Ep. 45 - Sex After Breast Cancer: How to Rediscover Pleasure

[00:12] Introduction: Cancer and Sexual Wellness

Dr. Bawa: Welcome back to the Dr. Sex Fairy Podcast. I am Dr. Kanwal Bawa, America's favorite sex doctor, and I am here to transform your life. I talk about issues that affect your intimate and sexual wellness and consequently your quality of life. Make sure you follow the Dr. Sex Fairy Podcast so that you never miss an episode. Don't forget to leave me a five-star review. And if you don't already follow my Blockbuster hit TikTok account, Dr. Sex Fairy, follow me there now. Today we are discussing an issue that the average person does not consider when thinking about sex and sexuality.

Dr. Bawa: And that issue is cancer. We just assume that it won't happen to us. According to the American Cancer Society, in 2022, there will be an estimated 1.9 million new cancer cases diagnosed and 609,360 cancer deaths in the US alone. According to the International Agency for Research on Cancer, in 2018 there were 17 million new cancer cases and 9.5 million cancer deaths worldwide. By 2040, we expect 27.5 million new cancer cases and sixteen point three million cancer deaths worldwide. Men and women are suffering the aftereffects of cancer equally. Men develop symptoms including severe erectile dysfunction, infertility, and penis shrinkage.

Dr. Bawa: Women develop pain with sex, dryness, poor libido, infertility, and more. This is an important episode for both men and women. Because even if you haven't suffered cancer yourself, perhaps your partner or a friend has or will. Listening to this episode will change lives, either your own or someone else's. It is critical that you share this episode with family, friends, and even your co-workers. After all, sexual dysfunction after cancer is one of many silent pandemics that I discuss here on the Dr. Sex Fairy podcast. I have a very, very special guest on the podcast today, so don't go anywhere.

Dr. Bawa: You know me as a vibrant person, and I know that you never think of cancer when you look at me, but I am a cancer survivor.

[02:17] Breast Cancer Awareness and Sexual Health

Dr. Bawa: October is breast cancer awareness month, and I'm going to tell you a little bit about my own story before we discuss the topic of sex and cancer. This episode is important for both men and women. After all, understanding what a common cancer like breast cancer can do to a woman's sexuality will help both partners restore their intimate relationship. I will be discussing the effect of cancer on male sexual function in an upcoming episode, so make sure that you subscribe to the Dr. Sex Fairy Podcast right now. You won't want to miss that episode.

Dr. Bawa: Ladies, you should subscribe as well, because you will need to hear that episode to better understand your partner. And there's so much more great content headed your way every single week. I am not America's favorite sex doctor for nothing.

[03:08] Dr. Bawa's Breast Cancer Journey

Dr. Bawa: Let's start by discussing my cancer journey. I was 42 years old when I was diagnosed with breast cancer. It was deeply upsetting because I had originally felt a lump three and a half years prior, but was dismissed by multiple physicians. To begin with, my gynecologist said that he did not feel anything and that I was younger than 40, so not a suitable candidate for a mammogram. That made no sense at all to me. I had to insist on a mammogram. The radiologist did actually detect the lump that I had felt.

Dr. Bawa: I was sent for an ultrasound at this point, but no biopsy was recommended. When I went back the following year, they saw the lump again and called it benign. At no point was a biopsy ordered, and at every step of the way my concerns were dismissed. In November 2020, that same lump was now diagnosed as invasive ductal carcinoma. It wasn't just a little lump anymore. I had many and they were large. It was mind-numbing. I had, after all, done the right thing with breast self-exams. I had sought help at the right time.

Dr. Bawa: I went for all the studies that were ordered and fought for many that were not. This time my gynecologist did send me to see a breast surgeon. Ironically, the surgeon, a woman no less, was very nasty and told me that I clearly had fibrocystic breasts and didn't need further testing. I had to fight for testing. And now the radiologist sat me down and told me that I likely had breast cancer. A biopsy a few days later confirmed her diagnosis.

Dr. Bawa: I didn't receive any kindness from this breast cancer surgeon or even see a semblance of humanity in her and made the decision to go to the University of Miami's Sylvester Cancer Institute instead. This decision likely saved my life. I now had a top-notch team that helped me navigate the abyss of cancer. I received truly world-class care from them. They were the best doctors in the field. And our special guest today is one of them.

