Sexuality after cancer treatment: What women can expect

Sex might be the last thing on your mind as you start thinking about cancer treatment options and cope with the anxiety that comes with a cancer diagnosis. But as you start to feel more comfortable with yourself during treatment and afterward, you'll want to get back to a "normal" life as much as you can. For many women, this includes resuming sexual intimacy with their partners.

An intimate connection with a partner can make you feel loved and supported as you go through your cancer treatment. But sexual side effects of cancer treatment can make resuming sex more difficult. Find out if you're at risk of sexual side effects after treatment and which treatments can cause these side effects. Knowing more about your situation can help you feel more in control and help you find a solution that will work for you.

Who's at risk of sexual side effects?

Women being treated for breast or gynecologic cancers are most likely to experience side effects that make having sex painful or difficult. But cancers anywhere in the pelvic region can cause these effects. Pelvic cancers include:

• Bladder cancer
• Cervical cancer
• Colon cancer
• Ovarian cancer
• Rectal cancer
• Uterine cancer
• Vaginal cancer

Treatment for each of these cancers carries the risk of causing physical changes to your body. But having cancer also affects your emotions, no matter what type of cancer you have. These emotions can also impact your attitude toward sex and intimacy with your partner.

What sexual side effects are most common?

The treatment you receive and your type and stage of cancer will determine whether you experience any sexual side effects. The most commonly reported side effects among women include:

• Difficulty reaching climax
• Loss of desire for sex
• Pain during penetration
• Reduced size of the vagina
• Vaginal dryness

Not all women will experience these side effects. Your doctor can give you an idea of whether your specific treatment will cause any of these.

Common sexual side effects of selected cancer treatments

Adapted from: American Cancer Society, 2005

How does cancer treatment cause sexual side effects?

Cancer treatments that are more likely to cause sexual side effects include:

Chemotherapy
Many women experience a loss of libido during and after chemotherapy. Often the side effects of the treatment, such as nausea, hair loss, and weight loss or gain, can make you feel unattractive. Side effects usually fade soon after treatment ends. But it may take time to rebuild your self-confidence to bring back your desire for sex.

Chemotherapy can cause a sudden loss of estrogen production in your ovaries. This can lead to symptoms of menopause, such as a thinning vagina (vaginal atrophy) and vaginal dryness, which both can cause pain during penetration. Ask your doctor about what you can expect from your chemotherapy drugs, as some can cause permanent ovary damage. Depending on your cancer type, your doctor may prescribe estrogen replacement therapy — also called hormone therapy for menopause — to reduce the sexual side effects you experience. However, women with breast or ovarian cancer should discuss this carefully with their doctors, as some cancers are hormone sensitive and shouldn't be combined with hormone replacement therapy.

Radiation therapy
Sexual side effects related to radiation therapy are most common in women receiving treatment aimed at their pelvic area. Radiation to the pelvis causes:

• Damage to the ovaries. The amount of damage and whether it's permanent depends on the strength of your radiation treatments. Damaged ovaries don't produce estrogen. This causes symptoms of menopause, such as vaginal dryness. If you've already been through menopause, you likely won't experience such symptoms.
• Changes in the vaginal lining. Radiation therapy can irritate healthy tissue in its path. This can cause the lining of your vagina to become inflamed and tender. Penetration during sex may be uncomfortable during treatment and for a few weeks afterward. As the lining of your vagina heals, it may become thickened and scarred, causing your vagina to tighten and resist stretching during penetration. Your doctor might recommend using a vaginal dilator to prevent scar tissue from forming after radiation.

Talk to your doctor about what you can expect from your specific radiation treatments. Some side effects may be preventable. For instance, surgery to relocate your ovaries to another part of your body might spare them from the damage of radiation and preserve your fertility. Ask your doctor about your options.

Surgery
Whether surgery affects your ability to have sex will depend on your type of cancer, where it's located and its size. Surgeries that are likely to cause sexual side effects include:

• Radical hysterectomy. Women with cervical cancer may opt for a radical hysterectomy to remove their uterus and related ligaments, as well as their cervix and part of their vagina. A shortened vagina usually doesn't change your ability to have sex, though it may take some adjustment. Women over 40 may also have their ovaries removed during this procedure. If you're premenopausal when your ovaries are removed, you'll experience menopause.
• Radical cystectomy. In this operation for bladder cancer, the surgeon removes your bladder, uterus, ovaries, fallopian tubes, cervix, the front wall of your vagina and your urethra. Your surgeon reconstructs your vagina, though it may be shorter or narrower than it was before surgery. This can make sex painful. If you haven't been through menopause, removal of your ovaries will cause early menopause.
• Abdominoperineal (AP) resection. AP resection is used if you have colon or rectal cancer. Your surgeon removes your lower colon and rectum. Without the cushion of the rectum, you might experience pain in your vagina during penetration. Some women who have an AP resection also have their ovaries removed. If you're premenopausal, this will cause premature menopause.
• Vulvectomy. You may undergo vulvectomy if you have cancer of the vulva. Your surgeon removes the entire vulva, including the inner and outer lips, as well as the clitoris. These play a major part in sexual arousal in women. Removing the vulva and the clitoris can make the area less sensitive and make it harder for you to reach orgasm.

Vulva

Vulva

The vulva is the outer part of the female genitalia, including the labia and clitoris.

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What can you do to regain your sexual function?

Knowing what sexual side effects to expect before you begin your cancer treatment can help you be more prepared to deal with them as you go through treatment. If you experience sexual side effects, find out as much as you can about what's impeding your sexual function. This will help you feel more in control of the situation and help guide you to treatment options. You may also want to:

• Talk with your health care team. You might be embarrassed to talk about the sexual side effects you're experiencing, but don't be. Though talking about sex can be awkward, you'll never find a solution if you don't let someone know what you're experiencing. Write down your questions if it makes you feel more comfortable. Also know that your doctor may be embarrassed or hesitant to talk about sex. Ask to be referred to a specialist or seek support from other members of your health care team, such as nurses and counselors.
• Talk with your partner. Let your partner know what you're experiencing and how he or she can help you cope. For instance, you might find that using a lubricant eases your vaginal dryness or changing positions helps you avoid genital pain during sex. Together you can think of solutions to ease you back into a fulfilling sex life.
• Explore other ways of being intimate. Intercourse isn't your only option for closeness with your partner. Consider spending more time together talking, cuddling or caressing. Connecting in other ways might help make you feel more comfortable and less anxious about the sexual side effects you're experiencing.
• Talk with other cancer survivors. Your health care team might be able to steer you to a support group in your town. Otherwise, connect with other cancer survivors online. If you're embarrassed about discussing sex face-to-face with strangers, the online environment provides you anonymity. Start with the American Cancer Society's Cancer Survivors Network.

It may simply take time for you to regain your sexual function after cancer treatment. While that can be frustrating, know that if you had a positive and satisfying sex life before cancer, you'll likely resume that after your treatment.