Episode 52: Rekindling Intimacy & Empowerment After Cancer w/ Traci Owen

This episode features Traci Owen, an oncology nurse & certified sexual counselor to discuss sexual health in the face of a cancer diagnosis & beyond. As someone who has walked the precarious path of breast cancer myself, I bring a deeply personal perspective to our conversation on sexual health in the cancer community. Traci's extensive experience in guiding patients through the challenges of intimacy post-diagnosis couples w/ my own journey to offer a unique & profound exploration of the silent struggles that often go unvoiced.
E-Mail Traci Owen @Intimate Pathways 

Intimate Pathways Website 

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A Better Normal: Your Guide to Rediscovering Intimacy After Cancer

Intimacy After Breast Cancer: Dealing With Your Body, Relationships and Sex

The Ultimate Fun Book for Couples

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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .

Transcript

Speaker 1: 0:01

Welcome to Season 2 of Test those Breasts podcast. I am your host, jamie Vaughn. I am really excited to continue this journey and mission into 2024 to help shorten the overwhelming learning curve for those who are newly diagnosed, or yet to be diagnosed, with breast cancer. It has been such an honor and a privilege to be able to connect and interview many survivors, thrivers, caregivers, oncologists, surgeons, nurses, therapists, advocates and more, in order to provide much needed holistic guidance for our breast cancer community. Breast cancer has become such an epidemic, so the more empowered we are, the better. Hey, friends, now let's listen to this next episode of Test those Breasts.

Speaker 2: 1:08

Hey friends, welcome back to this episode of Test those Breasts. I am your host, Jamie Vaughn, and today my guest is Tracy Owen. Tracy has a very interesting bio and a wonderful, wonderful lady. Tracy has worked in healthcare since the age of 17. She has been a practicing RN for the last 35 years and in the last 14 years she has lived in the specialized world of oncology. In 2015, she created an oncology sexual health program focused around tender topics of relational intimacy, sexual body changes related to treatment and all that entails in the human experience. This passion fueled her to become a certified sexual counselor and sex educator through the American Association of Sexuality Educators, Counselors and Therapists. She is the executive director and clinician at Intimate Pathways Center for Sexual Health, where the mission is empowering women as they reconnect to their mind, body and intimate partner.

Speaker 2: 2:11

Intimate Pathways is located in Broken Arrow, Oklahoma. Today I'm super honored and excited to have Tracy Owen, with an organization called Intimate Pathways, on my show, and I am super excited to have her on my show. I was introduced to her through my friend, Natalie Stevenson, with Cancer Community Clubhouse here in Reno, Nevada, who I also interviewed in the past. She led me to Tracy and which really intrigued me because of the topic we are going to be talking about today. How are you doing?

Speaker 3: 2:44

Tracy, you know I love being able to reach out to people, so this is a treat for me. I'm doing great.

Speaker 2: 2:52

Good, you and I've had a conversation in the past. We have this great connection and I really learned a lot from you from just that, and I am certain my audience is going to learn so much and I will learn more today. But you really intrigued me because we're going to be talking about sexual intimacy with partners especially revolving around the cancer community. One of the reasons I was intrigued by it is because, well, I'm 56. So when I was diagnosed with breast cancer, I was 54. And literally, I would say maybe a month before I was diagnosed, I was being intimate with my husband. We've always had a fantastic intimate relationship. That is something I've never had any complaints about with my husband and we still are that way. We were intimate and it was crazy. It hurt so bad. One day it just knocked the wind out of me. I was just so upset about it, and so was he, because it just has never happened before.

Speaker 2: 3:49

And then about a month later, I was diagnosed with breast cancer and since then I've learned a lot about how breast cancer affects our sexual life. And of course, I'm also at menopause age and so there's so many things that kind of go along with that. You got all of it together. Yeah, I got it all together and it just. I mean, literally, I was just going along with life, tracy, and I was happier than a clam if clams are happy and all of a sudden it just all hit me. So I just would love for you to share with us. Can you give us our audience a little understanding of what you do and how that actually aligns with the cancer community?

Speaker 3: 4:29

Well, this is my story. I am a 58-year-old woman. I had menopause on a Tuesday at the age of 36 when I had all of my parts removed. That was quite an adjustment in life, right. But so Tracy is a nurse.

Speaker 3: 4:47

I have been in healthcare for 40 years. I've been a nurse for 35 of those years and I've worked in oncology for 15 of those years. So oncology I would say trauma medicine, which is where I started is my jam and I would say oncology medicine is my heart. So two very extreme places of health care. I moved into.

Speaker 3: 5:12

Cancer Treatment Centers of America is where I started 15 years back and I was a care manager. So I was walking the journey with all the people right, walking beside people, taking care of them from their first entry to our facility until they were hopefully released to go live their happy life right From our facility and you get really close to people. In that I'm just kind of a chatty people person and I just began to hear recurrent stories my breast cancer ladies, my GYN ladies, men and women who have rectal cancer, bladder cancer, prostate cancer for my gents I really began to hear of these struggles that were so common to every one of them and as I was trying to look for places for these folks, for help, I just kept coming up so empty handed, in my own sense of spirituality and I'm not trying to be offensive to anybody else, but in my own sense of spirituality I feel like I was picked up and tossed through a door. This is the door you're walking through and, like a good redheaded Scott Irish girl, I argued for quite a while about this internal drive that I was newly feeling because I'm like crap.

Speaker 3: 6:26

I live in Oklahoma and you want me to talk about sex, what? We don't even have sex in Oklahoma. We just, you know, our kids come from cabbage patches, you know. And so in my calling I just had to say yes, and this is a 2015. My facility comes and says after a year of badgering them, okay, go build a sexual health program. And that's what I got about doing. So I have been moving in this direction since 2014. I've got all these years now of working beside people, really and truly the most internally sensitive, gooey, sticky places that a human owns, what I know in the oncology world and in the menopausal world, right, because all of us ladies, if we have the blessing of living, long enough.