[05:20] Choosing to Live Defiantly Through Treatment

Dr. Bawa: With my medical team in place, I faced a major decision. I could either let cancer crush my soul or I could be defiant and live my very best life in spite of it. The decision was simple. I chose the latter. Cancer patients suffer many, many side effects due to chemotherapy, radiation, medications, and more. For instance, I didn't want to lose my hair without a fight. I am, after all, also a hair restoration specialist. And I am a woman in my prime. In the end, while I suffered significant hair loss, I never came close to being bald.

Dr. Bawa: I also decided that having great skin and cancer are not mutually exclusive and dealt with chemotherapy-related issues such as hyperpigmentation head-on. I also maintained glowing skin by using Bawa Medical Skin Care and have multiple medical grade skin rejuvenation treatments. I supplemented my diet with our line of supplements. In the end, Bawa Medical, my life's work, ended up giving me a sense of normalcy and above all.

[06:23] Turning Cancer Into Advocacy

Dr. Bawa: During the dark days and nights of chemotherapy and other cancer treatments, I decided that my cancer had to amount to something greater than myself. I couldn't possibly be going through all that hell randomly. I had been chosen to suffer this disease because I was meant to affect change. It was at this point that I began raising funds for cancer research and raising awareness about cancer misdiagnosis. I even entered a beauty pageant for the very first time in my life, in the middle of chemotherapy, no less, to inspire cancer patients to never stop seeing themselves as beautiful.

Dr. Bawa: I wanted them to always have dreams and goals. One month after my mastectomy, I walked on stage in a gown and high heels, with short hair, no wig, and my scars visible and without any makeup to hide them, and won Miss Florida. According to my oncologist, Dr. Carmen Calfa, my win redefined the concept of beauty after breast cancer, and for that I will forever be grateful.

[07:26] Survivorship, Body Changes and Sexual Health

Dr. Bawa: In that moment I seemed mostly whole to everybody, but my body and soul had been to hell and back. I had survived cancer, but the damage was undeniable. Due to the misdiagnosis, what could have been a simple lumpectomy became a mastectomy and life-altering nerve damage. I have also seen many patients in my office suffering from myriad after effects of cancer. I am now uniquely positioned to not only provide a cancer patient the very best services they need, I truly understand the sorrow and despair they feel.

Dr. Bawa: We have to start talking about cancer, and we have to start talking about the issue of sex after cancer.

[08:07] Introducing Dr. Kristin Rojas

Dr. Bawa: I have someone very special to me joining us on the Dr. Sex Fairy podcast today. Dr. Kristin Rojas is a fellowship-trained breast cancer surgeon at the University of Miami Sylvester Comprehensive Cancer Center and a board-certified OB-GYN as well. She is also the founder and director of the Menopause, Urogenital, Sexual Health and Intimacy Program, also known as MUSIC, a program for women experiencing sexual dysfunction after cancer treatment. I am a lucky woman because she is my breast cancer surgeon. I met Dr. Rojas at the lowest point in my life, shortly after my cancer diagnosis.

Dr. Bawa: She has been by my side every step of the way since. Not only is she a gifted surgeon and cancer researcher, she is a former beauty queen herself, and one of the people I respect and admire the most in this world. Welcome, Dr. Rojas. Welcome to the Dr.

[09:03] Dr. Rojas Joins the Conversation

Dr. Rojas: Sex Fairy Podcast. Thank you so much for having me. I am delighted to be here, and I can't wait to hear what we're going to talk about.

Dr. Bawa: Well, for one, thank you for helping save my life.

Dr. Rojas: Honestly, you were it was an honor to take care of you. every time I hear your story about your diagnosis, it it is so distressing. And I'm so proud of you for sharing your story because I'm sure there are other women who have been put in a position where they need to advocate for themselves. And so I just think it's such a powerful story. you know, I'm so happy to be your surgeon, and the fact that you did a beauty pageant a month after your mastectomy is like no pressure for the surgeon, but I'm so glad it was successful.

Dr. Rojas: It wasn't, it wasn't just successful, you won. And it's like, it's I could not have been more proud, more excited for you. And I'm just so happy for you.

Dr. Bawa: Thank you. And we all won that day. It wasn't just me. I could not have walked onto that stage had it not been for you and the rest of the team. We did it together.

Dr. Rojas: I do feel it was like a team effort. I there was some sleepless nights before surgery. I'm not gonna lie.

Dr. Bawa: Well, all's well that ends well, and here I am, and here you are.

