I love my job. There is no doubt in the world that I am doing exactly what I was made to do. I love reading about, writing about and speaking about sex.

But during Spring Break, I experienced one of the high points of my career. I was invited to speak to a support group for women in various stages of breast cancer on sex and cancer. To give you a bit of a peak into my personal world, I am a cancer orphan. I lost my mother to ovarian cancer and my father to brain cancer. My aunt is a breast cancer survivor. Cancer has ravaged my family and daily impacts the way I think, act and view life.

And yet, here I was, standing in front of a group of women who had been radically affected by cancer but who were determined NOT to be defined by it. They had come to hear me speak so that they could find answers and share solutions with each other on ways to have a good sex life once again.

There is no doubt that we live in an amazing age. More and more women are detecting cancer earlier and are surviving a disease which would have been certain death twenty years ago. Kids are getting to have their mothers for longer. Husbands are not been widowed as often.

But there is a shadowy side to this phenomenal survival rate. When you survive, you have to live life after cancer. Many women find that their sex lives are radically altered due to chemotherapy, surgery and the trauma of their experience. Their bodies don’t respond the same way that they did before cancer. They might have pain and discomfort. They have been launched into menopause and have to tackle all the effects of this passage in life. They grapple with bodies that no longer look the same…different breasts, scars, and defiled body image. And they may face a chasm of sexlessness which began during the early stages of diagnosis and was never quite bridged even after they were given a clean bill of health.

Under these circumstances, how do you restart the conversation with your spouse? How do you begin to have sex again? How do you get past all the physical and emotional hurdles that are thrown at you? These were all questions that these women had.

As I watched them share with each other, I was once again moved by the power of women talking openly and honestly about their sex lives. I have found that the most devious and insidious enemy of a great sex life is isolation. For if you feel that you are the only one who is dealing with the problems you face, you will be less likely to seek help. When we come together and share (with guidelines about privacy and confidentiality, of course), we can break through barriers that we had previously viewed as insurmountable.

Allow me to share with you five things that these women taught me from their own journeys:

1)   You are not alone. If you are struggling with sex after cancer, the issues you are facing have been faced by scores of women before you. Join a support group and see how other women have found solutions, read up on the subject, and talk to your doctor about different avenues to try. (Here is a great book suggestion: Woman, Cancer, Sex)

2)   Understand the stages. It is highly likely that when you are first diagnosed, you and your spouse will focus on the life-saving decisions you have to make. As you go through treatment, you will focus on making your appointments, having energy for your family and keeping a positive attitude. Sex will slide down on your priority list. This is normal and completely understandable. However, there will come a time when life normalizes and sex will come back into your thoughts. Making it a priority in your relationship once again might feel awkward and stilted.

3)   Communicate, communicate, communicate. Finding the ways to address this issue with your spouse can be difficult. The topic becomes the 800lb gorilla in the room that you both dance around. He is thinking, “If I bring it up, she might burst into tears.” You are thinking, “I wonder if he misses it?” If you are looking for a way to bridge the communication gap over this thorny issue, take a drive. Ask your spouse how s/he is feeling about sex and listen to his/her response. Sometimes being side by side (rather than face to face) helps diffuse some of the tension that has built up.

4)   Get uncomfortable being uncomfortable. There is truth to the saying that everything you want in life is outside your comfort zone. If you are going to have a good sex life again, you are most likely going to have to try new things to see what works with your new body. You are going to have to be brave and courageous. Perhaps you will need a vibrator to “find” your orgasm again. Perhaps you need a lubricant which does not contain any estrogen to combat the vaginal dryness. Perhaps you will need to find a naturopath who can give neuroshots to restore sensation to your pelvic floor. Being willing to push past your inhibitions in order to find solutions that work for you is a crucial piece to restoring a good sex life.

5)   Begin with sensate focus exercises. If you are wondering how to begin having sex again after a long dry spell, start slowly and don’t immediately shoot for gold. Trying sensate focused massages are a great way to get started. Remember point number 4 – communicate first about your desires and goals for the exercise. For complete instructions, read this article.

Finally, remember that every couple handles life after cancer differently. The key is making sure that how you approach your sex life is truly working for both of you. If you need some more tips on how other couples have dealt with this situation, check out this article from the Duke Clinical Research Institute.