Speaker 3: 7:21

We're all going through menopause and that has very distinct impact in our body. So whether we're going through a natural menopause, a surgical menopause or a chemical menopause, the same impact happens in the body. But those who get to go through a natural menopause are usually that's about a five to seven year period for women, right? So it's kind of a gradual occurrence where for those of us that are surgically and chemically menopause, that's a hard stop. And so I always know my younger women who are premenopausal when they're diagnosed, their trip is always going to be a little bit rougher when it comes to this part, because now we've got to really do some different body care. And so I'm a nurse, I'm going to always walk into the story. First of how can we take care of, protective and be safe with your body? And if your body is in a good place, then you get to do what you want to do with it. And then you add in the layer of breast cancer and the story around our breasts that society creates around the breast. And then if I'm you know, I heard all these stories of women talking about I'm married to a boot man what's it going to be if I don't have boobs. What's he going to think of me? So that's where the crossover into the sexuality counseling came. So I kind of stepped into it from a place of health, first of trying to help menopausal body health, and along the way I went back to school at 50, because that's what all the cool kids do. I went to University of Michigan Again, I live in Oklahoma and that was a year long program to become a sexuality counselor and a sex educator and then I went from there. We have a large governing body called ASECT A-A-S-E-C-T American Association of Sexuality Educators, counselors and Therapists. It's a thing. So I went on to get certification with them. We have less than 1500 certified providers in our nation and we have less than 80 that are healthcare providers. But who should be having that conversation? We should. We, the healthcare community should be stepping into this.

Speaker 3: 9:35

What people don't necessarily recognize is that in medical school and nursing school we know all the parts and what they do and the things that go wrong with them, but there's really never any crossover to how we utilize these parts in our life, and so that was the part that seems really missing. What I found at cancer treatment was once providers knew that they had a person they could refer people to. Then they were much more willing to do some screening question with people like, hey, how's this going? This is pretty common. You got anything going, I got a girl you can talk to. Right. So that really opened up a door when providers had permission to not be the person that held that responsibility because they're not trained in it and each one of us walk in the room with our own hangups and hiccups and values and worries around sex. That's all that to manage in a room. So I do what I do very purposefully, very intentionally, and that allows me, I think, to help other people find comfort in the conversation, because I have absolute comfort in the conversation.

Speaker 2: 10:47

Right, I love that you talked about how you try to work with providers, because that is one thing that Natalie Stevenson and I have talked about and I'm sure you guys have talked about this too how important it is for those providers to have their little toolbox, if you will, of people that they can refer out to their patients, because I never really had that. You know, I would come in and I would be having these issues. I didn't find out about a lot of things through my provider. It was mainly through friends or even people at Cancer Community Clubhouse or Nevada Cancer Coalition or online on Instagram or something like that. But I love the fact that you have that mentality and, I'm curious, you do things online as well, right, so it's not just in Oklahoma. You are able to support a whole heck of a lot of people.

Speaker 3: 11:44

At this moment, I think I'm licensed in 42 of our states. Okay, I'm working on Nevada. As we speak, I got to go get my fingerprinting done for the 15th time. You know, like, why do I need new prints every time? I'm still just the same old girl. So I'm working on that and the reason I'm doing it is because I think I know five girls like me and so the best way for me I mean, I see people privately in my private practice, but that's seeing one couple at a time. To me, these kinds of avenues help me get this information to other people so that they can take care of their body and their life and have permission to know I'm not the only one.

Speaker 2: 12:30

I'm so glad because I can't tell you how many women I have spoken to who've had these issues. Like, we talk about sex and you can talk about it to some people but not to others, and I think we need to be talking about it all the time, like now. I talk about my breasts all the time. I talk about a lot of things I never talked about before, but I really honestly believe that we need to talk about these things even before we even get diagnosed.

Speaker 2: 12:56

One of the reasons I started this podcast is because there were so many things I did not know. I knew a lot, but there were so many things I didn't know before. I got breast cancer and, knowing that one in eight women get breast cancer or any other kind of cancer, like your colorectal cancers and any kind of gynecological type cancers, it would be so nice if we were so much more knowledgeable before we ever even go into that and God forbid it happens to us. But the fact is is that the statistics are so high and so I would rather just know so much more than I did, and some people kind of think well, jamie, why are you targeting people who've never even had it?

Speaker 3: 13:38

And I think we absolutely need to, because one in eight of us are, and it might be me, and it might be my lover.

Speaker 2: 13:46

Yes, exactly. So everyone with boobs, I'm just saying should be interested in these kinds of things and learning more about these. And some people say, well, it's not even on our radar, though it's like it should be on your radar, and you know how to manage that.

Speaker 3: 14:01

Because it is true, and when you meet with people who are brand new diagnosed, they're not thinking about sex right, they're terrified, should have one, and we should have some very great healthcare education going down of how we can open these conversations, because we don't open them. What I found when we did create a program is I started with people from the very beginning Like we never even made it. It was just one of the visits of the people who are on your team to help you through this event, of the people who are on your team to help you through this event. And so from the very beginning I can say man, you guys are going through a lot hearing those words. What's that been like for you? How have you managed struggle in your past? Because we want to really bring up how we can problem solve.

Speaker 3: 15:00

So I try to go very proactive and let people kind of know at each step just a little bit about what was coming and how we could navigate that together as a strength, staying united and not pulling away, because couples either turn toward each other in these kinds of things or they turn away from each other, and my goal is to keep people turning toward each other, because that's where we're the strongest, and I know that my patients will make it through their journey in a much healthier way if they're strongly connected to their mate. So how can we help that happen? So I feel like being proactive and letting people know hey, this thing's coming, let's get ready for it. Don't be surprised by it, because I think on the journey there's so many surprises.