Dr. Rojas: Exactly.

Dr. Bawa: So let's help other women in my shoes. Let's talk about sex after cancer. Why does sex after cancer hurt so much?

[10:37] Why Sex After Cancer Hurts

Dr. Rojas: So, first of all, I'm so glad that you're you've you're you're dedicating your podcast to these otherwise traditionally thought of as taboo topics. as at, you know, my main job is as a breast cancer surgeon, but I'm also a board-certified gynecologist. And so I do run our sexual health after cancer program. So that's a real passion of mine. And we treat women with a history of any type of cancer who are experiencing sexual dysfunction.

Dr. Rojas: For those not touched by cancer or maybe not aware, up to 80% of women either undergoing cancer treatment or who have are in survivorship experience sexual health concerns. And the most common are vaginal dryness, painful sex, and low desire. And so in our sexual health after cancer program, those are probably the three most common issues that patients bring to me.

Dr. Rojas: The reason it hurts to answer your question specifically, you know, the most when we give cancer treatments, depending on what the treatment is, you know, most of my patients are women with a history of breast cancer, and most breast cancers are estrogen receptor positive. So part of their treatment is to either decrease the level of estrogen in their body or block the function of estrogen in their body. And, you know, natural menopause is when the ovaries start to decrease their the synthesis of estrogen over time.

Dr. Rojas: So your ovaries make estrogen that keeps your bones healthy, your brain, your heart, it's part of your monthly cycle. And then once the ovaries start to get, you know, tired, that level of estrogen gets slower, lower and lower over time. It's usually a gradual process. Well, cancer treatment, we put you either into an abrupt menopause if you're before if you're premenopausal, meaning you haven't gone through menopause yet.

Dr. Rojas: And this can be done by either estrogen blocking medications or chemotherapy, or we take a woman who's already in menopause and we might make her symptoms from menopause like hot flashes, vaginal dryness, et cetera, even worse. And so I think the pain part, specifically related to painful sex, has a lot to do with the vaginal dryness, which I know we're going to talk about some ways to tackle that today.

Dr. Bawa: Now, when it comes to vaginal dryness, the answer usually for most women is estrogen creams. What happens when somebody has just gone through breast cancer?

[13:07] Vaginal Estrogen After Breast Cancer

Dr. Rojas: You're right. The gold standard for women with what's known as genitourinary syndrome of menopause, which is this term that we use to describe dryness or what was traditionally called vaginal atrophy. You know, we don't say that that word anymore. It's not a very nice word, although I don't know if genitourinary syndrome of menopause is used to be better. But now it at least encompasses more symptoms, which could include things like pain, vaginal irritation, or things like urinary incontinence. And so so vaginal estrogen is an excellent treatment for patients with the onset of these symptoms.

Dr. Rojas: And while most prescribe prescribing information on the boxes or the way they've traditionally been described is prescribed, is to take it, use it, place it in the vulva in the vagina every night for two weeks and then space it out, you know, because there's a lot of drama and controversy surrounding using this treatment in women with breast cancer, a history of breast cancer, because as I said before, most women have estrogen receptor positive breast cancer, 80% of women of that type.

Dr. Rojas: And so while we don't have any evidence that the use of vaginal estrogen, which is different from systemic estrogen, so vaginal estrogen is considered like a local therapy, whereas systemic estrogen is if you were to take a pill of estrogen or estradiol or put a patch on your skin. So one is only the vagina receives the treatment, and the other one is your whole body receives the treatment. We don't have evidence that using vaginal estrogen increases the risk of the breast cancer coming back. But usually we have conditioned patients to avoid all estrogen products.

Dr. Rojas: So by the time they get to me, even if I told them to use vaginal estrogen, most of the time it elicits so much anxiety because we, you know, the messaging is mixed for these patients. So because we don't have, although we don't have any evidence, it increases the risk of recurrence, we have observational data showing that women have done fine. But we also have other options now. And so hopefully we can talk about those today as well.

Dr. Bawa: So let's talk about dryness. You mentioned that that's a major reason why sex after cancer is very painful. Is there a particular lubricant that you recommend?

[15:26] Moisturizers vs. Lubricants

Dr. Rojas: Well, the first thing I try to convey to patients is that there's a difference between moisturization or moisturizers versus lubricants. So, and they have different purposes. So I try to separate those in patients' minds when I'm counseling them in our program. So the way I explain it is lubricants are for love. And so those are the products that we want to be very slippery to decrease friction and decrease pain associated with intercourse. But what I, or any type of sexual activity, penetrative or not.

