Your sex life after pelvic radiotherapy
Pelvic radiotherapy can affect your sex life and how you feel about yourself sexually. This can be more of a problem if you’ve had surgery to the pelvic area.
Physical changes can make having sex difficult, reduce your sex drive (libido) and affect how you feel about your body (body image). Tiredness, a low mood or feeling anxious can also affect your sex drive.
For some women, sexual difficulties are temporary and gradually improve over time. But even changes that are permanent can be improved. With support, you should still be able to enjoy a fulfilling sex life.
Low sex drive (libido)
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If you have a partner, let them know how you feel. Explaining why you don’t feel like having sex can reassure them that it isn’t because you no longer find them attractive. You can show your partner how much you care in other sensual and physically affectionate ways. Being more relaxed and intimate with your partner may gradually lead to more sexual contact.
If sexual difficulties don’t improve, it may be a good idea to ask for advice rather than letting things drift between you and your partner. Our cancer support specialists have more information on the help that’s available.
Treating any late effects of pelvic radiotherapy that are causing you problems may improve things. For example, treatments for vaginal dryness will make sex more comfortable and improve your sex drive. If you don’t have much energy, having sex in different, less energetic ways or quicker sexual contact can help.
Managing menopausal symptoms may help improve your sex drive. You may want to talk to your cancer doctor about taking hormone replacement therapy (HRT), especially if you’ve had the menopause early.
Occasionally, doctors may prescribe the hormone testosterone for women who are experiencing distress because of a low sex drive. This is generally only considered if other approaches haven’t worked. Although testosterone is often thought of as a male hormone, women also produce it in smaller amounts.
If you have urinary or bowel problems, our section on sexuality and cancer has information about ways of adapting to having sex.
Radiotherapy can make the vagina become narrower and less stretchy. The vaginal walls may also be dry and thin, and can stick together. This can make penetrative sex and internal examination uncomfortable, so it’s important to try to prevent the vagina from narrowing.
Your hospital team may recommend you use vaginal dilators to help. Dilators are tampon-shaped plastic tubes of different sizes that you use with a lubricant. Although they’re commonly used, there isn’t strong evidence to say how effective they are. Rarely, they may cause damage to the vagina, especially if they aren’t used correctly. Your specialist nurse or doctor will explain how best to use them in your situation.
Having regular penetrative sex, using a dildo or vibrator, or using lubricated fingers may also help prevent the vagina from narrowing. Even if you are having sex regularly, you may still be advised to use a dilator.
The blood vessels in the lining of the vagina can become fragile and bleed more easily, especially after sex. Bleeding may also be caused by the vaginal tissue sticking together or scar tissue causing the vagina to narrow.
Always let your cancer doctor or nurse know if you have any bleeding. They will examine you and explain if it’s likely to be caused by the radiotherapy. If the bleeding is minor, once you know the cause you may find that it doesn’t trouble you much.
Using oestrogen creams (see below) or trying to prevent vaginal narrowing (see above) may help reduce any bleeding. Make sure you use lubricants during sex. You may want to try different techniques and positions that may reduce the bleeding.
If the bleeding doesn’t improve, a drug called silver nitrate may be applied to seal off the bleeding points. A drug called tranexamic acid may also be prescribed for you.
Occasionally, bleeding may be due to a sore (ulcer) in the vagina that’s developed as a result of radiotherapy.
You’ll probably be advised to avoid penetrative sex until it has healed. Antibiotics are prescribed to treat any infection, and you may have the area rinsed regularly with antiseptic fluids (irrigation). Treatments can be applied directly to the ulcer to help it heal. Rarely, hyperbaric oxygen therapy may be used.
We have a section on hyperbaric oxygen therapy.
Always tell your cancer doctor or nurse if you have vaginal bleeding.
Radiotherapy reduces the natural lubrication in the vagina, which can make having sex uncomfortable. Different creams, gels, lubricants or pessaries (small pellets that are put inside the vagina) can help with this.
If you’ve had the menopause early, hormone replacement therapy (HRT) will help with vaginal dryness. Your cancer specialist will let you know whether HRT is suitable for you, depending on the type of cancer you’ve had.
Your doctor may recommend using vaginal oestrogen creams or pessaries. They help with dryness and may prevent the vaginal wall from becoming thin. Although your body will absorb some oestrogen from the cream or pessaries, many doctors think it’s too small an amount to be harmful. Your cancer doctor will let you know whether oestrogen creams or pessaries are suitable for you.
Moisturising creams and lubricants
There are lots of products you can buy that help with vaginal dryness.
Creams can be applied regularly to help draw more moisture into the vaginal tissue, and can be prescribed by your doctor. You use lubricants when you want to have sex to make it feel more comfortable and pleasurable.
Replens MD® is a cream that’s available from most chemists. You apply it 2–3 times a week and it works for up to three days. Hyalofemme® is a newer cream that you can apply every day.
Water-based lubricants, including Senselle®, Astroglide®, Sylk®, Vielle® or Durex® lube, can be bought at chemists or some supermarkets. Organic lubricant products, such as Yes® or V Gel®, are available to buy online.
Vaginal dryness can make you more likely to get infections, such as thrush. Let your doctor know if you have symptoms such as vaginal itching or soreness.
Tablets, creams and pessaries to treat vaginal thrush are also available over the pharmacy counter under brand names such as Canesten®. But if you haven’t had thrush before, see your GP first. Always see your GP if you’re not sure whether it’s thrush, if symptoms don’t improve or if it keeps coming back.
Changes in sexual sensation
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After radiotherapy, some women find it harder to get aroused or take longer to orgasm. This might be because of the effects of radiotherapy, and also of surgery (if you’ve had it) on the nerves in the pelvic area. But it may be due to a difference in the way you feel about yourself sexually. A sex therapist or counsellor may be able to help you if this is the case.
It can be difficult to talk about your sex life and any problems you’re having, but doctors and specialist nurses are used to dealing with intimate problems. They can often give you advice and support if things aren’t going well. Your hospital doctor or GP can refer you to a counsellor or sex therapist.
A sex therapist can help you adjust to physical changes and explore different ways of getting sexual satisfaction.
If emotional problems are affecting your sex life, ask your doctor to refer you to a counsellor or doctor who specialises in emotional support.
If you have a partner, talk to them about the effect that treatment is having on your sex life. It’s good to look at ways of overcoming any problems as a couple. You can talk to sex therapists or counsellors in detail about the effects these changes are having on you and your partner. You can contact a sex therapist through your doctor or specialist nurse.
There are organisations that may also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a Iist of qualified practitioners and The Sexual Advice Association offers a confidential helpline.