Speaker 2: 15:49

Like I wouldn't expect so many. I love that word proactive, that is so me. I want people, and I again hopefully whoever's listening to this never gets it or whatever if they've never been diagnosed, but I mean they're going to know someone who does, and whether it be their spouse or their friend or whatever if they've never been diagnosed, but I mean they're going to know someone who does, and whether it be their spouse or their friend or whatever.

Speaker 2: 16:09

Yeah, yeah, and it would be nice to have that information. It's like, hey, I was listening to this podcast all about sexual intimacy and cancer and oh my gosh, you have to listen to this. It's really good and I so I just really like that word proactive. I'm just curious. I know this isn't one of the things that well, I'm sure that you're fine with it, but can you walk us through sort of a day in the life of Tracy Owens, like when a patient comes in? How does that all work? Like when they first meet you, what's going on?

Speaker 3: 16:39

So the first meeting starts with a phone call, and the phone call comes for reasons on both sides of the fence. I talk about sex and I try to join people in whatever language or experience is right for them. I don't bring my own I mean I have my own Right but I want to join people where they're at. So this phone call is a twofold process. Number one I want to make sure I'm the right next step for you. Everyone has a lot happening in their life and I don't want this to not be the right place for you, because there are some people I'm like, hey, the first step needs to be this. Then I'd like for us to tag in together. So first I just want to make sure I'm the right person. Second, I want them to have a human connection to this very daunting feeling appointment. I just saw a couple yesterday. She had breast cancer, was diagnosed with breast cancer, and then her husband was diagnosed with cancer while she was in the middle of her journey, and so they obviously have a lot to navigate in there. And they're three years down the road and they're just like, oh my God, we didn't even know that these things were possible. So starts with a phone call where we're going to connect. We're going to make it be. I want to try to put you at ease. You're coming to see somebody. I carry nothing in there. I'm not a judgy person. I join people where they are.

Speaker 3: 18:08

I want to improve health as the first thing and then connection as the second thing, and so when they come in, my office is set up very much like a home. It's very non-clinical. So when you walk in, it's like you're walking into a living room where we could just sit and have a conversation, and for some people, that conversation actually needs to start there. So I'm going to join them there and then, hopefully, we progress into my office. Right, but I tell people all the time I need you to use your voice here. You're safe here to use your voice. If something I'm saying isn't sitting right, please tell me. I'm here to serve you and I'm not bringing a template to the meeting. We're going to figure it out together. So once we get together, jamie, I gauge the person I'm with. Some people need to come and tell their story right away. Right, I need to offload that. Some people need me to guide the conversation to get us to that place. Okay, whichever way we need to go is fine with me. So I meet with people and we're going to just start.

Speaker 3: 19:13

We start from a place of health. How are your parts interacting in your body? How is your body functioning for you and for women? When I'm talking to women, that includes bladder health, bowel health, pelvic floor health, mental health, mind-body connection, because a lot of times, women, from that moment you have cancer, life goes into a chaotic spin and there's no footing along the way before the next thing is hitting and we're making horrible decisions, right? Do you want part of your breast removed? Do you want your whole breast removed? Do you want two breasts removed? Well, really I don't know. And I don't know because this isn't the world I live in. So I have no clue how to make an informed choice and I feel like we really push women in these really difficult decisions. So all these things happen and it's really not until that woman is six months, sometimes a year before finally she's maybe taking a couple of breaths and saying man, I'm ready to reclaim my life, I'm tired.

Speaker 1: 20:32

I'm done with this.

Speaker 3: 20:33

I need my life, I need to take my life back. And what does that mean? So that's typically where I see women in my community. Now that I'm not inside an oncology facility is that time and I call it reclamation, because this is the what I've been through and it starts back at the words you have cancer because they never got a chance to process that before the next thing. And then the next thing, you know, now I'm getting my boobs cut off and now I've got foreign bodies in my body, and now I've got to start chemotherapy, and now I've got to get to radiation, and now I've got to get to reconstruction and now I've got to start endocrine therapy. It's mind-blowing. So I like to go all the way back. Right, let's start back. What has this story meant and where are you holding the story in your body?

Speaker 3: 21:24

I'm a firm believer that women become very dissociated from their bodies. They get very heady right Because we're having to make hard, horrible decisions, and we're having to. Our bodies are probably not feeling good. They're going through surgery, we've got strangers touching places that are very private of us. As one thing about women with breast and GYN cancer, especially GYN cancer, these are parts of our body that we typically reserve for just a few people to have access to in our lifetime right, and suddenly we're on display for a parade, so that woman can't, you can't stay in that right.

Speaker 3: 22:02

It's so uncomfortable or scary, and some women get very in their head and not really in their bodies anymore. And, of course, what's intimacy and sensuality and sexuality? That's a brain body connection, right. Very first places we have for women is to help them reconnect to their own being, to be able to touch their own foreign body, breasts, to be able to be present in their own changed body. Before then they can reconnect, maybe to their mate, because I can't connect to someone else if I'm not connected to me. And so that's the place I start. That's our starting place is figuring out where in this story do we need to go back to, how do we improve health? And then we start doing the couple part of how we deal with it and partner they're dealing with a lot.

Speaker 2: 22:53

So that makes total sense that you would start there. Do you have I know there's probably more than just one, I'm certain Do you have like a I don't want to say a favorite, but do you have a success story that you're just so happy Like somebody came in and they were just not okay and in the end, one of my early stories?