Dr. Rojas: and but when I try to talk to patients about moisturization or vaginal moisturizers, this is a totally different category. And separating them in our mind and separating how we use them really optimizes their efficacy. So I tell patients, you know, just like you put your eye cream on at night or whatever other amazing products that you have, that's part of your routine. Now we're going to introduce, you know, the same concept, but for the vulva in the vagina.

Dr. Rojas: So if patients don't have like very severe symptoms when I examine them, or if the dryness is very mild, one good option is to start with single ingredient organic coconut oil. Coconut oil is actually a natural antimicrobial, antifungal. And so it's solid at room temperature. I tell patients make sure you read the ingredient list, make sure it's organic, rub the coconut oil between your fingers, and then you can place it on the external vulva. A lot of suppositories are also based in coconut oil, and it's totally safe.

Dr. Rojas: The only time I tell patients to not use coconut oil is if they're using condoms for either STD or pregnancy protection, because the oils can break down latex condoms. So that's a good starting point. And sometimes I'll have patients do that several times a week and then add another treatment on top of that. So this is not your, you know, in the last few years, vaginal moisturizers is a few that have come onto the scene that are kind of these like high-tech non-hormonal moisturizers. And one of those is products that contain hyaluronic acid.

Dr. Rojas: So, as you probably know from the same molecule that's in facial serums, et cetera, hyaluronic acid is a molecule that pulls water from the environment and holds it on the skin. So it's a very effective moisturizer. There's a few products on the market, some are suppositories and some are gels, but you want to look for a vaginal moisture that has hyaluronic acid. And I recommend patients use that two to three times per week. And remember, those are on days that you're not planning sexual activity. So it's literally moisturizers for maintenance and then lubricants for love.

Dr. Bawa: So lubricants for love.

Dr. Rojas: Yeah. Or not love, you know, whatever.

Dr. Bawa: No, I get it. No, I do like that.

Dr. Rojas: But it's, you know, it's helpful to remember that way.

Dr. Bawa: That is helpful to remember, yes.

[18:21] Protecting Vulvar and Vaginal Health

Dr. Rojas: Biggest thing that I try to convey to patients is to be really cognizant of everything that touches that delicate skin of the vulva in the vagina. There's actually a lot of products out there that contain long-named chemicals, preservatives, artificial fragrances, and these can actually cause a type of an allergic reaction of the vulva, which is like what we call contact dermatitis. And so if patients have an element of like burning and stinging with their symptoms, I tell them to kind of like let's back off any other products you might be using.

Dr. Rojas: So that includes like artificial fragrances in the detergent that they wash their underwear with, on toilet paper, you know, avoiding sitting in bubble bath and really just cleansing the area with really water only. So I tell patients the hair-bearing area you can wash with a normal soap that you wash with the rest of your body. But the area that doesn't have hair should really just be washed with water.

Dr. Rojas: I know if you go to the grocery store, there's a million products out there, but I really try to get patients to come away from that because I don't number one, they contain a lot of harmful ingredients. And number two, the vagina is actually a balance of good and bad bacteria. So the good bacteria are lactobacilli and the bad bacteria cause infection and inflammation and worsen these dryness symptoms.

Dr. Rojas: And so when those over-the-counter vaginal washes are used, they actually just destroy all the good bacteria, sets the whole equilibrium off, and then you can start this cycle of irritation and further inflammation.

[19:54] Vaginal Steaming and Yoni Myths

Dr. Bawa: I'm glad you're talking about all that. I think we should also mention vaginal steaming here. It's all the rage with Gwyneth Paltros goop and you know everybody else touting yoni steaming. Yoni, by the way, is an Indian Sanskrit Hindi word that means basically uterus or womb, and it's used here in the US as a more of a, I guess, a hippie term for you know vaginal health. And so it seems like everybody thinks yoni is this lovely magical word, and let's use that in place of vagina, except that women in India aren't sitting around in circles talking about yonis.

Dr. Bawa: We call them vaginas, and we don't steam them either. So, what are your thoughts on vaginal steaming?

Dr. Rojas: Wow, I just I was trying not to laugh out loud, but I really loved hearing your perspective on that. Yeah, so basically I tell patients not to go to the goop website or do anything that the goop website says. there's a lot of things that could be potentially harmful on there, you know, and so vaginal steaming is one of them. This concept of like steam entering the vagina and having all these like magical properties is complicated because number one, steam, like the vagina isn't an open tube. It's like a collapsed, a collapsed tube.

