The diagnosis of a neurological condition or a stroke turns your life upside down. Suddenly, you’re spending more time visiting doctors and therapists than working, may be unable to participate in activities you love and may find yourself coping with a baffling array of medications and other treatments. But have you ever considered the effect such conditions may have on your sexual life?

Well, if you consider that sex starts in the brain the center of any neurological illness it can have quite an impact. Add to that the multiplier effects of fatigue, physical disability, depression and loss of independence, and you can imagine how total the loss might be.

Neurological conditions can affect how you process sexual stimulus, whether it’s touch or visual. That can affect your level of desire, your ability to become aroused and your ability to reach orgasm. For instance, studies suggest that as many as 72 percent of women with multiple sclerosis have sexual dysfunction.

And women with may experience involuntary sexual gestures, such as touching themselves, grabbing their genitals, even having unintended orgasms, even as antiepileptic drugs tend to reduce libido.

Whether you are single (dating or not), in a committed relationship or married, your sexual self is part of who you are.

You may have enjoyed a sexually active life before your breast cancer diagnosis. Now, you might find yourself:

• Dealing with sexual side effects from treatment, such as vaginal dryness or pain
• Feeling anxious about how your body looks
• Wondering if your partner still wants to be close with you
• Worrying because you don’t feel like having sex (alone or with a partner) or being intimate at all.

These concerns and difficulties about sex are normal, normal, normal.

Will It Always Be This Way?

Breast cancer and its treatments often affect sexual health and function, including the emotional and

psychological well-being that supports an enjoyable sex life.

Regardless of your age, you might be surprised by such changes. Before diagnosis, you may have associated these issues only with menopause.

Many doctors and healthcare providers talk very little about the sexual side effects of treatment. You may be reluctant to bring up the subject, out of discomfort with talking about it or to protect your own or your partner’s feelings.

But take heart:

• Your “new normal” doesn’t have to include the loss of sexual expression and satisfaction.
• You can use simple solutions during and after treatment, or while on continuing therapy, to gain the quality of life benefits of sexual activity and intimacy.

Why Breast Cancer Affects Sex and Intimacy

Breast cancer diagnosis and treatment produce physical and emotional changes that can alter your sexual self-image, comfort, arousal, response or desire.

Surgery may remove one or both breasts and nipples (mastectomy), or part of a breast (lumpectomy).

• For many women, breasts are important to sexual identity, feeling attractive and erotic play. Adjusting to that loss after surgery can be difficult.
• For those who have reconstruction, you may be unprepared for the lack of sensation in your new breasts, or for how the breasts look.
• You may have pain, scars and numbness from surgery, cording or lymphedema  swelling.

Chemotherapy can cause ovaries to shut down, limiting estrogen:

• Menstrual periods may stop temporarily or permanently.
  • This brings menopausal symptoms that affect sexual function — night sweats, hot flashes, sleep problems, vaginal dryness and depression.
• Reduced lubrication dries out the vaginal walls, vulva (external genital organs) and the opening to the vagina.
  • Vagina narrows and shortens. Walls become thinner, less elastic and more fragile. Vulva flattens and thins. Levels of pH and healthy vaginal acidity drop.
  • Pelvic floor muscle difficulties may develop.
  • These changes cause irritation, bleeding, burning and pain, especially during penetrative or insertive sex.
  • Once you have pain, you might avoid sex.
• Nerves and blood vessels which supply sexual organs may be damaged.

Hormonal therapy (tamoxifen, aromatase inhibitors) also causes menopausal symptoms, dryness and pain. Radiation can make skin feel too sensitive to touch.

Hair loss, fatigue or weight changes can affect sexual self-image and interest. Some antidepressants also lower sexual response.

Yes, sex can be satisfying after breast cancer treatment! Here’s how:

Forget penetration (for a while).

• Cuddle, hug, massage, make out, touch new parts of your body — enjoy sexual activity without penetration.
• Build sensual response and desire slowly.
• You and your partner can still share pleasuring each other to orgasm.
• Wait to enjoy intercourse, if you choose to, after you have no vaginal pain when using a dilator.

 Incorporate sexual fantasies.

• Use fantasies to fuel interest in sex or charge up a long-time relationship.
• Reading can include romance novels, fiction with explicit sex or books of women’s sexual fantasies.
• You might enjoy watching erotic movies, with or without your partner.
• Remember — you don’t have to read or watch anything that turns you off.

 Stimulate yourself.

• What feels good to you and how long it takes to become aroused may have changed after treatment.
• It helps to figure out what you enjoy on your own before sharing with a partner.
  • You aren’t being disloyal to your partner by masturbating.
  • Self-pleasuring can help you respond more to sex when you’re together.
• If you’re single, self-stimulation provides the benefits of sex without needing a partner. It also keeps your body ready for sex with a partner if you want it.

No matter what condition you’ve been diagnosed with, you don’t have to resign yourself to a life without sex or intimacy.

Talk to your doctor. 

Tell your doctor how important your sexual life is to you. I know this might be difficult, particularly if you’re not used to talking about such issues with “strangers,” but it’s worth it. In many instances, the medications you’re taking may be interfering with your libido; in other instances, your doctor may be able to prescribe certain medications to improve libido, such as supplemental testosterone and even sildenafil (Viagra).

Talk to your physical and occupational therapist. 

These health care professionals often spend hours a week with their patients. They get to know them and their problems well. And they often have unique strategies emotional and physical to help you retain the intimacy you desire.

Educate yourself. 

The more you know about the possible effects your condition or your partner’s condition may have on intimacy, the better prepared you are to face the challenge. Knowledge is power.

Talk to your partner.

 If you’ve had a stroke, for instance, and you don’t have as much sensation on one side of your body, ask your partner to focus on areas that can still feel sensation. Also have an honest conversation with your partner about the importance of intimacy in your life.

And listen to what your partner says without judging. For instance, your partner may tell you that the drooling that is a result of your Parkinson’s turns him off. If this is the case, talk to your doctor about options for reducing this symptom.

Rediscover intimacy. 

Who says intimacy is all about intercourse? Intimacy could be taking a bath together in candlelight or giving each other massages with scented body oil.

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