not so much in the vagina. We talk about vaginal dryness and vaginal atrophy, but the part that's most sensitive is often just right inside the little lips here. And so, if we have terrible pain with penetration, we want to avoid that.

 

However, the whole surrounding vulvar area is very rich in nerves, can be very much stimulated, and it can feel really good, however each person is comfortable stimulating that area. And another fun fact is that this entire structure is the clitoris. You know, when we think of the clitoris, we think of the glands, this tiny little magic button right here, which, by the way, has 10,000 nerve endings in it.

 

It's incredible. But the legs, the legs are the cruise of the clitoris, as well as the bulbs. They come down on either side of the vagina.

 

So, the vagina is here. However, this part of the clitoris can easily be stimulated, so the legs of the clitoris can be easily stimulated, just inside the labia majora, or the outer lips. So, using a vibrator here can be really pleasurable, and you're avoiding the part that hurts.

 

So, stimulating externally the clitoris, the labia, and wherever else feels good can be very fun. And so, if you try to approach it may be like a game, making it fun and exploring each other's bodies so that you can really figure out ways to make the other person feel good or experience pleasure without causing pain.

 

Laura Dugger: (41:18 - 41:43)

That's so great. And like you had mentioned, if they go see a Christian sex therapist, they would say the same thing as you to stop when there is pain, because it just makes it worse over time. And so, I love that you've given us other options, if that is the case.

 

Is there ever a time where orgasm is no longer possible after cancer?

 

Dr. Kris Christiansen: (41:46 - 43:14)

It's possible. Yes. Depending on the cancer and the treatment, that it can make it really difficult or even impossible to get there.

 

But that's where we want to not focus on orgasm as the ultimate goal, because if we engage in sexual activity with orgasm as the ultimate goal, your brain's not going to let you go there, whether it's the male or the female, either one, the brain is the biggest sex organ in the body. Just trying to go for the gold just won't let you get there. So, you have to relax and enjoy the journey regardless.

 

So even if the cancer or the treatment didn't necessarily affect orgasm or if it's just our brains, my encouragement is to approach a sexual encounter as an experience. Enjoy the experience. It's not a performance.

 

We don't want to perform because then we get in our head, and we get nervous and our muscles all tighten up. So, we don't want to perform. We want to enjoy the experience, and it can be very pleasurable.

 

Even if orgasm isn't part of the picture anymore, it doesn't mean you can't have fun and can't connect because you can.

 

Laura Dugger: (43:15 - 43:25)

But then I guess also to offer the hope, if I ask it a different way, are there times that orgasm is still possible after a cancer diagnosis?

 

Dr. Kris Christiansen: (43:27 - 44:01)

Absolutely. We always have hope. We always have hope.

 

Just because you're diagnosed with cancer doesn't mean you're not going to be able to engage in PIV sex or be able to experience an orgasm because that's always a possibility. Don't focus on just getting to the big orgasm. You want to slow down, enjoy the journey, and oftentimes it will come.

 

There are medications that help with blood flow, that help with arousal and orgasm, and sometimes they can be helpful. Sometimes they're not, but usually it doesn't hurt to try them.

 

Laura Dugger: (44:02 - 44:26)

There you go. That's a very helpful reminder. It's a piece of the puzzle, not the whole thing.

 

But if someone right now is walking through their own cancer journey, what else would you advise them both to do and to avoid doing so that they can still enjoy the healthiest sex life possible with their spouse?

 

Dr. Kris Christiansen: (44:29 - 47:19)

That's going to involve several pieces. One, first and foremost, maintain the communication about wants and desires, what hurts, what doesn't, what can we do, what do you want to try tonight? Maintaining the communication.

 

It's much better to prevent problems like the vaginal dryness and pain than to try to treat it after you've been dealing with it for years sometimes, or even months. If you have, say, breast cancer, just getting in the habit of using one of those vaginal moisturizers from the get-go even before the dryness starts can help prevent problems. Seeing a pelvic floor physical therapist can be really, really helpful.