Dr. Rojas: And so even if you were to sit over like hot steam, like it's not going to go into the uterus. The other thing that's like makes me very suspicious about these products is anytime you read a label and it says it's gonna help you with everything from infertility to acne to hypothyroidism, diabetes, pelvic pain, ovarian cysts, like that should really raise an alarm in your mind that this is that's a little bit suspicious. And so, you know, I actually have had patients who have burned themselves with these. you know, facial steaming sounds like a great idea. Love that.

Dr. Rojas: Opening the pores, vagina steaming, not a good idea.

Dr. Bawa: And it also messes with the pH.

Dr. Rojas: That's exactly right. A lot of the ingredients in vaginal steaming, you I'm not an expert on all of them. I just know from what patients tell me and the things I do look at when I'm trying to figure out where patients get their information. it certainly would disrupt the vaginal pH, which is a huge, a huge component of that like inflammatory pathway. And so the vagina is actually supposed to be have a low pH, it's supposed to be a little bit acidic.

Dr. Rojas: And doing all of these, the those types of activities can really disrupt that and also certainly kill the lactobacilli or those good bacteria we talked about.

Dr. Bawa: And the reason I brought this up is because everybody and their country cousin tells me to do yoni steaming, quote unquote. You should see me right now making that quote sign right now. And it makes my eye literally my eyes roll back in my head because I think of all the bad things that can happen from it. And everybody thinks that because I had cancer, I should do all these random, crazy things and that somehow it's going to heal me internally. And it's not, it just causes more problems, especially for a cancer patient.

[22:58] Misinformation, Kegels and Jade Eggs

Dr. Rojas: Yeah, I I want to empower all women with a history of cancer to really be very educated consumers about there's a lot of misinformation out there, and always try to think, you know, is this is someone trying to sell me something or does this make sense? You know, like I wish we had therapies that fix every symptom, but it's usually a little bit more complicated than that. And so part of you know what I do and what I'm so excited that you're doing this podcast for is to combat some of that misinformation.

Dr. Rojas: You know, another thing on that specific website that we mentioned are these jade eggs. and so for some patients, you know, historically we've always been like two kegels, two kegels, you know, GYNs will just tell patients to do kegels, which are when you flex the muscles of the pelvic floor, which are like a bowl that's holding all of your you know, the intestines in, but it's kind of a complicated woven basket. And so when patients have vulvovaginal symptoms and someone's telling them to do kegels, not everyone should be doing kegels.

Dr. Rojas: And oftentimes kegels can sometimes worsen spasm and pain in the vagina. And so while keagels may be helpful for some situations, they're not always the best thing for everyone because a lot of what we try to do after when we're undoing this pain cycle is help patients relax those muscles because oftentimes they're very tense because they've been having so many painful experiences. And so kegels are not the best thing for those patients, and so kegeling around a jade egg that you place in your vagina is also problematic for those reasons.

Dr. Bawa: Yes, and you know, how is that any different from a tampon or retained foreign body-causing toxic shock syndrome? I mean, it's the same idea.

Dr. Rojas: Yeah.

Dr. Bawa: I mean, they literally leave them in and go to sleep. And, you know, for all my years in the ER before I opened Bawa Medical, I've seen this time and again.

Dr. Rojas: Yes, we they sometimes it's hard to retrieve things that are placed in the vagina. Not every patient is facile at that. And so sometimes that can lead to embarrassing scenarios.

Dr. Bawa: Yes, and ER doctors fishing things out of nether regions, yes. So let's talk about libido. You had mentioned that one of the reasons why sex after cancer is complicated is because there's low libido. What causes that and what can we do to fix it?

[25:26] Why Libido Drops After Cancer

Dr. Rojas: So low libido or low desire is so tough for me to treat because it's often very complicated. You know, women are usually recovering from this big trauma of their diagnosis, all of the psychosocial impact of getting through treatment. and that can certainly impact their desire, their personal relationships, or whether or not they want to even be involved in intimacy. But that's a little bit outside of my area of expertise. Well, I can always offer patients advice. You know, I if they have a lot of issues in that sense, we have other resources that I can refer them to.