Speaker 3: 23:16

yes, and yes, I have so many and I hold every single one of them. So I met with this couple. She had been diagnosed with breast cancer when she was 38, 39. And I'm seeing her, and she had had a recurrence and they had come to my facility for a second opinion and I got connected up with them and then we started working together and I saw her for two or three times by herself and then she's like I guess she tells her husband she's like you got to come, You've got to, this is us, You've got to come with me.

Speaker 3: 23:53

And so this couple comes and we're working on vaginal hydration and access and all those things. And he looks at me so seriously and he says so are you telling me that all along these last five years that we haven't been able to be sexual because it's so painful for her, that it didn't have to be that way? And I'm like that's exactly what I'm telling you. And he looked at me and he says, woman, if you can get her where sex is not painful for her, and that maybe she can even enjoy it again, I'm going to send you flowers. So you fast forward, I'm going through my day. Going through my day. It's, you know, several weeks down the road. He didn't often travel with her, so I didn't get to meet him often. And one day I walk in from the clinic, I go into my office and there is this humongous bouquet of flowers and I'm like why in the world did my husband send me these very expensive?

Speaker 2: 24:56

flowers someone else's husband.

Speaker 3: 24:59

I don't even read the card, like I just assume. It assume it's my honey, right? So I call him. I'm like babe, oh my God, these flowers. And he's like what? I'm like these flowers you sent me. My gosh, they're beautiful, what did you do? Or what did I do? And he's like I don't know what you're talking about. But suddenly I'm pretty curious about who's sending my wife flowers. So I pick up the card and it's from him. It's signed by both of them and it just says you are hero. Oh my gosh, I knew what that meant. I knew from our previous discussions and the way she had been progressing that that she had finally been able to have an experience with her husband that had not been part of their life for about five and a half years.

Speaker 2: 25:47

That is amazing. So we have so many of those. I love it.

Speaker 3: 25:51

I think the thing is so. Women, especially with breast cancer or a hormone positive, like ovarian cancer or uterine cancer, those women are told, oh, you can't have any hormones, and then the conversation stops Okay, I can't have hormone. What are the other options? And I think we leave it with women thinking there's no other option, and that's a lie. That's lazy in my opinion. That's lazy healthcare, because there are things we can do.

Speaker 3: 26:21

There are a lot of things that we can do to help the health of our body. Even if we choose not to do estrogen, we do have a lot of growing research that tells us that the estrogen uptake when we only use estrogen vaginally does not increase risk to a cancer. But there are doctors who don't believe that. You know oncologists a lot of them are pretty hard in that. No, still, and there's a lot of women who are like I had a hormone positive cancer. I don't want to do nothing that might even potentially increase my risk of it coming back. Okay, so that's the decision you've made. You're making an informed decision. Now let's move on to the other options, and that's where I come in.

Speaker 2: 27:14

Two, my functional health doctor that I see right now says that there are a lot of doctors who will prescribe estrogen without even testing the levels and he said that's so important for us to know what the levels are and not give too much, you know, because people are over prescribing estrogen. So knowing what the levels are, knowing what your body actually does need or doesn't need, is really essential. I went to my a new gynecologist after I was cancer free and I was straight up with her. I said I had the worst painful sexual experience with my husband before I was diagnosed. I was just shocked Like I didn't know anything about it. So I have a lot of friends who have gone through menopause and it just lasts forever.

Speaker 2: 27:59

That was not me. It was like just all of a sudden and I think that cancer had thrown me into it, because at that time I had cancer. I just didn't know it. But she gave me a couple of items. I learned that our vagina shrinks this way and this way, but all the ways, and I had no idea. But she put me on a prescription, an insert that has helped tremendously. She suggested another insert that helps with the dryness and I remember after I had been on it for maybe a few months, my husband and I were like, oh, you want to try, and so I was. We were both kind of nervous about it, but we tried it and I was like, oh, my God, it worked.

Speaker 3: 28:48

So, and more than just the, a lot of times it's how long has it been this way? You know that's what's important, cause that tells you the health has been degrading and degrading over time, right Of these tissues that are not being fed. So estrogen in our body has impact literally head to toe, literally head to toe. So when I'm meeting with someone, we got to talk about keeping our brain crisp, right, because estrogen kind of helps our brain not feel foggy and helps to kind of help our emotions a little bit. So we got to be in tune with that. We have to pay attention to bone health. We have to pay attention to vaginal health, bladder health, bowel health.

Speaker 3: 29:26

It's all important, and women really have never been educated about their vaginas or their vulvas. We don't educate women about their own bodies. Like, I'll talk to you about your heart health, but I can't talk about that part of you. How do you separate a body? Right? It's all a body and, as I say after 40 years of healthcare nose, elbow, penis and toes they're all just body parts for us to take care of. All the parts have a purpose, all the parts are important and so we should take care of all the parts. So for those ladies who cannot use estrogen or choose not to use estrogen, we can use hyaluronic acid products.

Speaker 2: 30:10

That's what I use.

Speaker 3: 30:11

And there are several different types. There's a lot of price point in it, so we try to match to what the ability of that woman is. So the loss of estrogen in our pelvis, our genitalia area, and that for me includes the whole pelvis Estrogen impacts our pelvic floor muscles, it impacts our urethra where we pee from the urinary bladder, the outside of the vulva, all the external tissue and the vagina, and what happens is all those tissues will thin, they will shrink and they will become inflexible. So by using hyaluronic acid, hyaluronic acid sinks into the tissues, to the cellular level and it helps the cell hold more moisture in the cell to make the cell plumper and stronger. And if all the cells are plumper and stronger, so are we. That has a cumulative effect for us.

Speaker 2: 31:08

So that's what's going on with my vagina, how it got better. I like it. I'm picturing it.

