Effects of surgery on sexuality
Any type of surgery can affect your sexuality and sex life, even if it doesn’t involve your sex organs. However, cancer surgery that directly affects the genitals and other sexual and reproductive areas of the body may cause quite noticeable changes.
Your surgeon and specialist nurse will talk to you about the surgery and how it might affect you.
Effects of surgery on women
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A hysterectomy is the removal of the uterus (womb) and cervix. There are different types of hysterectomy, which affect sexual function in different ways. With a radical (Wertheim’s) hysterectomy, once the womb is removed the surgeon stitches up the top end of the vagina. This makes it approximately a third shorter than it was before. Sometimes one or both ovaries are also removed. A simple hysterectomy is unlikely to affect the length of the vagina.
Having a slightly shorter vagina is usually no problem at all. Early on however, while you’re still healing, you may prefer not to have penetrative sex or to be very gentle, controlling the depth of penetration. Try different positions to find out which are most comfortable.
A hysterectomy may affect a woman’s experience of orgasm. This happens because once the womb is removed there are no longer any uterine contractions, and because some of the nerves leading to the clitoris can be affected by the surgery. Most women find that they are still able to have an orgasm, but the sensation may be different from before the operation. Some surgeons specialise in doing surgery that is less likely to damage the nerves. This is known as nerve-sparing surgery.
Unfortunately, women who have a hysterectomy will be unable to get pregnant. This can be very difficult to cope with.
Other methods of having a baby may still be possible. We have more information about possible ways of preserving fertility.
For some women with very early cancer of the cervix, it may be possible to have a radical trachelectomy rather than a hysterectomy. In this type of surgery, the cervix, the tissues next to the cervix and the upper part of the vagina are removed. The rest of the womb is left in place, so it may still be possible to get pregnant.
After a trachelectomy the vagina will be slightly shorter than before. This is not normally a problem for most women, but if you find penetration uncomfortable, try different positions where you can control the depth of penetration.
This is the name of the operation where an ovary is removed. The ovaries produce most of the oestrogen in the body. If both ovaries are removed (a bilateral oophorectomy), you’ll go into a menopause and may have menopausal symptoms such as a dry vagina and a lowered sex drive.
Removing both the ovaries is sometimes known as a surgical menopause. It’s likely that you’ll notice menopausal symptoms occurring more quickly than the gradual onset that occurs with a natural menopause. For many women, HRT (hormone replacement therapy) can return the body’s systems to nearly normal. You may find it helpful to talk all this through with your doctor or specialist nurse.
A cystectomy is removal of the bladder. During a radical cystectomy, the surgeon may also remove the womb, the ovaries, part of the vagina, the tube that drains urine from the bladder (urethra) and the fallopian tubes. The surgeon will explain this to you before the operation.
This operation may include a reconstruction of the vagina, which often means that the vagina will be shorter than before. This can make penetrative sex painful or difficult, and can also affect the ability of some women to have an orgasm.
If the urethra is removed, the end where it opens outside the body is often also removed. This can affect the blood supply to the clitoris, making it less responsive to arousal. The end of the urethra doesn’t always have to be removed, and your surgeon can advise you about this. Because the womb is removed during this operation, you’ll be unable to get pregnant, which can be very difficult to cope with.
Removing the ovaries will cause an early menopause and menopausal symptoms in women who haven’t already reached their natural menopause.
When the bladder is removed, a ‘new’ bladder can often be made using part of your bowel. If it’s not possible to reconstruct the bladder, an opening is made in the wall of the abdomen (a stoma) so that urine can drain into a bag.
Mastectomy and lumpectomy
Mastectomy is the removal of a breast. This operation creates a body change that can affect sexual arousal in many ways - particularly if you were previously aroused by having your breasts touched. Some women say the operation affects their image of themselves and makes them feel less womanly. Some women may find that they need a lot of time to talk through the feelings and emotions that a mastectomy can cause.