Dr. Rojas: I try to focus on really the biologic aspect of desire, and that's like explaining to patients exactly what's happening when we're giving you these medications. So if I if we're giving a patient an aromatase inhibitor, which many women take after estrogen receptor positive breast cancer, so that's anastrozole, letrozole, an exemestane, we're actually making the estrogen in your body much, much lower than a normal postmenopausal woman. And so it's like not a natural thing to do, but it does definitely decrease those women's risk of recurrence.

Dr. Rojas: The problem of what happens with desire when we do that is that estrogen and testosterone are closely related, and or testosterone, also known as androgens. And so when estrogen goes down, testosterone tends to go down, and testosterone, while we typically think of that as being the male hormone, you know, women have testosterone just like men have a little bit of estrogen. And so when testosterone goes down, that can definitely tank desire.

Dr. Rojas: And then the last thing is is thinking about, you know, if patients have been having these recurrent painful experiences every time that they try to engage in sexual activity, like eventually that's gonna train their brain to like avoid this activity. And of course, desire isn't gonna happen spontaneously, it's like a protective mechanism. So the things I talk to patients about for desire, you know, I tell patients, like, think about that part of your brain as being like a highway where the lights have been off. And so, like, no cars are gonna go down that highway.

Dr. Rojas: So, what you have to try to do is think about waking that part of your brain back up through all these different things that I different interventions that I talk to them about.

Dr. Bawa: Yeah, and then there's that whole problem with weight gain because everybody thinks that cancer patients lose weight, but in breast cancer, I know I gained weight, and I know many other people did.

[28:01] Weight Gain, Exercise and Recovery

Dr. Rojas: Yeah, thank you so much for bringing that up. You know, because we're suppressing estrogen, it can also do things to the metabolism, but also most patients will either stay the same weight during chemotherapy or gain weight during chemotherapy. And also you're feeling just terrible and exhausted. some patients feel okay, but other patients do not feel like going to the gym. So, whereas you may have been like physically very active, usually that goes down during or after treatment. And so that can also lead to weight gain.

Dr. Rojas: I really try to encourage patients to try to do some sort of physical activity through treatment for a couple of reasons. Number one, we know it decreases the risk of recurrence, and it doesn't have to be the same thing that you did before. Like if you used to do boot camp, you know, you don't need to do boot camp anymore. You can do something a little bit more one level less intense than that. But it decreases your risk of recurrence, it helps you maintain your weight.

Dr. Rojas: And then the the other thing is actually it boosts all those natural testosterone and can make you feel a little better about your body image and also increases your testosterone. So I always try to get patients if they haven't been able to get back to exercising. I try and through this discussion also inspire them to get back to that as well.

Dr. Bawa: What do you think about sex toys during cancer treatment?

[29:23] Sexual Health Aids, Vibrators and Dilators

Dr. Rojas: So I think of these as you know, sexual devices. and I think that they can be helpful in a lot of different ways. For instance, so with regards to vibrators, there are internal vibrators and external vibrators, and you know, everybody's different in the things that they prefer, but the internal devices can be used to actually maintain the shape of the vagina during treatment if they're not sexually active. So, like if you are going through treatment, your estrogen is very low, you start to experience this dryness that also affects the vagina and can cause loss of elasticity or stretchiness.

Dr. Rojas: And so sometimes I'll recommend a dilator to those patients that, which is like a rigid tube, they place in the vagina a couple of times per week for 10 minutes, and that's to keep the vagina from becoming narrower or shorter over time with that low estrogen. Patients that are having regular sexual activity, penetrative intercourse or otherwise, probably don't need dilators because it's like dilation. But for those patients who aren't having that, for whatever reason, a dilator can be really helpful for that reason.

Dr. Rojas: And then patients who are maybe having a hard time kind of getting back into the swing of things, I'll sometimes recommend external vibrators to be used during sexual activity as a way to kind of like as part of, you know, I call it whereas you used to do four play, now you're gonna do five play. You really need to give yourself a lot of time. And I actually took that from Dr. Partridge, who's an Ann Partridge, who's an amazing medical oncologist in Boston. everyone should look her up.

Dr. Rojas: But so I I will talk to patients and kind of try to also normalize that discussion for them so they don't feel so intimidated. I'll also point out some good websites for them to go to where they can just like order something that comes to their door and they don't feel intimidated about going into one of what I call pleasure shops and trying to pick something out from a wall of products, which can be really intimidating for a lot of patients.

