I lay on my side, cradling my iPhone, looking up “bleeding after sex” and dabbing a piece of toilet paper between my legs. I thought about whether or not I should wake my new boyfriend up.
The Healthy Woman website stated, “It’s common for women of all ages to have bleeding after sex at one time or another. In fact, up to 9 percent of all women experience post coital bleeding (outside of first sex) 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?
Great. I had already had acute myeloid leukemia multiple times, and now, when things were looking up, WebMD said this new symptom could mean I have pelvic organ prolapse (when pelvic organs, like the bladder or uterus, jut beyond 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 — where you’re soaking through a pad every hour or passing clots larger than the size of a quarter — warrants a visit to the emergency room.”
I didn’t have a quarter, but I did have a clock that showed it had been two hours. The doctor on call for my internist’s office, around 2 or 3 a.m., sounded annoyed.
“You should have called your gynecologist,” he said. But he called ahead to the ER. I shook my boyfriend awake, and off we went into the spring night that had held so much promise. Intellectually I knew it wasn’t my fault, but I was more embarrassed than if I had been wearing white shorts and gotten my period in gym class.
On the TLC series, ”Sex Sent Me to the ER,” worse things happen, such as objects stuck where they shouldn’t be. My issue was more mundane, but I found out also very common: lack of information after my cancer treatment.
Nobody told me that chemotherapy, which I’d 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 this could lead to symptoms of menopause such as a thinning vagina and vaginal dryness. (Actually, the first round put me into early menopause at 48.) Nobody told me that vaginal dryness can cause pain and bleeding during intercourse.
Yet data shows that the incidence of sexual dysfunction among female cancer survivors is somewhat 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 my part, it had been a 10-year dry spell. You shouldn’t need a reason for not having sex, but I had good ones: treatment in 2009 for relapsed leukemia, life-threatening infections after a rare fourth stem cell transplant, a coma, a four-month hospitalization and a year just to get back on my feet.
My 13-year marriage, long over, had consisted of 10 good years and three downhill all the way along a road full of land mines. Afterward, a four-year relationship with an English professor ended in fitting dramatic form when he rediscovered his childhood sweetheart while I was mourning the death of my father. Pulling his hands through his long gray hair, he declared, “We’re like Heathcliff and Cathy. I love her more than I love you!” I had to brush up on my “Wuthering Heights” to get it. Heathcliff and Catherine were soulmates.
My soulmate was nowhere to be found. He was not the guy who walked into a restaurant looking pale and pasty and nothing like the photo of the fit guy on his online profile, making me think of climbing out the bathroom window. He was not the guy I met at a Matzo Ball, where Jewish singles go on Christmas Eve to comport themselves like eighth graders at a school dance; we lasted for about six months until he complained that he was lower on the totem pole than my three children. I thought he might be the tennis player who strung my rackets and said he was falling in love with me, but he disappeared, in a feat I later learned had a name: hanging you out to dry.
'Please tell me you’ve seen worse than this,' I said to the nurse as I lay on the exam table.
I decided to follow the advice of friends who were tired of hearing me talk about heartbreak and disappointment: Live your best single life. I stopped paying for dating websites but left a profile on a free one.
Stop trying to find something, and then if you’re lucky, you will find it, or it will find you. A nice guy wrote that he liked my profile (ugh, I hated writing those things). He thought we had a lot in common (running, kids, reading, similar politics) and would love to have a conversation. Is it corny to say that as we walked toward each other in front of the restaurant where we were to meet, we were being pulled together? Maybe it was just relief that he seemed normal and resembled his profile photo.
We sat at a high table in the bar. Our fingertips brushed together when we held up our phones to show each other photos; his, of places he had traveled, and mine, of kids and dogs. The next day, we went for a walk, and he passed a big test: meeting my chocolate Labrador retriever. She got a crush on him. I think it’s the soft voice. It works on me, too.
I had been using a vaginal estrogen cream, Estrace (generic name estradiol), twice a week, to reduce symptoms of menopause such as vaginal dryness, burning, and itching. Though I was concerned about 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 OK to use Estrace once a week and Replens, a nonhormonal moisturizer, the rest of the time if I wanted to.
I remembered hearing that I would need to up the dosage 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 physician’s assistant who saw me said, “Go to the toy store.” I was confused. My children were grown. Why did I need a toy store? I learned that she meant the sex toy store tucked behind a doorway next to a pizza place.
I got a set of six pink dilators. They started pinky-sized and increased by gradations up to a dauntingly large one. They didn’t come with instructions regarding how long to leave them in. The small one went in OK. I kept it in for a few minutes and then put in the next larger one, increasing in size until I had had enough. There’s not much you can do when you’re lying around with a fake pink penis in your vagina.
When it finally came time for real sex, I liked it. It hurt after a while, so we stopped, but I thought that was normal. Next 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 got back into bed. It couldn’t have been less romantic.
The emergency room was even worse ― grungy and poorly lit. He sat with me, holding my hand and looking as upset as I was, until a nurse called me in and he went to sleep in the car.
“Please tell me you’ve seen worse than this,” I said to the nurse as I lay on the exam table feeling raw, emotionally and physically. She said she had. The doctor did an internal examination and said the blood had likely come from chafing. It was dawn when we finally got out of there. We went out to breakfast. Ordering my traditional blueberry pancake with an egg over hard brought a sense of normalcy to the misadventure.
The next week, I returned to the doctor’s office and this time saw the gynecologist herself.
“Let’s start from scratch,” she said. I was to leave a dilator in for between 15 and 30 minutes, while doing diaphragmatic breathing. She sent me to pelvic floor therapy to learn relaxation exercises. I used the Estrace for two weeks straight. By the time we had sex again, it didn’t hurt, but I nervously checked the sheets for a long time afterward. I figured if we could get through a post-coital visit to the ER, we could get through most anything.
I may not have known much about sex after cancer, but it’s a topic that’s starting to be talked about more. I learned that after years of dismissing women’s sexual function as just one of those things that cancer takes away, many see women’s sexual health as a survivorship issue. An expert who I interviewed for a story on sex after cancer even called the dearth of information for female cancer survivors “a health equity issue.”
Many cancer centers are beginning to open sexual health programs. My own cancer center was among them. “You missed us by about a year,” the director told me.
Luckily, I’m no worse for the wear and am still with the nice guy. I use Estrace (and sometimes Replens) twice a week and a lubricant when having sex. Doctors say that one of the best ways to treat vaginal dryness is to have more sex, because increased blood flow stimulates lubrication.
Now that memory of the ER visit is almost three years in the past, that seems like a fine idea to me.