Sex questions - no sex drive after cancer, menopause

Q I’m writing about my mom. She is in her mid-fifties, was diagnosed with cancer a few years ago, responded well to chemo, and thankfully has been cancer-free for a long time now. On top of the chemo, she’s been going through menopause for a few years. Since the chemo she feels like she’s dead below the waist. In her words, she used to be a real horndog and now has no interest in sex. She said her husband (not my dad) was wonderful in terms of not pressuring her for sex, but that they have recently tried it a couple times and she was definitely not into it. The thing is, she says she WANTS to get that lovin’ feeling back. She has been to a specialist who asked if she had sex toys (to which my mom replied that she “has toys coming out the wazoo”). My mom asked about “the female Viagra,” but the specialist instead recommended lube. None of the therapist’s suggestions address her lack of desire. Can you suggest resources to help her get her sex drive back? Or is her only option a “wait and see” approach?
A There’s more here than I can do justice to, so I’ll throw out a few ideas and suggest that your mom and her husband consider sex therapy (sstarnet.org). First, “wait and see” isn’t necessarily a bad approach. Most long-term couples experience a natural ebb and flow to their lust, even in the healthiest of circumstances. Add cancer, chemo, menopause and aging, and they have numerous changes to adjust to. Her doctor may have recommended lube because many menopausal women and cancer survivors avoid sex due to vaginal dryness. And while vibrators can be helpful with orgasm, it’s less clear how they can help with desire—but they might. For example, your mom might try spending time alone fantasizing or watching porn (yes, porn)—and seeing if adding vibration to the mix helps to enhance her arousal or desire. Mindfulness exercises have been shown to help many women with desire issues (I wrote about this in my book Because It Feels Good). And while I don’t know what kind of cancer your mom had, the books Living Well Beyond Breast Cancer (Three Rivers Press, $20) and The Breast Cancer Husband (Rodale, $15.95) may be helpful regardless of cancer type. Finally, there is no “female Viagra” right now, but some women are prescribed testosterone as an off-label way of trying to enhance libido, but that’s often a last-resort strategy.

Q How big a role does heredity play in one’s level of sexual desire? My ex-wife and I had a very troubled sex life because she just wasn’t interested. Our teenaged daughter is very similar to her mother (physically and in terms of personality), so I wonder if she will have the same low level of sexual interest. If she does, I hope she finds a similar partner, instead of pairing up with someone like me who has a high level of interest. As you can guess, there’s very little chance that I can ask my daughter about how interested she is in sex. Is there some way I can help her understand that if she isn’t interested in sex, she shouldn’t pretend she is but should find somebody like her?
A We don’t know how much heredity has to do with sexual desire or behavior, though some recent studies suggest that there’s likely some degree of influence. However, just because your daughter acts like your ex-wife in some ways doesn’t mean she does in all ways. Also, just because sex was a fundamental problem for you and your ex doesn’t mean it will be for your daughter. I think we often make the mistake of thinking that people are fundamentally the same in all of their relationships. And while it’s true that some people have low to no sex drive and others have a consistently high sex drive, many people are consistently inconsistent. They may have a crazily high sex drive with someone they’re madly in love with and a blah sex drive with someone whom they love but don’t find all that attractive. I’d just recommend that you be open with your daughter about as many areas of life as you can, including sexuality, and that you let her know that you’re always there to talk with her. Consider gifting her with Changing Bodies, Changing Lives (Three Rivers Press, $24.95), suggesting she check out Scarleteen.com and sharing your own thoughts on the matter when you feel it is age-appropriate.

Q I’m a straight middle-aged male. In my twenties, I did not use condoms. In spite of my risky behavior, I never had any STD symptoms. I regret how reckless I was. Years ago, I became aware that it’s possible to have herpes without any symptoms. One doctor I asked said not to bother with testing because test results, even if positive, would be inconclusive about the type of herpes (HSV1 or HSV2). In 2000 I began a monogamous relationship, shared my concerns about having asymptomatic herpes, and we agreed to use condoms. As time went on we stopped condoms. Several years into our relationship, I learned about a new herpes test, got it, found I was positive for HSV1 and HSV2 and felt horrible. We started using condoms again. We’ve since broken up and she’s told me that she is still negative for both. Since our 2006 breakup, I have been celibate. I am not comfortable initiating a dialogue and I’m also worried that if I do, word will spread about my diagnosis. After I end a relationship, months pass before I ask someone out, then the cycle repeats. It’s like my personal version of Groundhog Day. I’ve considered that maybe I need a therapist as much as I need answers to my HSV2-related questions.
A Your doctors are correct that blood tests for herpes are not always conclusive, even though some independent labs on the Internet will try to win your business by telling you otherwise. If you ever have genital sores or lesions, it’s a good time to go to the doctor, as it’s easier then to culture the sores and get a more reliable test result. As many as one in five Americans has genital herpes, and many don’t know it. If you’ve never had a symptom, it is extremely unlikely that you will develop symptoms at this stage of the game or that you will pass it on to others, but if you have questions, ask your health-care provider. While there, ask your doctor about the possibility of taking antiviral medications that can greatly reduce the risk of transmitting herpes. That way, you can feel more confident dating people. And yes, I would recommend seeing a counselor (apa.org or sstarnet.org), if only because it seems as if anxiety is getting in the way of your love life.

Debby Herbenick, Ph.D., M.P.H., is a research scientist at Indiana University, sexual health educator at the Kinsey Institute and author of Because It Feels Good: A Woman’s Guide to Sexual Pleasure and Satisfaction. Send letters to Debby Herbenick, Ph.D., c/o Time Out Chicago, 247 South State Street, 17th floor, Chicago, IL 60604, or send e-mail to inandout@timeoutchicago.com.