[31:32] Normalizing Sexual Health Aids

Dr. Bawa: It is intimidating. So many people ask me why I don't carry vibrators because I often tell them that they need to start seeing vibrators as sexual health aids. And that's why, you know, I've decided that I've got to come out with my own and to carry them through my office because taking stigma out of sex also involves taking stigma out of vibrators and sexual health aids and even toys. It's all part of the same thing.

Dr. Rojas: Yes, I think that's a great idea. I can't wait to see what types of products you offer.

Dr. Bawa: It'll be fun. It'll be a fun place. Well, Bawa Medical already is a fun place, but you know, we can make it more fun. So let's talk about what happens a few months, a few years out from cancer treatment and chemotherapy, or perhaps even radiation. When does this start to improve? Does it ever fully come back to normal?

[32:24] Does Sexual Function Return to Normal?

Dr. Rojas: I'm so glad you asked that. usually the symptoms like hot flashes get better. They're usually pretty bad in the beginning and then they they get better over time eventually. But the symptoms related to the vulva and the vagina, if we don't treat them, they're going to get worse. And so that's why I really always start with that. And early intervention is key. And even if you've had these symptoms for a long time and you feel like, oh, there's no way I could get back to sexual activity, baby steps, you know.

Dr. Rojas: And I've really seen a lot of patients do really well with just implementing, you know, one thing at a time. And so I don't think that the genitourinary symptoms get better over time. They will potentially get better if you address them and can get back to regular sexual activity where you're having, you know, episodes of increased blood flow, lubrication, dilation through devices or your partner. And if they can get back to that, then that's kind of like a way of maintenance per se.

Dr. Rojas: But if they don't get back to that point and we're just trying to maintain vulvovaginal health, it is really something that needs to be thought of throughout a woman's lifetime. And even in a normal woman who goes through menopause, I think these are really important concepts to know and to prepare for.

[34:20] PRF, PRP and Research After Cancer

Dr. Bawa: Yeah, I think that's great that you're able to offer them that. speaking of platelet-rich fibrin or PRP, I know you were telling me that PRF is actually better, but speaking about just like that concept in general,

Dr. Rojas: there's actually pretty good data from an Egyptian study and a French study on using PRP injections to the vulva and the vagina and breast cancer survivors. And so we're actually starting a pilot study utilizing that at Sylvester Cancer Center as well. We actually just received funding for it. So that's gonna be, I think it really is having many tools in your toolbox to help patients. The more options you have for them, you know, the better. And also the, I think the more optimistic they feel about getting better.

Dr. Rojas: And so I think that's a great option and something we're also gonna be exploring in our practice as well.

[35:35] Off-Label Treatment and the FDA

Dr. Bawa: I'm really happy to hear that because sometimes people will attack doctors like me who are doing this kind of therapy by calling, you know, us quacks or saying, oh, well, this isn't FDA approved, that isn't FDA approved, but so much that we do in medicine isn't really. So much of the medication we use is off-label. Because sometimes as practitioners we are way ahead of the, you know, the FDA game. And so many times overseas, doctors are doing things years before it's ever approved in the US.

Dr. Bawa: Now, this is not an attack on the FDA, it's just the way things are nowadays. And I find that by doing that, I'm not only helping women internally, but externally. You said, you know, atrophy is a bad word nowadays, but you know, the tissue atrophies, the the labia just shrivels up. And by even injecting that, the collagen that's formed, it now gives it a little more shape.

Dr. Bawa: And now the woman isn't as as self-conscious as she was prior, because you know, there are body issues when you have cancer, you have scars, you have, you know, weight gain, you have your body just isn't your your body anymore. And when the vaginal area is atrophying, you're even more self-conscious in front of a partner. So not only are we improving it internally, we're improving it externally.

Dr. Rojas: Right. And I think, you know, I could do an entire podcast about my concerns about the FDA also and the way that they do things. but I think that you're exactly right. There are a lot of things that we do that aren't FDA, FDA approved per se. And the way I manage that is I always just make sure to explain, you know, the knowns and unknowns for everything we're offering patients. You know, I know this or I think this, but there's always a risk of XYZ. And this, I feel like patients are extremely savvy.

Dr. Rojas: And if you involve them in the decision making, they can determine what they're what is going to work best for them. And as long as they're informed, then then it does give us a little bit more opportunity to operate outside the bounds of only FDA-approved treatments because that process is extremely arduous. And even when things do become FDA approved, there's also issues with that process as well.