 

A pelvic floor physical therapist is a physical therapist who specializes in these pelvic floor muscles that help support everything on the inside. And so if these muscles are too tight, causes pain, and if they're already too tight, doing tangles is the last thing that you want to do, because sometimes it means being able to relax them. Or women who have, who need pelvic radiation, say for uterine cancer, the gynecologic oncologist is usually really good about giving you a vaginal dilator and to use it, but they're not always really good at telling you exactly how to use it, how frequently and how long, so be sure and ask.

 

Because again, we want to maintain the integrity of the tissues, because it's better to maintain them than try to get it back. That's often quite hard. For guys, especially with prostate cancer, it means participating in that, we call it penile rehabilitation.

 

So, it's basically physical therapy for the penis. You know, its muscle, so we want to keep that muscle healthy and to help maintain healthy tissues. And just trying to be as good to ourselves as we can, giving ourselves and our partners grace when we need it, because it's a journey and it's not an easy one.

 

But we believe in a big God and he's there to help us through this and he delights when husband and wife can unite as one, whatever that looks like. And it makes him happy and he's there to try to keep this going for us.

 

Laura Dugger: (47:21 - 47:40)

And you may have already answered this question with that, but I love how you're always encouraging and gentle and full of hope. So, any other hope that you want to share with anyone who's battled cancer or is in the midst of their journey, but they're still desiring to connect intimately with their spouse?

 

Dr. Kris Christiansen: (47:47 - 48:33)

Sometimes it means asking for help. So, for finding a provider, whether that's a therapist, a gynecologist, a sexual medicine provider, or even your pastor counselor to help you through this. In the show notes, we'll put in websites where you can find a provider because not everybody is educated.

 

Hardly anybody's educated on this, unfortunately. But there are people out there throughout the country, throughout the world, where you can find to help guide you on this journey. Don't suffer in silence.

 

We're here to help. So be sure to reach out so we can help you.

 

Laura Dugger: (48:33 - 48:50)

That's so good, Dr. Christiansen. And are there any other proactive measures that all of us can take to set us up for a healthy sex life into aging or any diagnoses that we may get in the future?

 

Dr. Kris Christiansen: (48:53 - 50:38)

Well, treating our body like a temple, like God says. We have to take good care of ourselves. And just in general, going for your preventative visits and checking your cholesterol and your blood sugar and your blood pressure and screening for cancer so we can prevent them or catch them really early.

 

And it's so much easier to treat. But things like smoking and diabetes and being overweight and high blood pressure, high cholesterol, they impact sexual function very negatively, especially smoking. Guys are still surprised when I tell them, or I show them a picture of a cigarette with ashes that are kind of wilting off the end.

 

This is your penis. This is what happens with smoking. Okay.

 

So quitting smoking. And in women, we have those same little blood vessels and nerves that men do. And so not taking care of ourselves as far as weight, exercise and diabetes and all that stuff, that affects our sexual function, too.

 

So just making sure that we take a proactive stance on just taking really good care of our medical and our mental health because that's so important. And our spiritual health. Can't forget that, too.

 

Yeah. Just, you know, taking care of ourselves because aging does impact sexual function. As we get older, our endurance isn't quite what it used to be.

 

Certainly not as flexible as we used to be. Things kind of hurt. Achy joints and whatever.

 

So, the more we can take care of ourselves, the more we can enjoy that sexual intimacy, which does involve a little bit of physical exertion.

 

Laura Dugger: (50:39 - 51:03)

Absolutely. Well, you've shared a lot of places where we can go to seek help. But I would love to know where we can continue to learn from you or a website where people can find out more of your offerings because you mentioned not many people are educated in this field or on this topic, but you are a great resource.

 

So where would you direct all of us after this chat?

 

Dr. Kris Christiansen: (51:05 - 52:23)

Well, I started my own business called Intimate Focus, Intimate-Focus.com. Where my goal is to offer education and quality products that people can use to help equip them and enhance sexual intimacy. As part of my clinical career where I see patients, we'd often talk about using a good lubricant or getting a vibrator to help with those nerves that just aren't quite as effective anymore.