A lumpectomy removes just the breast cancer and an area of surrounding tissue - not the whole breast. It can still affect the way a woman feels about her body and may affect the sensations in the breast.
An abdomino-perineal (AP) resection is one of several different operations used to remove tumours of the rectum. During the operation, the anus, rectum and part of the lower end of the large bowel (sigmoid colon) are removed, and a stoma is formed so that bowel motions can drain into a bag. Sometimes an AP resection may also involve the removal of the womb, ovaries and part of the vaginal wall.
After an AP resection, some women find that penetrative sex can be uncomfortable in some positions. This is because the rectum normally cushions the vagina and because you may have an altered vaginal shape. Trying different positions can help. It’s not recommended that stomas should be used for penetrative sex, but in some situations this may be possible. Your doctor or specialist nurse can discuss this with you further.
If your ovaries have been removed, you may experience menopausal symptoms that make sex difficult, such as a dry vagina or lowered sex drive. HRT may be possible for some women.
An AP resection will mean that women who previously had anal sex will no longer be able to, which can be difficult to accept. It may be possible to keep the rectum, although this will depend on the individual situation and can increase the risk of the cancer coming back. You may want to discuss this issue with your surgeon before surgery.
A vulvectomy is where part or all of the vulva is removed. This is a rare operation that’s sometimes necessary for women who have cancer (or melanoma) of the vulva. Removing the vulva will affect sexual sensations, especially if the clitoris has been removed.
This is a major and rare operation that’s sometimes used to treat advanced pelvic cancers. During the operation, all the structures in the pelvis are removed. This can include the womb, cervix, ovaries, vagina, bladder and rectum. If the rectum and bladder are removed, two stomas may be formed. A ‘new’ vagina may also be reconstructed, which may be shorter and narrower than before.
A pelvic exenteration can change the way that women have sex, alter their sensations and cause problems with body image. The operation varies from woman to woman, and the effects it has on sexuality will also vary. Your surgeon and specialist nurse will advise you about the extent of the operation needed and how it may affect you sexually.
Effects of surgery on men
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A radical prostatectomy is the removal of the prostate gland. Many men who have a prostatectomy will have difficulty getting or keeping an erection (erectile dysfunction - ED) after the surgery. This is due to damage to the nerves that control an erection. This can be permanent and starts immediately after the surgery.
Long-term ED is more likely to occur in older men and in those who had difficulty getting an erection before the surgery. There are ways of dealing with ED, and these are discussed in a separate section. Some surgeons specialise in surgery that is less likely to damage the nerves and can reduce the risk of problems. This is known as nerve-sparing surgery. Another type of surgery for prostate cancer is called robotic surgery, which uses a special machine, called a da Vinci machine, to help with the operation. ED seems to be less common with this type of surgery, but it’s currently only available at a few centres in the UK.
After a prostatectomy no semen will be produced, and any sperm produced by the testicles are simply reabsorbed back into the body rather than being ejaculated. In men who can still have and maintain erections, it’s still possible to have an orgasm, but there will be no ejaculation. This is called a dry ejaculation or dry orgasm.
These changes will mean that it’s impossible to father a child using normal methods. It may still be possible to have children if you stored sperm before the operation, or using a method called testicular sperm extraction (TESA), where a small sample of testicular tissue is removed to look for sperm. If you’re infertile after a prostatectomy and wanted to have a child, this can be very upsetting. Some of the feelings and emotions that you may have are discussed in another section. Other methods of having a baby may still be possible.
After a prostatectomy, some men may find that they leak small amounts of urine (incontinence). This is often temporary and can usually be managed very well with advice from a specialist nurse or continence adviser. Incontinence can cause embarrassment if you’re sexually active, especially if you have to wear pads or need a catheter (tube to drain urine). We have more information about urinary problems.
A cystectomy is the removal of the bladder. During a radical cystectomy, the surgeon will also remove the prostate gland. It’s very common for men to have nerve damage after this type of operation, which may make it impossible for them to get an erection. Sometimes the ability to get an erection returns with time. Nerve-sparing surgery may be possible, which can reduce the risk of erection problems. Because the prostate is also removed, men who have had a radical resection will also have dry ejaculations.