[37:47] Dr. Bawa on In-Office Sexual Wellness Treatments

Dr. Bawa: No, the results I've had have been night and day, truly. Truly night and day. So I'm glad that I'm doing this because it's a game changer for women where I may not feel comfortable enough doing, for instance, a CO2 laser or those kinds of more invasive treatments. There's something so benign that doesn't require any numbing, like, you know, the acoustic wave therapy, no numbing, no downtime. there's really nothing but positives to it, at least in my experience.

Dr. Rojas: Well, hopefully I can report back to you after our pilot study.

Dr. Bawa: Good.

Dr. Bawa: Give me something to give my patients. So, how can people find you online?

[38:25] How to Find Dr. Rojas and the MUSIC Program

Dr. Rojas: Well, I have a what I call my doctor gram, which is an Instagram that's dedicated to advocating for women's health and women with breast cancer and breast cancer women and men, you know, breast cancer treatment, and that's at Kristin Rojas M D, K-R-I-S-T-I-N-R-O-J-A-S-M-D. to make an appointment, you can, you know, search for me on the Sylvester Comprehensive Cancer Center, University of Miami website. you know, my main gig is as a breast cancer surgeon, and that's where I see most of my patients. But we do also have the sexual health after cancer program, which is called Music.

Dr. Rojas: It stands for menopause urogenital sexual health and intimacy clinic, and we offer it at the cancer center. And you can make an appointment for that program through the Sylvester website. But the MUSIC program also has its own dedicated Instagram where I try to post updates on new therapies and and tips for managing a lot of these symptoms, and that's @music_sexaftercancer.

Dr. Bawa: Thank you so much for that because I know that there are many, many people who are listening today who feel the need to talk to you, and they should, because not only did you save my life, you gave me a life I never knew I could have. So thank you, thank you, thank you. I will never stop saying thank you.

[39:46] Expanding Access to Sexual Health After Cancer

Dr. Rojas: That is the biggest gift that I get from my job is seeing patients like you do so well, and you know, being able to help patients get through when they're not doing so well, and then to see to see you succeeding and inspiring so many other women is and men is just amazing. So I do want to say one more thing though. the MUSIC program when we opened, it was we had a hard time with the volume of patients that were being referred to us, but I'm happy to report that we have two new team members.

Dr. Rojas: And so I've recently trained two amazing nurse practitioners who work with me at the cancer center. And so we have a little team and we're able to see a lot more patients now. So hopefully anyone who tried to make an appointment and was discouraged, we can accommodate you now.

Dr. Bawa: Isn't that something? Awesome. So you are doing God's work, and now you have a few extra assistants doing it with you. Awesome.

Dr. Rojas: It is a team effort, as you said before.

Dr. Bawa: It takes a village, yes. So thank you, Dr. Rojas. I hope you'll be back again, and thank you so very much for your time today.

Dr. Rojas: It was truly an honor, and I hope to see you soon and wish you the best of luck.

[40:59] Closing: You Can Feel Pleasure Again

Dr. Bawa: Thank you. As you just heard, there is a lot that can be done for women suffering through the sexual and intimate health aftermath of cancer treatment. From medications to sexual health aids to BawaWave® acoustic therapy, to BawaShot®, to an incredible device that I just introduced to Bawa Medical. There is so much that can be done to improve your quality of life. You can feel pleasure again. You can start to live again. To those of you who have had cancer or are currently fighting cancer, I have walked in your shoes. I am here to support and to inspire.

Dr. Bawa: I am here to fight the good fight. I am here to raise funds for cancer research. I am here to make your life better. We are in this together. If you are a cancer patient or someone you love is, please call me sooner rather than later. It is never too early to fight the effects of cancer and to minimize the toll on your mind, body, and soul. As I said earlier, it is very important that you share this episode with family, friends, and co-workers. Text them a link right now.

Dr. Bawa: Help me spread not only breast cancer awareness, but my message of sexual wellness and healing. And remember, always let your faith be bigger than your fear. Until next time.

[42:29] Recorded Outro

Dr. Bawa: I hope you enjoyed the Dr. Sex Fairy podcast today. I would love to continue this conversation with you. If you would like to get in touch with me, email me at askme@drsexfairy. com. Don't forget to follow this podcast and leave me a five star review. And make sure you follow my Blockbuster hit TikTok account, Dr. Sex Fairy.