Dr. Nancy Chun shares her dual perspective as a triple board-certified physician and breast cancer survivor on breaking taboos around pelvic health, anti-estrogen therapy, and intimate wellness.
When the oncologist becomes the patient: Reclaiming intimate health after breast cancer
By Nancy Chun, MD
After being diagnosed with breast cancer, I had to stop hormone replacement therapy and was suddenly plunged into menopause-essentially becoming postmenopausal overnight. I began experiencing persistent discomfort, irritation, stinging, itching, and sensitivity of my external intimate skin-including the vulva, perineum, and anal area. I was distressed by these new symptoms and didn’t know how to help myself, despite being a triple board-certified physician.
To make matters worse, once I started anti-estrogen therapy with anastrozole, my symptoms intensified. I was an oncologist, yet I had never been taught that the changes we casually referred to as “vulvovaginal dryness” could actually feel like this. I didn’t understand the extent to which the loss of estrogen could affect my external intimate skin, my pelvic health, and my sexual health.
I remember thinking:
How could I, an oncologist, not know this? And if I didn’t know, how many other women don’t know either?
And then there was something I wasn’t prepared for: sex became painful.
With penetration, it sometimes felt as though my vagina had suddenly become smaller or had somehow “shrunk.” In simple terms, that wasn’t entirely my imagination. When estrogen levels decline, vaginal tissues can become thinner, less elastic, and less lubricated, and the vaginal canal can become shorter and narrower. For many women, these physical changes can make penetration uncomfortable or even painful.
I also learned that there was another important piece to the puzzle: the pelvic floor. When penetration hurts, the pelvic floor muscles can become tense or tighten involuntarily in anticipation of pain. That tension can make penetration even more uncomfortable, creating a cycle of pain and tightening that can be difficult to break.
As I navigated my own survivorship journey, I learned about pelvic health and discovered approaches that helped me, including vaginal dilators and mindful relaxation to help my pelvic floor release rather than brace against discomfort. These were things I never expected to have to learn as a physician-and yet they became an important part of my own healing.
What struck me most was how little we talk about these issues with our breast cancer patients.
As oncologists, we spend so much time appropriately focused on treating cancer and monitoring for recurrence. But we don’t always discuss painful sex, vaginal and vulvar changes, pelvic floor tension, or other intimate health concerns. I know this because I was an oncologist who wasn’t asking these questions either-until I became the patient.
I think one reason oncologists may hesitate to bring up pelvic health and sexual wellness is the fear of opening Pandora’s box. What if the patient has questions we can’t answer? What if she brings up a problem that we don’t know how to treat? As physicians, we are trained to have answers, and it can be uncomfortable to open a conversation when we aren’t sure where it will lead.
But we don’t have to have all the answers.
We do, however, have a responsibility to prepare our patients. Anti-estrogen therapy, chemotherapy, and pelvic radiation can cause changes to vaginal, vulvar, and pelvic health. Patients deserve to know what they may experience before these changes become severe. They deserve to understand that dryness, irritation, painful sex, changes in tissue elasticity, and pelvic floor tension can occur-and, most importantly, that there are things they can do to help prevent or manage these symptoms.
We shouldn’t wait for women to suffer before we start the conversation.
Our role as oncologists isn’t to become experts in every aspect of pelvic and sexual health. It is to tell our patients what to expect, listen without embarrassment or judgment, validate what they are experiencing, and have pathways to people who can help-pelvic floor physical therapists, sexual health specialists, gynecologists, menopause specialists, and other qualified providers.
Sometimes the most important thing we can give a patient isn’t an immediate answer. It’s the reassurance that what she’s experiencing is real, that she isn’t alone, and that there are people who can help.
There is hope. There are things that can help.
That realization was part of what inspired me to create Nancy Chun Formula. I wanted to develop a non-hormonal approach to external intimate skin care for women navigating menopause, cancer survivorship, and other life stages that affect intimate health. I approached the problem the way I approach medicine: by looking at the whole system rather than treating one symptom in isolation.
But my hope isn’t simply that women use my products. My hope is that we normalize these conversations-to ask questions without embarrassment, to speak openly about changes in our bodies, and to support one another with compassion instead of silence.
There is still so much I have learned through my own experience as a breast cancer survivor-about intimate skin health, pelvic health, pelvic floor tension, painful sex, and the many ways our bodies can change after treatment. And I want to continue this conversation.
To my fellow breast cancer survivors: please know that you are not alone. Ask the questions you’ve been hesitant to ask. Tell your doctor what you’re experiencing. Seek out pelvic health professionals when appropriate. You don’t have to figure this out by yourself.
And to my fellow oncologists: let’s do better at preparing our patients for the changes that may come with treatment. We can start by simply telling them what to expect and letting them know that pelvic and sexual health are part of survivorship care, too.
So today, I encourage you to connect with someone new, share your story, and remember that investing in your health is never selfish. It is one of the greatest gifts you can give yourself.
After everything we’ve been through, we deserve not just to survive, but to feel comfortable, connected, and fully alive.
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