Ask Debby Herbenick | Sex after breast cancer

Q My sex drive has been decreasing for a while, and now I feel very bad, because I do not want to have sex with my girlfriend for days at a time. Is there anything natural out there that I can take to regain my sex drive?
A Sexual desire is complex and frequently misunderstood. For example, it is very common for people to notice a decrease in their sex drive as they stay in long-term relationships. This doesn’t mean that long-term relationships are bad; in fact, many people have their most satisfying sex in committed relationships. It is also common for sexual desire to decline with age, and it does so most noticeably in one’s forties and later. That said, sexual desire may change in response to pretty much anything. To date, there are no scientifically validated sexual-desire-boosting medications, so I can’t recommend anything. Check with a doctor to see if medication side effects or a health condition (such as depression or diabetes) could be to blame. Then, try meeting with a sex therapist (find one at aasect.org) to find solutions. Finally, you didn’t say if your change in desire is causing problems in your relationship. If your girlfriend is not bothered by it, and you can be okay with it too, then ease up on yourself about it. Some men and women find that their desire dips for a bit and then reignites in time. To explore new ways of connecting with your girlfriend and boosting your desire, check out Mating in Captivity (Harper, $13.99).

Q I have knee problems that have gotten worse over the past year. The pain has gotten in the way of my sex life with my husband because we can’t do many of the positions that we used to like, such as woman on top and doggie-style. I was going to have surgery, but then I lost my job and insurance. I thankfully started a new job, but my new health insurance has a waiting period of several months before I can have my knees treated. In the meantime, can you suggest ways for us to have a better sex life?
A Bodily pain is common with age—and not just with old age, either. People in their twenties, thirties and forties often need to adjust their favorite sexual positions because of leg cramps, flexibility constraints, sports injuries, prosthetics or whatever else. Fortunately, there’s a great book that aims to provide practical information about better sex in the midst of pain or disability: The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain & Illness (Cleis Press, $18.95). There are also useful sex props such as the Love Bumper (lovebumper.com), which is basically sex furniture (similar to the Liberator) constructed with ergonomics and chronic-pain conditions in mind. You may find, for example, that you can use one of the Love Bumper pieces to have woman-on-top sex at an angle that doesn’t place downward pressure on your knees. Even without buying any sex props, you can modify other positions in ways that feel good. For example, if what you like about woman on top and rear entry is the chance to have the front wall of your vagina massaged by your husband’s penis, then perhaps you can start in missionary, then sit up a bit with pillows behind your back so that your husband comes in at an angle that directs his penis to your front vaginal wall. You might even try propping your legs and hips up on pillow while in missionary (with your back flat on the bed) for more focused stimulation.

Q A few years ago, I was diagnosed with breast cancer, and I am happy to say that I am a survivor and about to make it to the five-year mark. As part of my treatment I had a mastectomy, which took me awhile to adjust to, but now I’ve accepted the changes to my body and feel increasingly interested in having sex with my husband, almost like how it was before. Unfortunately, my lingerie doesn’t fit me the way it used to, as I chose not to have reconstruction. Do you know of any lingerie made for women like me? I always felt sexier when I dressed up, and I think it would make me feel even prettier and sexier now.
A Surviving breast cancer takes a unique combination of good fortune, strength, patience, support, treatment and a smart, compassionate medical team; I am sure your friends, family and husband are very grateful to have you with them. Moving on often involves reenvisioning one’s life somewhat, and it sounds as though you have a healthy and patient perspective. This is particularly true with changes to one’s sexual response and experiences following cancer treatment. Not everyone is aware of what is likely to make them feel sexier, but you are, and that’s an important step toward actually feeling sexier and more in the mood. You’re also in luck, as more lingerie companies have been creating lines for women who, like you, have had a mastectomy. English Rose (myenglishrose.com) and Lingerie Illusions (lingerieillusions.co.uk) are two such companies. Newer to market is DiMurini (dimurini.com), which offers a more luxurious line of mastectomy bras and other lingerie. You might also find it useful to check out Living Beyond Breast Cancer: A Survivor’s Guide for When Treatment Ends and the Rest of Your Life Begins (Three Rivers Press, $17) for additional information about sexuality and sexiness. Finally, if there are other sexual issues that you are dealing with such as vaginal dryness or genital pain (both are fairly common following cancer treatment), Pure Romance (pureromance.com) and A Woman’s Touch (awomanstouch.com, with a location in Milwaukee) often offer sexuality workshops or revised product lines (e.g., unscented lubricants and massage products, vaginal moisturizers) that are specifically for cancer patients and survivors.

Q My husband and I had our first baby two weeks ago, and he already wants to have sex. I’ve told him that my doctor says we should wait until at least six weeks after I gave birth. He thinks that’s an eternity, but isn’t that normal?
A Yes, doctors commonly recommend that couples not resume intercourse until at least six weeks after birth; some even suggest eight weeks as a minimum. Jumping back into the game too quickly can irritate the vagina, cause soreness and increase the risk of infection. Even when new parents begin having sex again, moms may find that sex is painful for several months (particularly if they are breast-feeding, which is associated with lower estrogen and, thus, less vaginal lubrication). Try reading Love in the Time of Colic: The New Parents’ Guide to Getting It On Again (Collins, $16.99) together to prepare for your about-to-happen sex life. You should also ask your husband for a little patience and understanding going forward. In the meantime, consider other forms of sex play, such as licking mint-julep-flavored body sugar ($9.50 at Tulip, 3448 N Halsted St, 773-975-1515) off his penis or trading sexy massages (and maybe finishing his up with a handie and a warm towel).