Late effects and sex life

For some people the effects of pelvic radiotherapy on their sex life that began during treatment may not improve even after treatment has ended. Other effects on your sex life may not develop until months or years later.;

Some people’s interest in sex may be reduced after treatment. Low sex drive can be caused by:

  • tiredness
  • how you feel about yourself sexually
  • changes to the vagina
  • men may have low testosterone.

Women may have some changes in sensation, which could be due to vaginal dryness or narrowing. There are treatments that your doctor can suggest to improve these. Less commonly, women may suffer from vaginal bleeding. This can usually be reduced by using creams or lubricants.

Men may experience erection problems. The risk depends on the type of cancer, the dose of radiotherapy and any other treatments. Treatments that help with erection problems include tablets that increase the blood supply to the penis, injections and vacuum pumps.

There are organisations that may help if you are having problems in your sex life. For example, the College of Sexual and Relationship Therapists and The Sexual Advice Association.

Your sex life

Pelvic radiotherapy can cause changes that affect your sex life and the way you feel about yourself. Physical changes can make having sex difficult, reduce your sex drive (libido) and affect the way you feel about your body (your body image). Tiredness, a low mood or anxiety can also lower your sex drive.

Men may develop problems with getting or keeping an erection. This is more likely to happen if you’ve also had surgery to the pelvic area or chemotherapy treatment. Hormonal therapy for prostate cancer can also affect a man’s sex life.

For some people, these difficulties are temporary and gradually improve over time. But even permanent changes can be improved. Sexual difficulties can also be caused by other medical conditions and they’re common as people get older.

Getting help

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, specialist nurse or GP can also 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.

Men may be referred to an erectile dysfunction (ED) service. This is a clinic for men who have problems getting and maintaining an erection. You may see doctors who specialize in the physical and psychological causes of ED, and ways to treat it. You will be asked about your general health and the problems you’ve been having. Some men may have blood tests and an examination of their genitals.

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 a sex therapist or counsellor in detail about the effects these changes are having on you and your partner.

There are organisations that can also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a list of qualified practitioners and the Sexual Advice Association offers a confidential helpline.

Low sex drive (libido)

If you have a partner and your sex drive is low, let them know how you feel. Explaining why you don’t feel like having sex can reassure them that the reason isn’t that you no longer find them attractive. You can show your partner how much you care in other sensual and physically affectionate ways. There are different reasons for low sex drive:

  • Coping with cancer and its treatment can cause anxiety, depression and low self-esteem.
  • Tiredness (fatigue) may carry on for months after treatment.
  • Late bladder and bowel effects may lower your sex drive because they affect the way both men and women feel about themselves sexually.
  • Occasionally, men who’ve had pelvic radiotherapy make less testosterone. This is important for sex drive.

If sexual difficulties don’t improve, it may be a good idea to ask for advice rather than letting things drift between you.

One way to improve things may be to treat any late effects of pelvic radiotherapy that are causing you problems. Men may be prescribed a testosterone replacement therapy. This isn’t always suitable for men who had prostate cancer.

For women, treatments for vaginal dryness will make sex more comfortable and improve your sex drive. And if you don’t have much energy, it can help to have sex in different, less energetic ways or to have quicker sexual contact.

Managing menopausal symptoms may help improve your sex drive. If you’ve had an early menopause, talk to your cancer doctor about taking hormone replacement therapy (HRT).

Occasionally, doctors may prescribe the hormone testosterone for women who are distressed by their low sex drive. We normally think of testosterone as a male hormone, but women also produce it in small amounts. Doctors usually only consider prescribing it if other treatments haven’t worked.


Late effects for women

Women may experience some of the following problems, which may affect their sex life.

Changes to the vagina

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 it uncomfortable to have penetrative sex. It can also make it uncomfortable to have an internal examination. So it’s important to try to prevent the vagina narrowing.

Your hospital team may recommend that you use vaginal dilators. This is to help stop the vagina narrowing. 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 the best way to use them in your situation.

Other ways to help stop the vagina narrowing include:

  • having regular penetrative sex
  • using a dildo or vibrator
  • using lubricated fingers.

Even if you are having sex regularly, you may still be advised to use a dilator.

Bleeding

After pelvic radiotherapy, the blood vessels in the lining of the vagina can become fragile. This means they can 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.

If you have any bleeding, always let your cancer doctor or nurse know. They will examine you and explain whether 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.

You can try to reduce bleeding by:

  • using oestrogen creams
  • trying to prevent vaginal narrowing
  • making sure you use lubricants during sex
  • trying different sexual techniques and positions.

If the bleeding doesn’t improve, your doctor may be able to use a drug called silver nitrate to seal off the bleeding points. They may also prescribe you a drug called tranexamic acid.