Speaker 3: 31:14

And then we have to look at the other kinds of products that we use, Like I talk to women about do you take hot baths? Do you use Epsom salt in your bath? Do you get recurrent BV, yeast or urinary tract infections? That oftentimes speaks to the balance of good bacteria in our body, and so using probiotics can really help improve getting rid of yeast, BV, recurrent UTIs. Hydration certainly helps that get better. And then we have to look at bowels. You know we have to look at how the bowels are functioning. If you're squeamish, turn away. I'm showing a picture so you help me know when you can see it, Okay.

Speaker 2: 32:01

There's a little bit of a glare, but that's actually better right there. Okay, I can see it. Okay, there's a little bit of a glare, but that's actually better right there. Okay, okay, I can see it pretty good.

Speaker 3: 32:06

So, female reproductive Cut the woman in half, right down the middle, and this is kind of what you see, so landmarks. This is the bladder, this is the urinary urethra and the urinary meatus where we pee from. This is the head of the clitoris, this is the vagina, the cervix, the uterus, one of the ovaries, and this is the rectum, and you see how close that rectal wall lives to that vaginal wall. Yeah, yeah, so women with chronic constipation will have pain with sex and it may or may not have anything to do with health of the vagina. It may be because this rectum is staying so distended with constipation that it's pushing into the space it's pushing.

Speaker 2: 32:55

Yeah, so that was what I was going to ask. You is some of the signs. What are some of the signs that people should look up for? And that might be one of the signs is constipation.

Speaker 3: 33:04

So chronic constipation. We need to find a way to help our bowels work more routinely. Period, end of conversation. People always laugh at us nurses because we're so bowel and bladder focused. But here's the reality the bowel and the bladder is where we get rid of the toxins of our body, and so if we're not pooping, then those toxins are staying present in our body and we don't want them there and they're uncomfortable there and they don't do our body good there. So we should be pooping at least every other day, and if we're not pooping at least every other day, then we need to seek intervention.

Speaker 3: 33:39

Here are some of my favorites. First thing what's your fluid intake? How much fluid are you actually getting? And I'm not talking coffee or tea, because those have caffeine, which are dehydrating Water, water, water and fiber. And people kind of go cross-eyed with me. I'm like put your lemon, put your lime, put your flavor, whatever it is that you need to do. Put your lemon, put your lime, put your flavor, whatever it is that you need to do, just get it in your system, get it in, and then I'll talk about a probiotic putting good chemical or putting good bacteria into that bowel so that it can help do its job. So a good probiotic is good for all of us.

Speaker 3: 34:18

We're also going to talk about movement. How much movement do you get? Sitting causes constipation. For people, it just does so how much movement are you getting? And then, if they have a lot of struggle, we can also talk about massage of the abdomen in a very specific way that helps to increase peristalsis or movement. So those are the things for the bowel, and if the bowel is not managed well, sex doesn't feel good for women.

Speaker 3: 34:44

Yeah, that makes total sense to me and then bladder if you have recurrent like if every time we have sex I feel like I have a bladder infection or I get a bladder infection, or I just feel really raw and irritated for a couple of days after, for a couple of days after. That's telling us that the friction of sex is going against unhealthy tissues and we just need those tissues to be healthier so they can tolerate the friction. And we need to talk about lubrication, because in a female body, lubrication vaginal lubrication comes from the cervical cap, like that little cervix makes a lot of our natural lubrication. The vaginal walls make lubrication, but when we don't have any hormone we don't make that. Or if we lose that cervical cap from a hysterectomy, there's a big maker of that. So lube is our friend. We should all use lube.

Speaker 2: 35:39

That's what I was told. Like, my husband and I never used it before all this happened and we just didn't feel the need or I don't know. But my gynecologist said, no, everyone should be using lubrication, and she gave me some really good stuff.

Speaker 1: 35:53

What's your?

Speaker 2: 35:54

favorite. What's it called? I'll have to. I'll have to look it up. I definitely suggest it to anyone. It's pretty popular and I've heard a lot of other people, but I will let you know.

Speaker 3: 36:07

I am a lube lover. I have a whole. When people come into my office they will always leave with some lube samples.

Speaker 2: 36:16

Okay, so what kind is it I?

Speaker 3: 36:17

have different kinds depending on the woman. If I have a woman who's really sensitive, oh, Uber lube kinds, depending on the woman.

Speaker 2: 36:23

If I have a woman who's really sensitive, oh, uber Lube, I love that stuff it doesn't smell, it's silky, it's yeah.

Speaker 3: 36:34

I got it right next to my bed. So here's the good about Uber Lube it feels lovely and it leaves a nice softness to the skin after, so you get some after protection of it. This is a pure silicone lube. So for people who use vibrators, toys, whatever in the bedroom that are silicone covered, we want to use a different lube because the silicone chemical of this visuals again, visual warning and silicone covered vibrator this silicone chemical will not completely be able to get off of this, even when we wash it, and it will degrade it oh, and so you're going to be inserting stuff in there later that you don't want in there.

Speaker 2: 37:15

Got it okay?

Speaker 3: 37:16

makes total sense I love this for just lovers. When lovers are together, that's perfect. But if a couple likes to use has some variety in their bedroom of things that they play with, I'll say let's go for a hybrid lube which is a combo platter of silicone and water-based, but it's enough of a watering down, if you will, of the silicone that you can safely use it with a silicone toy.

Speaker 2: 37:42

Okay, wow, I never even thought about that.

Speaker 3: 37:50

So my I have a couple of what am I? I got all kinds of stuff here. One of my favorite is this gold hybrid.

Speaker 2: 37:58

Oh, move it over just a little bit. There we go. Gold, hybrid Gold hybrid, gold, hybrid.

