Q: I’m lucky because my breast cancer treatment went well and I am in remission, but I have zero interest in sex with my partner. Will this ever get better or will I be stuck in neutral the rest of my life? Help!

A: It is very common for women survivors of breast cancer to struggle with low sexual desire and other problems, including vaginal dryness and difficulty with arousal and orgasm. First, let’s look at why that is, and then let’s look at what can be done about it.

Breast cancer survivors (really, a survivor of any type of cancer) can understandably have mild to moderate depression as well as anxiety as a result of diagnosis and treatment. This level of injury to the body causes injury to the psyche. Having cancer can make the survivor feel vulnerable, for example. Or they may struggle with feeling dependent on caregivers if they are used to being independent.

Then, there are issues related to body image. Cancer treatment can lead to scarring and other changes in the body, including weight loss or weight gain from medications. When hair grows back after chemotherapy, it can be a different texture or even color. Being in ill health can cause someone to look pale or tired, which some people perceive in themselves as being unattractive.

Many breast cancer survivors are put on Tamoxifen, which is used to suppress the production of estrogen. Tamoxifen puts the survivor into menopause, which can have multiple annoying symptoms, including hot flashes, night sweats, irritability, and vaginal dryness. It can also cause a woman’s libido to drop, which can lead to difficulty enjoying sex.

Fortunately, there are a number of steps a breast cancer survivor and her partner can take to sustain their intimate relationship. One of the first is to acknowledge that there have been changes, some psychological and some physical, and that things may never be the same. Many oncologists and psychologists refer to this period after cancer treatment as the “new normal.”

The “new normal” can mean different things. One is that the reasons for having sex might be different. Instead of being motivated for sex by physical desire, the cancer survivor may be motivated by more affection, more words of love and praise, or other actions. The survivor may also need to find new reasons to engage in sex, such as feeling connected or simply feeling like a desirable woman.

The survivor and her partner may also need to engage in exploring new ways of getting aroused, such as using toys or exploring different parts of the body, especially if the survivor once had pleasure from having her breasts caressed. On a physical level, the survivor may need to use lubricant, vaginal moisturizer, or if not contraindicated, topical estrogen to overcome vaginal dryness. Vaginal intercourse, however, requires a certain amount of energy. Being open to other ways of having sex might create more possibilities for pleasure.

On a physical level, taking good care of one’s self is paramount, whether the aim is to feel good or to have enough energy for sex. Watching one’s diet, getting enough sleep and rest, and taking time for a meditation or yoga practice can all help the survivor have more self-esteem and cope better with stress. This, in turn, can make the survivor feel more in touch with her sexual nature and her desire for an intimate connection.