Q I am 62 and recovering from breast cancer. My husband and I have been married for 40 years and he has been wonderful through it all. Before my diagnosis I had to give up HRT — that, and the side effects of the medication I am on, means that sex has become difficult. We have tried lubricants but nothing works. We still cuddle and are intimate but both miss full sex. Any suggestions?

The Times expert replies: I am very glad to hear that you are recovering and very envious of your fabulous relationship with your husband. You (plural) are an inspiration. Serious illness can put a real strain on any relationship but breast cancer is even more difficult because 90 per cent of women who undergo treatment experience sexual difficulties and 50 per cent of them suffer chronic problems.

The physical issues are compounded by women who have undergone the trauma of cancer possibly being inclined to take the view that, in the greater scheme of things, painful sex is not important enough to complain about.

It is hard to talk about sexual difficulties with doctors at the best of times. At the European Congress on Menopause 2009, research was presented showing that seven out of ten menopausal women are too embarrassed to discuss dryness with their doctor, but, crucially, 67 per cent of women who had, or were, currently taking treatment experienced benefits, including an improved quality of life, a return to normal sexual activity and an improvement in their relationship with their partner. So if you have not spoken to your oncologist, your gynaecologist or your GP about these issues you need to do so as soon as you can. The most effective treatments are all oestrogen- based, which generally makes them a no-no for breast cancer sufferers, but some doctors believe that, in certain women, very low-dose topical oestrogen creams are safe even for those who have been treated for cancer.

Research into new treatment options is continuing and the good news is that results from phase 3 clinical trials of Pilocarpine (Salagen), a new non-oestrogenic treatment for the relief of dryness in breast cancer patients, are very promising. In the meantime, you should try Replens MD gel.

A study published in the New England Journal of Medicine in 2008 showed that regular use of this oestrogen-free moisturiser results in thickened tissue that is better able to handle the friction of intercourse. Available over-the-counter from most good chemists, 12 applications costs about £9.99 and should last four weeks. The effect is cumulative so you need to use it three times a week for three months regardless of whether you are having sex or not. In conjunction with Replens you should also be using a dilator.

Dilators are plastic cones that come in sets of different sizes and are inserted into the vagina to help to stretch it. You begin with the smallest one and progress to the larger ones as it becomes more comfortable. Doing pelvic floor exercises would also be helpful. You can find out how to do them and why they are important at www.thewomens.org.au/ Pelvicfloorexercises.

I know you have tried a few different lubricants but I would recommend that you opt for silicone-based products because they tend to last longer than water-based versions. You may need to try several to find the one that feels right for you. Because the cost of experimenting with different products soon adds up, the lovely Ruth at LoveHoney (www.lovehoney.co.uk) has kindly volunteered to give you and your husband a special selection. Expect a discreet brown package to be delivered in the next few days — and do let me know how you get on.

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