Speaker 3: 38:04

Okay, it's a combo platter of silicone and water. What I love about silicone is that women who have recurrent bb and ye, silicone has less impact on vaginal ph than water-based does. Okay, so if I have a woman who gets recurrent infections while we're trying to get those tissues healthier, a silicone lube is good for her, and if we're working on dilation, silicone can feel really good for that woman as well. So I'm a lube lover. But I say you got to find the lube that works well for you, right?

Speaker 2: 38:35

I love how you call it a combo platter. It's like being at a restaurant, like at a Chinese restaurant. I'll take the combo platter of the combo platter right. I work on sex menus with people right, what's on your?

Speaker 3: 38:50

menu. The only thing on your menu is chicken fried steak. I might love chicken, but if that's the only thing on the menu, I might get tired of it after a while.

Speaker 2: 39:01

Yeah, yeah. Oh my gosh, this is so enlightening. I mean I'm learning even more from you now. I always thought I knew a lot, but I mean I do but I just know it, there's always so much more. Every time I shut this computer after an interview and I'm like holy cow I learned so much more.

Speaker 3: 39:22

Look at my brain, you can still learn. So I do want to talk about hydration. So I talked about hyaluronic acid. I want to give women who are like, what's that deal? I want to tell them, like the top three that I use of hyaluronic acid, my first and foremost is called hyaluron.

Speaker 2: 39:40

Okay, hyaluron.

Speaker 3: 39:41

And it comes in two forms. It comes with an applicator and gel, and it comes with or you can get suppository. I'm a suppository lover.

Speaker 3: 39:53

I've used hyaluronan for about eight or nine years of my own life journey and we didn't get suppositories until about a year or a year and a half ago. I was a convert immediately. But I tell women, if you're menopausal sexist and you're feeling a little dry, this is a great routine to put into your life. So twice a week I hydrate my vagina. Twice a week at bedtime I have these right by the bed so that I don't get in bed and be like, oh, I don't even want to get back.

Speaker 2: 40:23

So you hydrate your vagina two times a week. You at least poop every other day.

Speaker 3: 40:27

Yes, but here's the caveat on the twice a week For some women who are on AIs for their breast cancer. Endocrine therapy right Like Aromatase, Letrozole, Femara, Aromacin, all of those they're AIs and they, what we know, is they create a Sahara desert down there. And so women who are on endocrine therapy for 10 years, their vaginas get very dry. And to me it's unconscionable that we're prescribing these medications to women all day long, every day, and we're not providing information about hey, sis, they're getting ready to dry up for you here. Yeah, yeah, that you can do to be protective of your body. What's the number one reason older women die? Do you know? Oh, um.

Speaker 2: 41:23

They die in the desert. Urinary infection oh oh, my gosh Tracy. I have always been very prone to urinary tract and UTIs and I've had two in the last year and I've gone immediately to the doctor to get it taken care of because I recognize it immediately. That totally makes sense to me. It's awful.

Speaker 3: 41:47

Urocepsis is the number one killer of older ladies. My thought is, if we helped women stay healthier along the way, perhaps we wouldn't have this story. Okay, that makes sense. Two to three times, oh, I tell women if they already have pain, I'm like I want you to hydrate your vagina three times a week for the next month and then we can talk about maybe going down to two or exploring two. But let's really saturate with hyaluronan and then, if they're really super dry and it's gone on for a while, I may even add in a vaginal vitamin E suppository. And for all of my women who have had radiation in the pelvis, I will almost always use a vitamin E because we know they're scarring down there.

Speaker 2: 42:35

And is that that's an insert as well?

Speaker 3: 42:37

Okay, it's just a suppository, but it's just vitamin E.

Speaker 2: 42:41

So there's times where I'll forget, like I always tell my husband and husbands need to know, partners need to know this. I think it's really important for the partner to remind too, because sometimes I forget, like I'll get in bed. It's like, ah, I forgot to put my supplementary in my vagina. I said, honey, you're supposed to remind me, and there's times where I'll get in bed and he goes did you put something in your vagina? So I get up and I put it in there.

Speaker 3: 43:14

But so I started putting it on my calendar. So every day it says it on my calendar and you know whatever days.

Speaker 2: 43:17

If it's not in my phone, yep, I'm not going to be exactly, exactly. But I feel like that's something like a partner could help with, like and I get this together assignments your day, help with like and I get this together.

Speaker 3: 43:30

Assignments your day. And I say everything as a couple. Right, because our partners have a vested interest in our vaginas. Yes, they do. Let them participate in the care of her as well. Right, instead of just showing up for the party, you're going to have to be part of the preparation and the cleanup, right? Yeah, I think hydration is the very first. It's always the first place I start. Women, this is about your health. This is about tissues being healthier, and if our tissues are healthier than they perform better in the way we want them to. The next thing I always go to is vibration, and this can be a real stretch for some people. But we don't have to use a vibrator for the intent of orgasm and pleasure, unless it's okay for us. Like I tell women, I'm going to ask you, I'm going to give you options and choices and information, and you're going to do what's right for you. So for some women, that means I have to.

Speaker 2: 44:26

Sometimes that means we use a vaginal dilator because that doesn't feel as threatening or as right whatever Right, there's different sizes, so I bought that from the very beginning and it's really meant to this is the Dr Laura Berman by a dilator set.

Speaker 2: 44:44

Move it over a little bit. There we go, okay, so Tracy, just so you know, like I do put these videos on YouTube, so all the other platforms are audio to my audience. If you want to see what Tracy is showing, go to the YouTube channel Tessa's Breast Podcast, and then you can see us talking. You can see our faces and us talking about sex.

