Imagine a woman. The word that pops into my head when I hear the word ‘€œwoman’€ is ‘€œjuiciness’€. I imagine her juicy lips, the juicy sway of her hips, a voluptuous body that oozes juiciness. And of course her juicy genitals.   I have an immediate image of hair both on her head as well as her pubic area. Lush hair that defines her ‘€˜womanliness’€™. I think about her soft skin, plump cheeks, her waist line that tells us she is in her reproductive prime. And of course, her perky breasts.

Imagine a woman who has had all the estrogen sucked out of her body. And you are left with the opposite of juiciness. Dry, barren, sallow, hairless, waistless, wasted. Sexless juiceless woman. Depressed ,dried out memories as there is no estrogen to give you cognitive functioning that allows you to remember your hairdresser’€™s telephone number. Or your own mobile number.   Dried out vaginas and labia that look old and shrunken. Penetration that becomes so painful that eventually all sexual play dries out.   Dried out sexual desire that leaves you longing for the days when once a week was a good week.

Despite feminism, despite woman’€™s rights being deeply honoured, at heart all women are creatures wanting strokes and admiration for their looks. At heart we want to be aesthetically admired and even if we do not see ourselves as men’€™s trophies or adornments, we do want recognition for our juiciness. Women spend hours of their lives in angst over their looks, never feeling fully satisfied with their own mirror reflection. Women spend much money on their bodies, on jewels, clothes and perfumes in the hope to improve, hide and make invisible what they struggle to accept in themselves. Estrogen is the magic hormone that gives women juiciness.

Women take their estrogen for granted. Its just there. And as they go through peri-menopause they kind of know something changes that sucks them somewhat dry. They call these changes ‘€œageing’€ and adapt to accommodate acceptable, though disliked, changes as society knows about ageing. Many women who are good candidates, who are well informed, turn to estrogen replacement to get back their juiciness.

Society does not know about women who loose their estrogen due to cancer treatments and maintenance therapies. Especially women who are chronologically far away from natural menopause. We do not know how to elegantly deal with a 30 something year old woman having a hot flush. Until someone whispers to you that she is a cancer survivor. Suddenly we feel empathy for this woman and treat her as a ‘€˜patient’€™.

Being ill is never associated with sexuality. Thus there is no way that this 30 something year old estrogen deprived woman will be seen as a juicy sexual woman. Not by herself and too often, not even by her health care provider.

 Presently female sexuality is under the spot light. New research is being conducted into the classification of female sexual dysfunctions as the DSM V manual is to be released in 2013. The DSM is the Diagnostic and Statistical Manual used by every clinician to diagnose psychiatric illnesses, including sexual dysfunctions and gender identity disorders. Right now we know a lot about healthy women’€™s sexual responses. For example we know that ‘€œhealthy’€ women, i.e. women with estrogen, do not have spontaneous desire, but are much better at responding to sexual cues. This means that because women have little testosterone, and much estrogen with progesterone too, they do not feel naturally horny, as do men. Women need to be motivated to have sex. As in, I will have sex with my partner as this will make me feel close to him/her; because it will be a great physical experience for me, because it will stop him straying. As you can hear it takes somewhat a lot of effort for the healthiest woman to want sexual play much and often times much less than her man. But once she gets going, her juiciness begins to flow and she will love having sex and even orgasms.

Women start out sexually disadvantaged ‘€“ they have their sexual desire beaten out of them in childhood (‘€œnot lady like’€), 1 in 3 will be a victim of sexual violence , and then she   feels conflicted about her   sexual desires as a teenager (‘€˜slutty’€ is a label all women try to avoid)   She looses lots of her sexual desire and arousal after having children, finds it difficult to accept her changed body and then, at that point of her life she may be hit with a diagnosis of cancer.

Cancer commonly occurs in the woman who is just adapting to menopause. She may have finally found her sexual flow after being placed on hormone replacement therapy only to have what feels like the elixir of life, removed from her blood stream.

Hormone replacement therapy for women is controversial. Women   on maintenance treatment plus HRT is   even more controversial. Many oncologists refuse to go there , considering the risks outweigh the benefits.

Consider the principles of sexual medicine, and I write to you from my paradigm of sexual medicine consultant and therapist, not as a medical doctor. Principle 1 is that we work in a ‘€œpatient centered’€ manner. This means the rights, needs of the patients come first. Health care providers are obligated to provide patients with information and education and must allow patients AND their partners, to make decisions. Principle 2 is that all information must be ‘€œevidence based’€. This means all information given to a patient and her partner must be based on rigorous updated scientific evidence. Principle 3 says all health care providers must work in an integrated multidisciplinary manner. So your dietician must consult with your oncologist who must consult with your surgeon and your sexual medicine health care provider.

Sexual medicine, like all branches of medicine, further embraces the principles of the patient and partner’€™s rights to   ‘€œquality of life’€, ‘€œsexual satisfaction’€ and ‘€œoverall well being’€.

Consider the role of estrogen therapy (ET) in the life of a cancer survivor. Clearly an excellent individualized assessment of risks to benefits must be conducted, bearing in mind the principles of sexual medicine. The health care provider must be open to the needs of the patient and partner. Including the sexual needs. Much can be done to overcome simply horrible symptoms of estrogen loss, described above.

The literature suggests the use of systemic therapy as controversial. However the use of local vaginal therapy is well supported by evidence based research. In addition to the use of this , water based and even better, silicone based lubricants can be offered to women to ease the pain of sexual penetration. Imagine how fine a woman with an estrogen replenished vagina will feel.. just knowing she is back to being beautiful ‘€œdown there’€ and it functions.

Let’€™s not be naïve, however. A single intervention, such as a local estrogen vaginal replenisher, is never enough to get a woman hot and horny- not even a ‘€œhealthy’€ woman. A woman needs a lot of various interventions to take her to the promised land of sexual bliss.

In my next article I will discuss other needed interventions. Right now, however, I do want women who lack juice to begin juicing their vaginas. It is an important, vital step, to begin juicing yourself into your rightful sexuality. Find a health care provider who will listen to you and work with you in a competently honorable manner. Let the juices flow’€¦

 Dr Eve has a Doctorate in Human Sexuality and is in private practice as a clinical sexologist and couple and sex Therapist in Cape Town. She is a part time lecturer at UCT Medical School. She will be contributing to Health-e’€™s Cancer Expert column dealing with issues around Cancer and sexuality.