When the bladder is removed, a ‘new’ bladder can often be made using part of your bowel. If it’s not possible to reconstruct the bladder, an opening is made in the wall of the abdomen (a stoma) so that urine can drain into a bag. Stomas are discussed in more detail below.
An abdomino-perineal (AP) resection is one of several different operations used to remove tumours of the rectum. During the operation, the anus, rectum and part of the lower end of the large bowel (the sigmoid colon) are removed, and a stoma is formed. It can affect the nerves that control erections and ejaculation. Modern surgical procedures try not to damage the nerves in this part of the body but, even so, many men will have erection problems.
An AP resection will mean that men who previously had anal sex will no longer be able to. This can be very difficult to accept for some men. It may be possible to keep the rectum, although this will depend on the individual situation and can increase the risk of the cancer coming back. You may want to discuss this issue with your surgeon before surgery. It is not recommended that a stoma should be used for penetrative sex, although in some situations this may be possible. Your doctor or specialist nurse can discuss this with you further.
An orchidectomy is an operation where a testicle is removed:
Removal of one testicle
In men with testicular cancer, usually only one testicle is removed. This won’t cause infertility and doesn’t usually affect sexual performance. Sometimes, however, men who develop testicular cancers may have testicles that aren’t working properly and are only producing fairly small amounts of male hormone (testosterone). In this situation, removing one testicle may mean that the other one can’t produce enough testosterone. This can cause problems such as a loss of interest in sex (reduced libido) or difficulty getting or keeping an erection (erectile dysfunction - ED). Low levels of testosterone may also make orgasms less intense.
Initially after the operation, sexual positions that apply pressure to the area should be avoided. Some men say that orgasms feel different, and the normal contractions of the testicular sac (scrotum) at orgasm may feel uncomfortable. The amount of fluid ejaculated is usually less than before.
Removal of both testicles
If both testicles are removed, for example as a treatment for prostate cancer, you will be infertile and you may be unable to have an erection due to a lack of testosterone. There is more information about infertility in another section.
Hormone replacement therapy (HRT) can be used to replace some of the testosterone, which can help to improve libido and the ability to get erections. HRT can be given as tablets, injections, or patches and gels that are applied to the skin. You may find it helpful to talk all this through with your doctor or specialist nurse.
It’s common for a false testicle (prosthesis) to be inserted into the scrotum. This gives the appearance and feel of a normal testicle. However, although it looks normal, men may still feel differently about their body. Some men describe feeling less masculine, and need time to talk through this change.
Retroperitoneal lymph node dissection
Some men who have had testicular cancer will have an operation to remove the lymph nodes in the lower abdomen. This is done if the nodes are still enlarged after radiotherapy or chemotherapy. The operation, called a retroperitoneal lymph node dissection, can affect the nerves that control ejaculation of semen. This can cause the semen and sperm to flow back into the bladder (a retrograde ejaculation). Having retrograde ejaculations is harmless, although orgasms will feel different and you will no longer be able to father children. Before the operation it may be possible to store sperm samples so that you can still father a child. Some men will recover their ability to ejaculate normally over the next few years and regain their fertility.
Sperm storage is discussed in our section about cancer and fertility for men.
A retroperitoneal lymph node dissection doesn’t stop a man getting an erection and having an orgasm, although the intensity of an orgasm may be weaker.
Penectomy and penile reconstruction
Surgery to remove the penis is called a penectomy, which may be partial (where part of the penis is removed) or total (where the whole penis is removed). The surgeon will try to remove as little of the penis as possible and may be able to reconstruct it if necessary, although the penis is likely to be smaller than before and may have scars.
Penile surgery can have a significant impact on a man’s body image and self-confidence.