Speaker 3: 45:03

Well, yeah, you want to see the face of the chick who's having? Who's this girl? So this is what a base of a dilator looks like. It's about the size probably a man's finger, I would say in size, and so that's level one. This vibrates. What does vibration do? Here's the vibration story. Vibration increases blood flow. Female genitalia, just like male genitalia, needs to become erect for it to feel good. The sensory pleasure response part of it. So if we're just trying to hardcore, go straight into sex in a post-menopausal woman, her body isn't prepared to sex. And a post-menopausal woman, her body isn't prepared. And that's the problem when we rush through sex, because, as a menopausal woman, sex starts I mean, for everybody. Sex starts in the brain and the brain is what triggers the cascade of events down below. If we don't give that time, that transition. When we were younger that was a much quicker swing, right, but it's a slower transition now because we don't have those hormones to mediate that message. So vibration helps to prepare the female body for sexy time.

Speaker 3: 46:22

Ok, so I'm all about the body now, and that would be one that we use on the outside. So I'm all about the box now and that would be one that we use on the outside. That can be one that can be used inside or outside. That's something that can be done on a woman's own to try to help improve health of her vagina.

Speaker 2: 46:39

I have a question for you, tracy. Yes, you know there's a lot of people out there who, when we're talking about sex, are just so like private and offended and wouldn't even be caught at all with any kind of vibrator or anything. How do you help those people? How do you?

Speaker 3: 46:55

I use the dilator. I step into it from a dilator standpoint because this is a clinical tool. Okay, this is something we use for pelvic floor physical therapy, we use in the gynecology office. This is a tool to accomplish a task. So I tell people this is a tool.

Speaker 3: 47:13

And so, for people who have never had any kind of experimentation in their bedroom, we're always going to start here and we're always going to start with the woman herself, right? So for some women who have had vibrators in their play, that's an easy step. But there's a whole lot of women that this is a difficult step. So it's pacing, it's all about pacing. It's about permission, it's about perspective shifting or perspective exploration.

Speaker 3: 47:46

Like, what are we trying to do here? Like, really, what story of what we're doing? And if the story is, I'm trying to keep my body healthy and I'm trying to maintain a great connection with my mate, where's the negative in that, right? How is that a bad thing? So I'm going to tell you in my time and I'm not trying to like I'm not sitting here, being like Whoa Tracy I think every woman and every couple can come to these conversations. They just got to have a good guide, right? Okay, you take a good guide on the tour, right, right, yeah. And so I don't know why, but I like being the guide. I like giving people information that the rest of the world tells them they're not entitled to.

Speaker 2: 48:31

Right, and I feel like you are the type of person. I feel like I would probably be the type of person like this too, because we know that sex is important. We know that intimacy is important, like seriously important. There are some people who can joke around about it Like I can see your personality you can be very clinical and serious about it. You can be humorous according to the people you are talking to, which is great. I think part of the reason I wanted to have you on this show is because I wanted people out there who are in a situation where sex is not fun intimacy. They can't even see themselves in a situation where it's feels good again to be with their partner. I really feel like this can help them understand that it is possible, yeah, and with the right tools, with the right therapist, they can get back to a place, maybe even better than they were before, right?

Speaker 3: 49:31

So once we open up conversations and take some of the fear part out and we connect, then because, to me, we have to feel really safe to each other to have curiosity and try different things, and so the first place is making sure that that couple is feel safe together, because once they do, then what they choose to do together is better. Right, because we're not holding ourself to some impossible standard or expectation and we're not bringing expectations to the bedroom that don't match our body's abilities.

Speaker 2: 50:08

Right. I do want to let the audience know like, for me, I had a double mastectomy and reconstruction. I've had the deep flap, so I have my own tissue and skin, but I've lost sensation in a lot of parts of it. I know it's there, it feels natural, all the things my abdomen is definitely has lost feeling things. My abdomen is definitely has lost feeling. But I will say that my husband and I, whether we're having sex or not, we are intimate and he is very good at making me feel really good about myself and which makes me feel good about myself. So I want to tell my audience that if you are in the situation where you are faced with mastectomy and reconstruction and all that, you can get to a place with your partner, that you feel better about your body and again, I really hope that people are able to reach out to get that help. I mean, we need therapists for different things and I feel like this is a really good way to go about it with you, like this is a really good way to go about it with you.

Speaker 2: 51:10

I want to end this by asking you any providers out there that are listening, because I know that there's a lot of breast cancer and gynecological type cancer patients, people who've had colorectal cancers, advocating for others and trying to get messages to our providers. So how can providers be proactive? What are you doing to reach out to providers, to give them this information and say, hey, if you have patients you need to, don't just give them a packet Tracy Like when I went into my first oncological appointment. I was given a pack like a whole. I don't even think I looked at it?

Speaker 3: 51:51

I always laugh, is that in our new patient packet? And I'm like, yeah, let's put it in there and it'd be another 52 things they don't read Right.

Speaker 2: 51:58

It's overwhelming.

Speaker 3: 51:59

They're overwhelmed before. They ever picked that up. So they can't read all that, and we have to say it three or five times before it can soak all the way through. You know Right, it's not a one and done.

Speaker 2: 52:15

The oncologist, breast surgeon, I don't care who it is, oh my gosh, I don't know if you're having trouble with any kind of intimacy. Or maybe the patient says something like sex hurts and they're kind of uncomfortable about saying it. So providers sometimes have to be a little savvy, in kind of drawing that I love to help physicians, nurse practitioners, pas and nurses learn how.