 

And so many times they told me they were just not comfortable going to an adult store or they didn't want to purchase them on Amazon because it could be a shared account and kids or whatever may see what they're ordering. So, this is a private and secure site and I don't even know how to sell your email so don't worry, that's not going to happen. Where you can purchase good quality products, I vet them out myself to make sure that they don't contain the ingredients that I encourage women to avoid and no pictures with nudity or anything like that because I want it to be a comfortable space or at least as comfortable as we can make it for everybody.

 

Laura Dugger: (52:24 - 52:43)

Wonderful. Well, I'll certainly link that in the show notes as well. And Dr. Christiansen, you are already a friend of The Savvy Sauce, so you know that we're called The Savvy Sauce because savvy is synonymous with practical knowledge. And so, as my final question for you today, what is your Savvy Sauce?

 

Dr. Kris Christiansen: (52:46 - 53:15)

Well, you know, James in the Bible is a very practical kind of guy and I love his advice that we should all be quick to listen, slow to speak and slow to become angry. And if we were all able to do that or at least just a little more of that, I think our world would be a much better place to live.

 

Laura Dugger: (53:16 - 53:42)

This is so good. I cannot hear that verse enough and I just truly look so forward to the times that I get to spend with you. You are such a calming presence full of wisdom.

 

That's what we prayed for before we had the recording begin for today. And I am just overflowing with gratitude. So, thank you, Dr. Christiansen, for all that you've shared. Thank you so much for being my returning guest.

 

Dr. Kris Christiansen: (53:43 - 53:48)

Well, thank you, Laura. This has been great. It's an honor to be on your show.

 

Laura Dugger: (53:50 - 57:32)

One more thing before you go. Have you heard the term gospel before?

 

It simply means good news. And I want to share the best news with you. But it starts with the bad news.

 

Every single one of us were born sinners, but Christ desires to rescue us from our sin, which is something we cannot do for ourselves. This means there is absolutely no chance we can make it to heaven on our own. So, for you and for me, it means we deserve death and we can never pay back the sacrifice we owe to be saved.

 

We need a savior. But God loved us so much, he made a way for his only son to willingly die in our place as the perfect substitute. This gives us hope of life forever in right relationship with him.

 

That is good news. Jesus lived the perfect life we could never live and died in our place for our sin. This was God's plan to make a way to reconcile with us so that God can look at us and see Jesus.

 

We can be covered and justified through the work Jesus finished if we choose to receive what He has done for us. Romans 10:9 says, “That if you confess with your mouth Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved.” So, would you pray with me now?

 

Heavenly Father, thank you for sending Jesus to take our place. I pray someone today right now is touched and chooses to turn their life over to you. Will you clearly guide them and help them take their next step in faith to declare you as Lord of their life?

 

We trust you to work and change lives now for eternity. In Jesus' name we pray. Amen.

 

If you prayed that prayer, you are declaring him for me, so me for him. You get the opportunity to live your life for him. And at this podcast, we're called The Savvy Sauce for a reason.

 

We want to give you practical tools to implement the knowledge you have learned. So, you ready to get started? First, tell someone.

 

Say it out loud. Get a Bible. The first day I made this decision, my parents took me to Barnes & Noble and let me choose my own Bible.

 

I selected the Quest NIV Bible and I love it. You can start by reading the book of John. Also, get connected locally, which just means tell someone who's a part of a church in your community that you made a decision to follow Christ.

 

I'm assuming they will be thrilled to talk with you about further steps, such as going to church and getting connected to other believers to encourage you. We want to celebrate with you too, so feel free to leave a comment for us here if you did make a decision to follow Christ. We also have show notes included where you can read scripture that describes this process.

 

And finally, be encouraged. Luke 15:10 says, “In the same way I tell you, there is rejoicing in the presence of the angels of God over one sinner who repents.” The heavens are praising with you for your decision today.

 

And if you've already received this good news, I pray you have someone to share it with. You are loved and I look forward to meeting you here next time.