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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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Pelvic radiotherapy can affect your sexuality and sex life.
You may also have effects from other treatments, such as surgery| , chemotherapy| or hormonal therapy| . It may help to read information about how these other treatments can affect your sex life. If you've had a combination of treatments, you may be more likely to have effects on your sex life than if you only had pelvic radiotherapy.
Our section on sexuality| discusses ways of dealing with the physical and emotional changes that cancer treatments can cause.
If you have a partner, you may find it helpful to talk to them about any changes you've noticed in how your body responds sexually. It's good to look at ways of overcoming any problems as a couple.
You can talk to sexual therapists or counsellors in detail about the effects these changes or difficulties are having on you and your partner. They can be contacted through:
Many women find that their interest in sex reduces, or may disappear completely, both during and after treatment. There are many reasons for this including:
Sexual interest may also be lowered after treatments which stop the ovaries producing hormones. This causes an early menopause. Taking hormone replacement therapy (HRT) containing oestrogen and progesterone can increase your sex drive. Some doctors may recommend a small dose of testosterone to replace the amount normally produced by the ovaries. Your doctor can tell you whether or not HRT (with or without testosterone) may be helpful for you.
Some women with breast| or womb cancer| are advised not to have HRT as there is a risk that the hormones may stimulate the growth of these cancers.
Radiotherapy to the pelvic area can cause inflammation of the walls of the vagina. When the inflammation reduces, scar tissue can form, which can make the vagina narrower and shorter. The vaginal walls may also be dry and thin, and can stick together. Less vaginal lubricant may be produced, which can make you more likely to get vaginal infections such as thrush. Vaginal changes can be very uncomfortable and can make the vagina sore, especially during sex. Penetrative sex or a medical vaginal examination can be more difficult and possibly painful.
To help keep the vagina supple and to prevent scar tissue from forming you will be advised to use vaginal dilators. Usually to start using them from 2–8 weeks after the radiotherapy treatment has ended. You will be given a range of dilators to use, starting with a small one and working up to larger sizes. Regular sex can also help to keep the vagina healthy, although this may initially be uncomfortable. You can also use a vibrator or your fingers to gently stretch the vagina to keep it supple and make sex and vaginal examinations more comfortable.
Vaginal dilators are tampon-shaped plastic devices with a rounded end. There are a number of different types available. They also come in varying sizes. Instructions for using dilators may differ slightly from hospital to hospital, but the principles are the same.
You will be given a range of dilators to use, starting with a small one and working up to larger sizes. Before inserting the dilator, a water-based lubricant should be placed on the dilator and around the entrance to the vagina. You can lie down or may prefer to stand, with one leg bent up and supported on a chair or the toilet. Or you may also prefer to use the dilators during a bath. If you have a partner you may want to involve them when using the dilators.
Once you have inserted the dilator, you can slowly and steadily withdraw and insert it repeatedly over 5-10 minutes. Or you can rotate it gently while pushing deeper into the vagina using a circular motion. The movement will help to break down any fixed scar tissue (adhesions). Doing pelvic floor exercises while you use the dilators can help them to work better.
When you have finished, remove the dilator and wash it with warm soapy water. Try to use the dilators at least three times a week.
Most specialists advise using the dilators for about 6–12 months. Some women may need to carry on using them for life. If you have regular sex – for example, at least twice a week – you may not need to carry on using the dilators.
Other things to remember when using the vaginal dilator:
Radiotherapy and an early menopause can reduce the production of natural lubrication in the vagina. Hormone replacement therapy (HRT) can help to keep the vagina healthy.
If you are not able to take HRT you may still be able to use vaginal oestrogen creams that are put inside the vagina. Oestrogen creams are sometimes given to help prevent the vaginal wall from becoming too thin. Your body absorbs some of the oestrogen but not enough to have a harmful effect. Your doctor, radiographer or specialist nurse can discuss this with you.
You can also use non-hormonal lubricants, such as Replens®, KY Jelly, Aquagel, Sylk®, and Vielle®, which are available from your chemist. Some women find that rinsing the vagina using a benzydamine douche can help to relieve dryness and irritation. The douches can be prescribed by your doctor or specialist nurse.
You may find that a few months after the radiotherapy, when the early side effects have reduced, you have a slight stinging or burning in your vagina when your partner ejaculates. You can use extra lubricant gels to help reduce this feeling.
If the usual lubricants don't work, you can try silicone-based lubricants which can coat the vagina more effectively. Silicone-based lubricants are available from sex product shops or websites such as www.sh-womenstore.co.uk| or www.beecourse.com|
Some women find that the silicone-based lubricants help, but for others they may cause stinging or itching. It's important to take note of any effects that the lubricants cause and stop using any that cause irritation. Let your doctor or specialist nurse know if you are having problems.
The skin and the blood vessels just below the surface lining of the vagina can become fragile and easily damaged. This is known as telangectasia. It can cause pain, soreness or bleeding, especially after sex. Rarely, sore areas in the vagina can take a long time to heal. This is known as vaginal ulceration. It's best to avoid sex while the vagina heals. You can still enjoy a sexual relationship. It's important to talk to your partner about what you both want.
Some women notice that after cancer treatment their orgasm can feel different. Some women find that the sensation may feel less intense than before. It may also take longer to reach orgasm. This is thought to be due to changes in the blood flow and nerves in the pelvic and genital area which may occur after pelvic surgery or radiotherapy.
Many women say that the changes may be due to feeling different about the way their body works and feels sexually.
If you have any changes that make you feel worried or upset it can help to speak to someone such as a sexual counsellor. They can help you explore things that can improve the situation.
You may find our list of useful organisations| helpful.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.