Katie Atkins welcomes attendees and explains how to use the Q&A box, reach the tech support email, and find the slides and replay on myeloma.org. She also mentions the post-event survey and thanks sponsors Johnson & Johnson and Sanofi.

Katie introduces Monika Brown, a women’s health nurse practitioner with 14 years of experience in gynecologic oncology at VCU Health. Monika’s approach centers on education, open communication, and trust.

Monika outlines the session: sexual desire, arousal, and function; bone pain and safe positioning; psychological factors; intimacy; and fertility preservation and resources.

Bone pain, fatigue, and reduced mobility can make everyday living hard and lower interest in intimacy, which can strain relationships. Monika encourages patients to seek psychological support alongside physical care.

Treatment-related neuropathy can involve the pudendal nerve, which supplies sensation to the pelvic organs, and may cause genital pain, burning, reduced sensation, or erectile dysfunction. Chemotherapy and radiation can also trigger menopause, causing dryness, pain, and loss of interest.

Katie notes that neuropathy is often discussed only in the fingers and toes. Monika explains that these effects are less visible in daily life, so they receive less attention.

For women, options include vaginal moisturizers, hormone replacement therapy when appropriate, dilators, and other tools for irritation and dryness. Monika refers erectile dysfunction questions to urology and suggests that exposure to erotic reading or viewing can help with low desire.

Patients should involve their medical team, including orthopedics, to find positions that take pressure off affected bones and joints. Pillows and other supports can help, and a linked diagram of positions used after hip and knee surgery is a useful reference. Monika advises controlling pain beforehand, as you would before a walk or errand.

Sexual changes can contribute to anxiety and depression, and care partners can drift into a caregiver role that makes touch feel more medical than intimate. Monika recommends keeping small rituals of connection, talking openly about boundaries, validating feelings about body image changes, and considering counseling.

SSRIs and SNRIs can reduce libido and sensation, and Monika mentions that bupropion (Wellbutrin) is one option some patients find helpful. For cognitive changes, she suggests reading or listening to audiobooks, open conversations with a partner, self-reflection, and journaling.

Monika suggests a 20 to 30 second hug, a 10-second kiss, massage of unaffected areas, cooking or planning together, starting a new hobby, and routine cuddling. Intimacy does not always mean intercourse.

Chemotherapy and pelvic radiation can cause premature menopause and male sterility. Options include egg retrieval and freezing, sperm banking, and ovarian transposition, and these should be discussed with the cancer team before treatment starts. Foundations may help with the cost.

Monika shares four questions: your sexual health before cancer, your current status, where you would like to be, and what barriers stand in the way. She encourages self-exploration first, keeping the focus on the patient whether or not a partner is involved.

For patients in active treatment, partners may need to follow precautions in the days after chemotherapy. Monika suggests bringing a partner to appointments so the patient is not the one translating medical information, and knowing your own preferences before dating.

A simple opener is “I’ve been thinking about my sexual health, and these are my concerns.” Patients can also ask their primary care provider, a gynecologist, or a sexual health therapist for a referral, and cancer-specific sexual health programs such as the one at MSK can connect patients to therapists.

Palliative care teams focus on symptom management and often do not perform pelvic exams. Monika recommends a gynecologist or urogynecologist for women, a urologist for men, a sexual health therapist, and pelvic floor therapy for everyone.

The conversation starts with understanding your own feelings. Some patients write a letter, others say it directly, and Monika shares an example of a patient who found lingerie designed for breast cancer survivors that helped her feel more confident.

Monika recommends outdoor dates over crowded indoor settings, masking during flu and COVID seasons, using condoms, and getting tested together with a new partner. She encourages being open about being immunocompromised.

Care partners are often afraid of causing harm, while the patient may be eager to resume intimacy. Monika recommends reassurance, a game plan discussed ahead of time, counseling, and processing the guilt that can come with changes in sexual function.

For chemotherapy, Monika describes a typical 48-hour window of double flushing and using condoms or abstaining. She notes that radiation does not pose a transfer risk, and that kissing is fine. Patients should confirm details for their own treatment with their care team.

Monika says it can be safe if both partners have been tested, you feel up to it, and good hygiene is practiced. Patients should check with their transplant team about their own situation.

Menopause lowers estrogen, which can lead to atrophy, scarring, and narrowing of the vagina. Dilators help keep the area open for patients who are not otherwise having penetrative sex. Monika names Good Clean Love and Replens as non-hormonal moisturizer and lubricant brands she often recommends.

Monika shares her personal view that cannabis can help with pain, nausea, stress, and anxiety, and mentions relaxation aids such as baths. These are her individual opinions, so patients should discuss cannabis with their own care team.

Monika recommends dilators or similar tools to keep the vaginal canal open for exams, and notes the same post-chemotherapy waiting period applies. For male partners, she highlights positioning challenges with hip involvement and the importance of lubrication and relaxation to reduce tears and infection risk.

Monika describes sativa as more stimulating and indica as more helpful for pain and body relaxation, and explains how CBD differs from higher-THC products. In Virginia, medical dispensary staff can help patients choose a form and dose, and rules vary by state.

Katie reminds attendees about the replay, slides, and feedback survey. Monika closes with the message that myeloma can change the body and relationships but does not take away the capacity for connection, pleasure, or love.