Changes to sexual function after bowel cancer treatment
Bowel cancer and its treatment can affect your sex life and how you see yourself (self image).
Sexual difficulties can arise as a result of the physical and emotional effects of cancer and its treatment. You may feel too exhausted to have sex during treatment and for a while afterwards. Most people find that this gradually improves, but occasionally it can last for months or even longer.
Many people find it difficult to talk about sexual issues because they feel embarrassed or self-conscious. Your doctor or specialist nurse will be used to talking about these issues and can advise you where to go for specialist help and support. There are a lot of organisations that offer information and treatment.
We also have more detailed information about sexuality and cancer.
Low sex drive (libido)
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Some people find that their interest in sex is reduced after treatment. There can be different reasons for this:
Coping with cancer and its treatment can cause anxiety, depression and low self-esteem.
Tiredness (fatigue) may carry on for months after treatment.
Changes to how you feel about yourself sexually may lower your sex drive.
Reduced levels of sex hormones due to treatment.
If you have a partner, let them know how you feel. Explaining why you don’t feel like sex can reassure them that it isn’t because your feelings for them have changed.
Possible sexual changes in women
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After treatment for rectal cancer some women feel their orgasm is 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.
The vagina may be shortened or narrowed by surgery or radiotherapy. If the rectum, which normally cushions the vagina, has been removed, sex may be uncomfortable.
Sometimes a different sexual position can feel better. You may need to experiment to find out what works best for you. Some women feel more relaxed if they can take control over the depth and speed of penetration. You can also use pillows and cushions to give you support.
Radiotherapy to the pelvic area can cause changes to the vagina. It may become drier, narrower and less flexible. Your hospital team may recommend that you use vaginal dilators to help. Dilators are tampon-shaped plastic tubes of different sizes that you use with a lubricant. Your specialist nurse or doctor will explain how best to use them.
If you find sex uncomfortable because of vaginal dryness, your doctor can prescribe you a cream or gel to treat this. Simple lubricants such as Aquaglide®, Senselle® or Replens® can be bought from most chemists.
Some treatments such as chemotherapy, radiotherapy or rectal surgery may affect the ovaries in women who haven’t been through the menopause. This can cause menopausal symptoms that make sex difficult, such as a dry vagina or lowered sex drive. Your doctor may be able to give you hormone replacement therapy (HRT), which can make up for these changes.
A woman who has already had her menopause will have far fewer hormonal changes. The Daisy Network offers information and support for women going through an early menopause.
We have more information about managing possible sexual changes after radiotherapy.
Possible sexual changes in men
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Surgery or radiotherapy for rectal cancer can affect a man’s ability to get and maintain an erection. During surgery to remove rectal cancer, nerves that supply the penis may be damaged. After radiotherapy some men notice that their erections are less strong than before and that this gradually gets worse over a year or two.
This may happen if radiotherapy has caused damage to nerves or scarring in blood vessels that supply the penis.
Treatment with drugs such as sildenafil (Viagra®) can help some men to get and maintain an erection after surgery or radiotherapy. When problems do occur after treatment, there’s some evidence to suggest that by starting tablets (such as Viagra) sooner rather than later, your ability to get and maintain an erection will be improved.
For men who can’t take these drugs or who aren’t helped by them there are alternative methods that may help. We have more information about these in our section on sexuality and cancer.
Low testosterone levels
After radiotherapy for rectal cancer the levels of the male hormone testosterone are reduced in some men. If blood tests show you have low testosterone levels your specialist can tell you if testosterone replacement therapy is likely to be helpful for you.
You can read more about the possible effects of radiotherapy in our section on managing the late effects of pelvic radiotherapy in men.
If you have a stoma, you may find some sexual positions uncomfortable. It can also affect your self-confidence and you may feel self-conscious about the change in your body. This may result in sexual difficulties with your partner or make you feel anxious about new relationships.
Occasionally problems may arise because partners are struggling with change. However, your partner may not have a problem with your changed appearance. It can be helpful to try to discuss it if you feel there’s awkwardness between you.
If you’re feeling self-conscious about how you look, talking with your partner about how you feel can help you regain some confidence. Focus on a part of your body that you like and use this as a foundation to build confidence in your body. If you feel very self-conscious, making love while partly dressed or keeping the lighting low may help.
Stoma nurses can give you advice and help with the effects a stoma can have on sexuality. Information is also available from the Sexual Dysfunction Association or the Ileostomy and Internal Pouch Support Group.