Aromatase Inhibitors, Vaginal Atrophy and Sexuality

It is hard to put this to words – the way that I know my spirituality and sexuality to be intimately connected. There is an energy – an aliveness – that I am aware of when I am in touch with my sexuality. This does not necessarily mean that I am having great sex with my husband. It is something much broader that carries through my whole day, into every corner and cranny of my life. It’s how I know myself, a deep joy in my bodily existence that I can tap into at any time.

Aromatase Inihibitors – Femara for me – brought all of this to an abrupt stop. Extreme vaginal dryness not only has made sexual intercourse painful and something that I fear (what if my skin in there tears? what if I get another urinary infection?) but also has confused my sense of sexuality.

I have been taking Femara for 9 months. After using a myriad of over the counter creams and gels, 3 major urinary tract infections and repeated complaining about the discomforts of vaginal dryness, both my oncologist and my gynecologist have recommended that I use Vagifem. Vaginal atrophy is progressive, they tell me, and will not get better with time. It most likely will get worse.

This is confusing and scary to me.

The articles on the Internet say that Vagifem is not recommended to women taking AIs because it counters the effect of the AI – blocking all estrogen from the system. Estrogen levels are elevated in the blood of women using Vagifem with an AI.

So, I would be taking a drug ($30 a month) to block estrogen, and another one ($30 a month) to put estrogen back in.

Money matters aside, I wonder if I wouldn’t be better off stopping both drugs.

I’m annoyed about all those years that doctors were prescribing estrogen, en masse, to menopausal women. The drug companies made a bundle before they discovered that estrogen increased the incidence of breast cancer.

Now the drug companies are making a bundle on estrogen-blocking drugs taken by all those women who got breast cancer. Who is to say that in a few years we won’t find the down side of these drugs?

Doesn’t Nature know best how to manage the hormones in my body?

And then there is the cancer worry. What is it that caused my body to develop breast cancer? Something in the environment? Hormone pumped cows? The synthetic estrogen that I took 10 years ago?
Will an estrogen free body keep the breast cancer from returning, and should I diligently pursue this approach, even if it means no sex and urinary infections?

I have many questions.

the thing about the Femara

The thing about the Femara is that I never know if my feeling bad is due to the drug, or just the way I would be feeling anyway.

Well, almost. I do know that my bones and joints ache a lot more. And that the vaginal dryness is like nothing I have never before experienced.

But why do I feel so disconnected from my body? Like my body is no longer me, but somewhat distant. I think that sex has a lot to do with connecting myself with my body, and that has been less than satisfactory. But also I don’t seem to get a rush of endorphins when I exercise anymore. I always feel more or less, not well.

a place to put my hurt

First, a confession: I can be quite neurotic – hypersensitive, over-dramatic, lacking in objective perspective, even downright loony.

Perhaps I am still “processing” the whole ordeal of losing my right breast. Or maybe I'm this way all the time, but won't admit to it without an excuse.

I do not want any of the feelings that I write here to reflect on the professionalism and skill of the doctors who have treated me. Even though I have not quite come to terms with my reconstruction surgery – things are, in fact, still changing – I consider my plastic surgeon to be extremely competent, responsive, and perhaps a genius.

I am getting used to my new breasts – even starting to feel that they look good, despite not being perfect matches. The right breast is falling more and I don’t feel so strange looking.

And because I’m more healed, I’m not afraid to expose my breasts anymore. (Yes, I make love with nothing covering them now – yeah!) What is it about the way I do not want others to see my wounds - to see where I hurt? I bet a shrink could make something of that.

Maybe part of my reason for writing here is to have a place to put my hurt.

sadness

when sadness comes to the surface
does that mean that it is about
to go away?

when all I can do is sit with it
does that mean that
I have made a home for it?

today Dr. Rimmer told me that
it was time for me to be
happy again.

but happiness comes through
(not after)
sadness for me.

things are getting better

Things are getting better.

For one thing, I think that some swelling is going down in my right (silicon) breast, so that I don't feel quite so freak-y looking. This all may work out without an additional surgery.

For another, I have an appointment with my primary surgeon on Monday. It's really just a final followup from the mastectomy surgery in Decemeber, but I also need some reassurance that everything, anatomically, is stable and ok - like, are you sure that that little strip of skin going down the center of my 2 breasts is not going to pop out??!

And ... I had lunch with 3 friends yesterday (2 women and 1 man) and they all told me that my breasts looked fine. Maybe a little lopsided, but nothing that was overly obvious.

I'm ready to let go of my hyper-sensitivity and move on.

I'm stuck

I am confused. I am a mess.

The only way I know to work my through stuff is to write. Or at least write first, so I can have some idea of what’s going on.

I need to get beyond all this breast stuff. I’m hung up on the cosmetics of it all. How I look. I’m embarrassed with this big round silicon boob that sits high on my right side. I make sure my clothes cover it up, which isn’t always easy in Florida. I have no idea what I will do about wearing a bathing suit in public. I will have to get something very high and loose – do they make bathing suits like that? I am not naked when I make love with John anymore; I always have something covering my chest.

And I'm embarrassed with being so obsessed with it all.

Some people tell me that I should go back to surgery and get it fixed right away. Others tell me to wait, see if gravity and time will help.

I don’t know what to do.

I feel silly being so hung up on how I look. One woman said to me, “I never knew this part of your anatomy was so important to you.”

I didn’t either.

Someone recently pointed out something I wrote in 2006 on another blog about silicon implants. Boy, have times changed.

Am I over-reacting? Do I need to just think about something else and move on? How do I do that?

$39,070.61 for a boob job, and this isn't over yet!

The hospital bill came last week for the Breast Reconstruction Surgery that was done last month. $39,070.61. And this was an outpatient surgery. My gosh. How do women who are not breast cancer patients afford these boob jobs?! Or do they charge more when it is covered by insurance?

My insurance (for which I pay $1200 per month) is covering all but $1405.23. But I’m not sure if this is the end of it. It seems that these bills keep creeping in for months after the affair.

And it seems clear that I will need another surgery. Will my insurance cover that? We can barely even afford the insurance. (Actually, we can’t afford it.)

Yesterday I was visiting with girlfriends and I showed them my breasts. This is the first time that I have uncovered myself to people other than John or doctors. Both Lynda and Deb think that the way I am now is unacceptable. The left (native) breast is fine, lifted and slightly augmented with silicon at the top. The right breast, the silicon implant, is very high and round and much larger than the left side, at least on the top. So that I’m both lopsided and imbalanced. More and more, I’m beginning to think that taking out all implants, and learning to be as I am – a unibreast – is the best solution. But I’m not sure if I’m brave enough. I’m self-conscious enough of my strange looking chest without clothes on, how would it be to look so “different” with clothes on?

Before the surgery, Dr. Lickstein told me that 25% of Breast Reconstructions require further “procedures” to make things right. I guess I’m in that 25%. At the time I thought that meant a little tuck or something in the office. Now I realize that it means another surgery.