Speaker 3: 52:40

I don't maybe need to know how to have the whole conversation, but I, how can I lean into a comfortable screening with everyone, no matter their age, no matter their gender? The thing we know is that about 23% of women going through a cancer diagnosis will ever have anyone ask them about their sexual function. So 80% of women we know 80% of women with breast, gyn cancer, colorectal, will have sexual side effects, sexual body changes. 23% of them are going to get a conversation. I challenge providers to be brave and to take care of people in their whole being versus just the one thing, whole being versus just the one thing, because I can't separate your brain, your heart, your lung, your breast, your butt, your toe. You come as a whole being and if I'm not taking care of the whole being, I'm missing the boat. As a healthcare provider, right, but that's my own.

Speaker 2: 53:46

I feel like if couples can open up and talk about these things even though it's uncomfortable at first and whatever, talking about the elephant in the room I feel like opening up that conversation and both being part of it, because I know that there are some couples who are like, well, she's just frigid, or she, you know, or he can't get hard, or whatever it is. They're always pointing at the other one. Right, it's like we need to talk about it all together. I'm very, very fortunate to have a husband who absolutely will talk about it. He will work on things with me. We are still in therapy together because of some friction and non-communication, you know whatever.

Speaker 3: 54:25

We all need a little bit.

Speaker 2: 54:26

Yeah, exactly, I feel like we should go once a month as a couple for the rest of our lives. It's a bit of a crap show, so we've gotten so much out of our therapy to the providers out there. Please, please, please, like Tracy said, be brave and have that conversation. I want to wrap up here by asking you to kind of share some of the resources that you have on here. Number one I've got your phone number for your office and your cell. I have your email address, your website, your Facebook page. What are some of the resources? You've got A Better Normal, your Guide to Rediscovering Intimacy After Cancer. What's that?

Speaker 3: 55:06

They're all just different writings that people have done. A Better Normal was written by Testa Vez, who is a cancer survivor as well. She has lived experience in it. She's also an OT who does sex counseling. So that book speaks twofold right, like she's had the lived experience, and so I think that's good. And then I think different resources hit for different people. All resources are different.

Speaker 3: 55:35

People have different tolerances of reading, so really just trying to understand what people's particular worries are and trying to shift them to information that's good for them. I'm happy to send you just a list of resources that you could put out to your people and I'm happy for people to call and ask for resources. You know what I want to say to women and to couples that are hearing this if you try to step into these conversations and you struggle, please don't just walk away. Accept that, as now's the time. We've tried it on our own and what we're trying isn't necessarily giving us the result we want. Let's see if we can find somebody to be on our team, because sometimes just having a little bit of a facilitator gets you through conversations and point things out along the way helps us learn how to communicate so that we can hear each other.

Speaker 2: 56:30

Good, I love that because the last I heard and I could be wrong. I mean, it's been known to happen, isn't it like 40% of couples split up in these kinds of diagnoses? And it's a lot of times it has to do with communication.

Speaker 3: 56:45

Maybe they didn't have a connection before communication, or the body has changed and we haven't adapted our style. We're still trying to do things the way we did in our different bodies and we haven't brought it to the body we're in today. None of us are. I mean, there may be some 20 year olds on here, but you and me for sure, those days are gone, right, right. So if I keep trying to hold a standard and expectation to the sex I had at 20, to the sex I have at 58, I'm going to be disappointed because my body is completely different, my brain is completely different.

Speaker 2: 57:21

And if we can know these things before going into a diagnosis. I heard recently, if you have boobs, you should be learning about breast cancer because men have, women get yes, they do get breast cancer.

Speaker 3: 57:35

So, just like me. It applies to everybody, yeah Right, not everything I do.

Speaker 2: 57:43

Yeah. So, knowing that if a couple goes into breast cancer regardless of who gets it, you know, whatever and they have this understanding that it's probably going to be really kind of tough on our relationship. We need to stay cohesive. We need to communicate what we're going through, how we're feeling and things like that. So, gosh, tracy, this has been amazing. Let's do it again.

Speaker 3: 58:05

Yeah, let's plan a get into it kind of a conversation after we broke the ice just a little bit sure I would. Now that we made it the first base together, let's go ahead and keep moving around.

Speaker 2: 58:20

I love it. Well, I do want to tell you that test those breasts is now a non-profit, so I'm moving forward and I don't sell anything or anything like that, but what I do is I am housing all kinds of resources like yours for people to know about. I bring education and awareness. I'm not a doctor, but I certainly use doctors and just different kinds of experts to be able to educate other people. So I would be thrilled to be able to house your information on the website so that people know where you are, what you do and what your personality is like, and so they can reach out to you. She's a hot mess express.

Speaker 3: 59:01

I'm a hot mess express. That's what I'm saying.

Speaker 2: 59:05

You and your husband must have a great old time, you and your husband must have a great old time.

Speaker 3: 59:12

We enjoy our life together. I think you know now through the years at 62 and 58, you know, love it, love it my husband's 62.

Speaker 2: 59:19

All right, I'm 56 and he's 62. So okay, tracy, thank you so much. I really appreciate your being on the show and absolutely I would love we can talk about other avenues that we can talk about and I would love to have you back on the show. And thank you very much. Is there anything you would like to leave us with?

Speaker 3: 59:37

Love yourself gently.

Speaker 2: 59:39

With lubrication All right and to my audience. I really appreciate your being on. Please check out Tracy's resources and her contact information on and on Facebook and her website. I really appreciate it again for you joining and we will see you on the next episode of Test those Breasts. Bye for now, Bye.

Speaker 1: 1:00:03

Friends, thank you so much for listening to this episode of Test those Breasts. I hope you got some great much needed information that will help you with your journey. As always, I am open to guests to add value to my show, and I'm also open to being a guest on other podcasts where I can add value. So please reach out if you'd like to collaborate. My contact information is in the show notes and, as a reminder, rating, reviewing and sharing this podcast will truly help build a bigger audience all over the world. I thank you for your efforts. I look forward to sharing my next episode of Test those Breasts. You.