Rarely, bleeding may be caused by a sore (ulcer) in the vagina that has developed as a result of radiotherapy. You’ll probably be advised not to have penetrative sex until it has healed. You will be prescribed antibiotics to treat any infection, and you may have the area rinsed regularly with antiseptic fluids (irrigation). You can apply treatments directly to the ulcer to help it heal. Some women may have an operation to remove the area of tissue where the ulcer is. Rarely, some women have hyperbaric oxygen therapy.

Vaginal dryness

Radiotherapy reduces the natural lubrication in the vagina.This can make having sex uncomfortable. There are creams, gels, lubricants and pessaries (small pellets that are put inside the vagina) that can help with this.

If you’ve had an early menopause, hormone replacement therapy (HRT) will help with vaginal dryness. Ask your cancer specialist whether HRT is suitable for you.

Oestrogen creams and pessaries

Your doctor may recommend that you use vaginal oestrogen creams or pessaries. These help with dryness and they may stop the vaginal wall from becoming thin.

Although your body will absorb some oestrogen from the cream or pessaries, many doctors think the amount is too small to be harmful.

Moisturising creams and lubricants

There are lots of products you can buy that help with vaginal dryness. Your doctor can prescribe creams that you can apply regularly to help draw more moisture into the vaginal tissue. You can also use lubricants, which help make having sex 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.

You can buy water-based lubricants from chemists and some supermarkets. These lubricants include Senselle®, Astroglide®, Sylk®, Vielle® and Durex®. You can buy organic lubricant products online, for example Yes® and V Gel®.

Having vaginal dryness can make you more likely to get infections, such as thrush. If you have symptoms such as vaginal itching or soreness, let your doctor know. You can buy tablets, creams and pessaries to treat vaginal thrush over the pharmacy counter. They have brand names such as Canesten®. But if you haven’t had thrush before, see your GP before you buy anything from the pharmacy. Always see your GP if:

  • you’re not sure whether you have thrush
  • your symptoms don’t improve
  • thrush keeps coming back.

After I had brachytherapy I had no long-term damage. However, I had to use dilators once a week for five years.

Joan


Changes in sensation

After radiotherapy, some women find it harder to get aroused or take longer to orgasm. This might be because of the effects of radiotherapy on the nerves in the pelvic area. If you’ve had surgery to the pelvic area, this can also affect the nerves. But it can also be due to a difference in the way you feel about yourself sexually. If this is the case for you, a sex therapist or counsellor may be able to help you.

There are organisations that can also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a list of qualified practitioners and the Sexual Advice Association offers a confidential helpline.

We have more information on sexuality and cancer, which gives more detailed information on dealing with the physical and emotional effects that cancer and its treatment may have on your sex life.

Pelvic radiotherapy may also have an effect on your fertility, which can be very hard to cope with.


Late effects for men

Men mainly have problems with getting or keeping an erection after pelvic radiotherapy.

Erection problems

Pelvic radiotherapy can damage nerves in the pelvic area and blood vessels that supply blood to the penis. This can cause problems in getting or keeping an erection (impotence). Your risk of erection problems depends on the type of cancer you’ve had, the dose of radiotherapy you were given and any other treatments you’ve had. Your cancer specialist will discuss this with you.

Some treatments can help erection problems. These include:

  • tablets that increase the blood supply to the penis, such as sildenafil (Viagra®), vardenafil (Levitra®) or tadalafil (Cialis®)
  • pellets that are placed into the tip of the penis, called alprostadil (MUSE)
  • injections into the base of the penis, such as alprostadil or papaverine
  • vacuum pumps that are placed over the penis.

Your doctor or nurse should be able to advise you on the different treatments. They can also refer you to a specialist if necessary.

There’s some evidence that starting tablets, such as Viagra, sooner rather than later is more likely to improve your ability to get and maintain an erection.

We have more information on sexuality and cancer, which has more detail about these treatments. The Sexual Advice Association also produces leaflets.

Changes in ejaculation

After pelvic radiotherapy, you produce less semen. This means that when you ejaculate, you may notice that only a small amount of fluid comes out. Some men don’t produce any semen at all, and this is known as a dry ejaculation. Although you will still be able to orgasm (climax), some men find the sensation feels different from before.

It may take longer to reach orgasm and you may find the sensation is less intense after pelvic radiotherapy. This may be due to changes in the blood flow to, and nerves in, the pelvic and genital area. But it may also be caused by a change in the way you feel about yourself sexually.

Pelvic radiotherapy may also have an effect on your fertility, which can be very hard to cope with.

Back to Late effects of pelvic radiotherapy

About late effects

Some people may have long term or late effects of pelvic radiotherapy. These can usually be treated or managed successfully.

Bladder changes

Late effects on the bladder can usually be managed or treated successfully. Talk to your doctor about any symptoms.

Bowel changes

Late bowel effects of pelvic radiotherapy are usually managed or treated successfully. Talk to your doctor if you notice any symptoms.