I lay on my side, cradling my iPhone, watching “bleeding after sex” and dabbing a piece of toilet paper between my legs. I wondered whether or not I should wake up my new boyfriend.
the Healthy woman website said, “It’s common for women of all ages to have bleeding after sex at one point or another. In fact, up to 9 percent of all women experience post-coital bleeding (other than first intercourse) at some point in their lives. Most of the time, it’s nothing major and goes away on its own. But bleeding after sex can also be a sign of something more serious. ” SIGN OF SOMETHING SERIOUS?
Awesome. I had already had acute myeloid leukemia many times, and now when things got better, WebMD said this new symptom could mean that I have pelvic organ prolapse (when the pelvic organs, such as the bladder or uterus, protrude past the vaginal walls).
I found a site where someone asked, “Could my uterus fall out?” No, it couldn’t. At least I had that.
“The most important thing to pay attention to is the rate and volume of bleeding,” the article read. “Most bleeding after sex is fairly light. Heavy bleeding – when you soak in a towel every hour or leave clots larger than a quarter – warrants a visit to the emergency room. ”
I didn’t have a quarter, but I had a clock that showed it was two hours. The doctor on duty at my internist’s office around 2 or 3 a.m. looked annoyed.
“You should have called your gynecologist,” he says. But he called for an emergency. I woke up my boyfriend and we left on the spring night that had so much promise. Intellectually, I knew it wasn’t my fault, but I was more embarrassed than if I had worn white shorts and had my period in the gym.
On the TLC series, “Sex sent me to the emergency room ” worse things happen, like things stuck where they shouldn’t be. My problem was more trivial, but I also found it very common: the lack of information after my cancer treatment.
No one told me that the chemotherapy, which I had undergone after my diagnosis in 2003 and again after relapses in 2007 and 2008, could cause a sudden loss of estrogen production in my ovaries, and that it could cause symptoms of menopause such as thinning. vagina and vaginal dryness. (In fact, the first round put me in early menopause at 48.) No one told me that vaginal dryness can cause pain and bleeding during sex.
Still, data shows that the incidence of sexual dysfunction in cancer survivors is quite common. Common sexual side effects are difficulty reaching climax, less energy for sexual activity, loss of desire, reduced size of the vagina, and pain during penetration.
For me, it had been a 10-year drought. You shouldn’t need a reason not to have sex, but I’ve had some good ones: 2009 treatment for relapsed leukemia, life-threatening infections after a rare shift stem cell transplant, a coma, hospitalization for four months and a year just to get back on my feet.
My 13-year long marriage had consisted of a good 10 years and three descending down a road full of landmines. Afterward, a four-year relationship with an English teacher ended in appropriate dramatic form when he rediscovered his childhood sweetheart as I mourned my father’s death. Running his hands through his long gray hair, he said, “We’re like Heathcliff and Cathy. I love her more than I love you! I had to revise my “Wuthering Heights” to get it. Heathcliff and Catherine were soul mates.
My soul mate was nowhere to be found. It wasn’t the guy who walked into a restaurant that looked pale and mushy and had nothing to do with the picture of the fit guy on his online profile, making me think of climbing out the window from the bathroom. It wasn’t the guy I met at a Matzo ball, where Jewish singles go on Christmas Eve to behave like eighth grade students at a school dance; we lasted about six months until he complained that he was lower on the totem pole than my three children. I thought maybe it was the tennis player who put on my rackets and said he fell in love with me, but he disappeared, in a feat that I later learned had a name: te to dry.
“Please tell me you’ve seen worse than this,” I said to the nurse as I lay down on the examination table.
I decided to take the advice of friends who were tired of hearing me talk about grief and disappointment: Live your best single life. I stopped paying for dating sites, but left a profile on a free site.
Stop trying to find something, and if you’re lucky you will find it or it will find you. Nice guy wrote that he liked my profile (uh, hated writing these things). He thought we had a lot in common (running, kids, reading, similar politics) and would like to have a conversation. Is it silly to say that as we walked towards each other in front of the restaurant where we were to meet, we were gathered? Maybe it was just a relief that he looked normal and looked like his profile picture.
We sat at a high table in the bar. Our fingers rubbed against each other as we lifted our phones to show us pictures; his, places he had walked, and mine, children and dogs. The next day, we went for a walk, and he passed a big test: meet my chocolate labrador retriever. She had a crush on him. I think it’s the soft voice. It also works on me.
I was using estrogen vaginal cream, Estrace (generic name estradiol), twice a week, to reduce symptoms of menopause such as vaginal dryness, burning and itching. Although I was concerned about the side effects, my doctor said the small amount was not absorbed outside the vagina, unlike hormone replacement therapy, which goes into the bloodstream. She said it was also okay to use Estrace once a week and Replens, a non-hormonal moisturizer, the rest of the time if I wanted to.
I remembered hearing that I would need to increase the dose if I wanted to have sex again. I made an appointment with my gynecologist to see if I should do anything else to prepare for physical intimacy.
The doctor’s assistant who saw me said, “Go to the toy store.” I was confused. My children have grown up. Why do i need a toy store? I learned she was talking about the sex toy store hidden behind a door next to a pizzeria.
I have a set of six pink dilators. They started out at the size of a rose and gradually grew to an intimidating size. They didn’t come with instructions on how long to leave them. The little one entered OK. I kept it on for a few minutes, then put on the next bigger one, increasing in size until I had enough. There’s not much you can do when you’re hanging out with a pink fake penis in your vagina.
When the time finally came for real sex, I enjoyed it. It hurt after a while, so we stopped, but I thought it was normal. Then I felt something sticky on my legs. It was blood. Blood on the sheets, blood on our legs. We got in the shower, changed the sheets and went back to bed. It couldn’t have been less romantic.
The emergency room was even worse – dirty and poorly lit. He sat down with me, holding my hand and looking as upset as I was, until a nurse called me and fell asleep in the car.
“Please tell me you’ve seen worse than this,” I said to the nurse as I lay down on the examining table, feeling raw, emotionally and physically. She said she had. The doctor did an internal exam and said the blood was probably from rubbing. It was dawn when we finally got out of there. We went out for breakfast. Ordering my traditional blueberry pancake with an overly hard-boiled egg brought a sense of normalcy to the mishap.
The following week I returned to the doctor’s office and this time saw the gynecologist herself.
“Let’s start from scratch,” she said. I had to leave a dilator on for 15-30 minutes, while doing diaphragmatic breathing. She sent me to pelvic floor therapy to learn relaxation exercises. I have used Estrace for two consecutive weeks. By the time we had sex again it didn’t hurt, but I nervously checked the sheets for a long time after. I figured if we could have a post-coital visit to the ER, we could go through almost anything.
I might not know much about sex after cancer, but it’s a topic that gets talked about more and more. I’ve learned that after years of dismissing women’s sexual function as one of those things cancer takes away, many see women’s sexual health as a survival problem. A the expert I interviewed for an article on sex after cancer even called the lack of information for cancer survivors a “health equity issue.”
Many cancer centers are starting to open sexual health programs. My own cancer center was one of them. “We missed you by about a year,” the director told me.
Luckily, I’m no worse for wear and I’m still with the nice guy. I use Estrace (and sometimes Replens) twice a week and a lubricant when I have sex. Doctors say one of the best ways to treat vaginal dryness is to have more sex, because the increased blood flow stimulates lubrication.
Now that the memory of the emergency room visit goes back almost three years, it seems like a good idea to me.
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