Monday 10th September 2012
Lisa Punt, Macmillan Consultant Radiographer in Gynaecological Oncology, writes about changes women may experience following pelvic radiotherapy and what can help.
There are many dimensions to cancer that can have an impact on a woman’s sexuality. Psychological, behavioural and physical changes are often difficult to separate and this can make addressing sexual effects a complex process.
Effects of radiotherapy
Pelvic radiotherapy is used either as a primary or adjuvant treatment for gynaecological or lower gastrointestinal cancer. Radiotherapy to the pelvis may result in short-term side effects such as fatigue, nausea, diarrhoea and perineal soreness, all of which can contribute to a loss of desire during a course of radiotherapy.
Long-term effects may include direct damage to the vaginal mucosa resulting in the lining becoming thinner, and vaginal stenosis, which may lead to the formation of adhesions and fibrosis. These changes will lead to a shortening and narrowing of the vagina and, ultimately, pain and discomfort during sexual intercourse.
These tampon-shaped plastic devices are used to reduce the risk of vaginal stenosis and formation of scar tissue. National recommendations were first published in 2005 by the National Forum of Gynaecological Oncology Nurses.
The recommendations suggest using a vaginal dilator three times a week for 5–10 minutes, for an indefinite time period. However, a recent review of published research found that routine vaginal dilation during, or soon after cancer treatment, may be harmful in very rare cases if used during the inflammatory period or immediately after radiotherapy. Women are now advised to use the dilators four weeks after completing radiotherapy to minimise risk during the time when the vaginal lining is most likely to be damaged.
While there is a lack of evidence to support the optimal use of vaginal dilators, it’s evident from clinical experience that the process of dilation improves vaginal capacity for some.
A woman who undergoes pelvic radiotherapy and hasn’t already entered menopause will enter a treatment-induced menopause.
The effect of changing oestrogen and androgen levels on sexual desire is poorly understood, but these clearly have a role to play. It’s believed that oestrogens and androgens work together to promote libido. Circulating oestrogen within the blood also plays an important role in the maintenance of healthy vaginal mucosa. Declining levels of oestrogen will result in the shortening and narrowing of the vagina, reduced vaginal blood flow, loss of lubrication, increased pH and atrophy of the vaginal wall.
The effects of reduced oestrogen on the vaginal mucosa may be improved with the use of oral hormone replacement therapy in women who have a oestrogen-receptor negative tumour. If vaginal atrophy continues or there is persistent vaginal irritation or infection, then it may be necessary to offer topical oestrogen cream. Just as normal sexual function relies on a complex interplay of physical and emotional well-being, addressing sexual difficulties requires a holistic approach.
1. National Forum of gynaecological oncology nurses. Best practice guidelines on the use of vaginal dilators in women receiving pelvic radiotherapy
[PDF, 183kb]. July 2005. Published by Owen Mumford, Oxon.
2. Miles T. and Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy
. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007291. DOI: 10.1002/14651858. CD007291.pub2.
We have more information about pelvic radiotherapy in women.