After surgery, most men are able to have a fulfilling sex life. Unless you’ve had all of your penis removed, you should still be able to have erections and orgasms. If your whole penis has been removed, you will no longer be able to have penetrative sex or receive oral sex, so you’ll need to experiment to find new ways to have sex. The areas around your scrotum and testicles will still be sensitive and you may still be able to have orgasms. If you’ve had a penile reconstruction, you may be able to get an erection, but this will depend on the type of reconstructive surgery you’ve had.
Your surgeon or specialist nurse will discuss the surgery with you and answer any questions you have.
Effects of surgery on both men and women
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Sometimes surgery is used to create an opening in the abdominal wall (a stoma), due to bowel or bladder cancer, or advanced cervical or ovarian cancer. A stoma will allow for waste from the body (either urine or bowel motions) to drain into a bag that’s fixed over the stoma. In this situation there’s a high chance of permanent damage to the blood supply and the nerves in the genital area. This may cause men to have problems in getting and maintaining an erection. It’s not clear how this type of operation affects arousal and orgasm in women.
A stoma can make some sexual positions uncomfortable. It can also affect your self-confidence and the way you feel about your body (body image). You should reassure your partner that sex will not harm the stoma.
Make sure that the bag fits well and doesn’t leak. It’s a good idea to empty the bag before sex, although this can sometimes affect spontaneity. Some foods can cause the bag to fill quickly, so avoid eating or drinking anything that usually causes you problems. You may also be able to plug the stoma or do a stoma washout so that a bag isn’t needed for a short time.
Stoma nurses can give advice and help with all the effects on sexuality that a stoma may cause. Information is also available from organisations such as the Ileostomy and Internal Pouch Support Group or the Sexual Advice Association. It is not recommended that a stoma should be used for penetrative sex, although in some situations this may be possible. Your doctor or specialist nurse can discuss this with you further.
A laryngectomy is the removal of the voice box (larynx), which can change the way a person talks and breathes. Communication between couples is very important. Although it’s usually possible to speak after a laryngectomy using an aid or oesophageal speech, it can sometimes be difficult or distracting during sex. Oesophageal speech is a way of speaking that can be taught to people who have had their voice box removed.
It may help to discuss what you’d both like before starting sex, and to develop ways of signalling messages to each other.
Surgery for head and neck cancers can sometimes leave scars and may be disfiguring. This can change the way a person feels about themselves and may cause low self-esteem. Surgery that involves the jaw or tongue may alter the way a person speaks, which can affect the way they communicate. Surgery may also affect the way a person kisses or gives oral sex. However, newer surgical techniques and advances in plastic surgery aim to minimise any lasting problems.
There are a number of organisations, such as Let’s Face It and Changing Faces, that can give advice and help to people trying to cope with a facial disfigurement.
Very occasionally, when treating some types of cancer such as primary bone cancer, it’s necessary to amputate the affected arm or leg. Advances in surgical techniques have meant that amputation is rarely needed as it’s often possible to remove just the affected part of the bone.
If amputation is necessary, the limb will often be replaced with an artificial arm or leg (a prosthesis). Some people are happy to have sex wearing their prosthesis, which can help with positioning and movement. However, some people find that the straps used to secure the prosthesis are uncomfortable and get in the way. You can try different sexual positions, and pillows can be used to help with positioning and balance.
Some people have problems with pain that appears to come from the part of the body that has been amputated. This is known as phantom pain. Any type of pain can be distracting during sex and may reduce sexual desire. If you have problems with pain, your doctor can often prescribe effective painkillers.
Removal of lymph nodes
If lymph nodes have been removed as part of your treatment, this can cause swelling in a nearby area of the body. For example, when lymph nodes are removed from under the arm as part of treatment for breast cancer, the affected arm may swell. If lymph nodes are removed from the groin, this may cause swelling of the legs and pubic area. The swelling is called lymphoedema.
Lymphoedema can affect the way that you feel about your body and may make it difficult to use the affected part of the body. You may need to find sexual positions that don’t put weight on the area affected by lymphoedema.
There are ways of reducing lymphoedema.