Managing changes to sexual sensation, the vagina and vulva

Cancer and its treatment can cause physical changes to your body which can affect your sex life. But there are ways to manage these changes so that you are still able to enjoy a fulfilling sex life.

You might experience changes in sexual sensation after cancer treatment.

Chemotherapy, hormonal therapy and treatment to the pelvic area can cause changes to the vagina, including:

  • pain during vaginal penetration
  • vaginal dryness
  • vaginal narrowing
  • vaginal shortening
  • vaginal bleeding
  • vaginal infection.

These changes can be upsetting, but there are ways you can manage them to help when having sex.

Changes to the vulva might mean that sex feels different to how it did before treatment. It might take you a while to enjoy sex again, but there are things you can do to help. It is important to give yourself time to heal.

If you are having sexual difficulties, it is important to talk about it with your GP or specialist. A sex therapist or counsellor may also be able to help you with some of these issues.

Changes in sexual sensation

After radiotherapy or surgery to the pelvic area, some women find it harder to get aroused, or take longer to orgasm. This might be because of the effects of radiotherapy or surgery on the nerves in the pelvic area. But it may be because of a change in the way you feel about yourself sexually.

If you have a partner, explain to them that you would like to take sex gently to start with. Try not to put too much pressure on yourself to expect the same levels of sensation that you had before your treatment. A sex therapist or counsellor may be able to help you with these issues.


Changes to the vagina

Surgery, chemotherapy, hormonal therapy or radiotherapy to the pelvic area may cause vaginal changes. These may include the changes listed below.


Pain during vaginal penetration

Vaginal penetration means putting an object such as a penis, finger or sex toy inside the vagina. There are many reasons for pain during vaginal penetration. It is important to let your partner know what is painful, so you can find other positions or ways of having sex.

The cause of the pain can often be treated simply. If you have pain during sex, tell your doctor or nurse. They can examine you to find out why, and suggest possible solutions.

If you have pain or are worried about pain, it may be helpful if you:

  • learn relaxation techniques to use before having sex
  • use vaginal lubricants if your vagina feels dry (see below)
  • take control of the depth and speed of penetration (being on top or on your side may help)
  • try to ensure you and your partner are fully aroused and close to orgasm before penetration
  • try different types of sexual contact that you don’t find painful, such as sexual contact without penetration
  • use pillows and cushions to help you feel more comfortable and supported.


Vaginal dryness

If the vagina is not wet during sexual arousal, having sex can feel uncomfortable. Creams, gels, lubricants or pessaries (small pellets that are put inside the vagina) can help with this.

If you’ve had an early menopause, hormone replacement therapy (HRT) will help with vaginal dryness. Your specialist will let you know whether HRT is suitable for you. This will depend on the type of cancer you have had.

Oestrogen creams and pessaries

Your doctor may recommend using vaginal oestrogen creams or pessaries. These help with dryness and may stop the vaginal wall 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. Your doctor will let you know whether oestrogen creams or pessaries are suitable for you.

Moisturising creams and lubricants

There are lots of products that help with vaginal dryness. You can buy them in chemists or online, or your doctor can prescribe them.

Moisturisers work by drawing moisture into the vaginal tissue. You apply them regularly. They include:

  • Gynomunal®
  • Hyalofemme®
  • Regelle®
  • Replens MD®
  • Sylk®
  • Yes® (vaginal moisturiser).

You can also use lubricants when you have sex to make it feel more comfortable and pleasurable. Lubricants can be water-based or oil-based.

They include:

  • Astroglide® Ultra Gentle
  • Sylk®
  • Yes® water based lubricant.

You can buy these from chemists, some supermarkets or online.


Vaginal narrowing

Your vagina may become narrower and less stretchy after surgery or pelvic radiotherapy. The vaginal walls may also be dry and thin, and can stick together. This can make penetrative sex and internal examinations uncomfortable.

Your hospital team may recommend you use vaginal dilators to help. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant.

Although dilators are commonly used, there is not strong evidence about how effective they are. Rarely, they may cause damage to the vagina, especially if they are not used correctly. Your specialist nurse or doctor will explain the best way to use them in your situation.

You may also be able to help stop the vagina narrowing by:

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


Vaginal shortening

After some types of pelvic surgery, the vagina may be slightly shorter than it was before.

Having a slightly shorter vagina is usually no problem at all. While you are still healing, you may prefer not to have penetrative sex. Or you may prefer to be very gentle during sex and control the depth of penetration. Try different positions to find the most comfortable for you.


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 infection

You may get vaginal thrush infections during radiotherapy or chemotherapy. If your vagina is dry, you are more likely to get infections.

Symptoms of thrush include a creamy-white discharge and itchiness in the vaginal area that gets worse if you scratch it. You can buy tablets, creams and pessaries to treat vaginal thrush over the pharmacy counter, under brand names such as Canesten®. But if you have not had thrush before, you should see your GP first.

Always see your GP if:

  • you are not sure whether it is thrush
  • symptoms do not improve
  • it keeps coming back.

If you have had sexual contact, including oral sex, your partner may also need treatment.


Changes to the vulva

Your treatment may have changed the way your genital area looks or feels. Many women worry that they will not be able to have orgasms if their clitoris has been removed. This is not necessarily the case. Although the head of the clitoris is the most sensitive part, there are nerve endings in the other parts of the clitoris that extend down both sides of the vulva. Stimulating these may lead to a climax. Your specialist nurse or doctor can explain this to you. You may need to be patient while you try to find other ways to reach a climax.

It may take some months before you really begin to enjoy sex again after treatment. Don’t be surprised if you feel very unsure about it. Remember that you need to look after yourself and give yourself time to heal. If you have a partner, talk to them and be as honest as you can about what you want and don’t want. It is fine to say no to any kind of sexual contact that does not feel right.

Some women find that penetration is not physically possible at first, because of the way their vulva has healed after treatment. For example, there may be some tightening or scar tissue caused by surgery. There are a number of things that can help with this, so it is important to tell your specialist nurse or medical team about it.


Menopausal changes

Your doctor may be able to give you hormone replacement therapy (HRT), which can help make menopausal changes easier. If you have had breast cancer or a hormone-sensitive gynaecological cancer, you may be advised not to take HRT. Your doctor can talk with you about HRT and whether it might be suitable for you.

Some other treatments can help reduce menopausal symptoms. It may be helpful to discuss this with your doctor or specialist nurse.

An organisation called the Daisy Network supports women who have an early menopause. You may find it helpful to contact them if you need support.


Other things you can do

It is a good idea to follow healthy living guidelines. Doing this will help your body recover and may help you feel more in control.


Other things to know

There is more than one way to have sex or experience sexual pleasure. You can take time to try new things, and find other ways of experiencing and giving pleasure. This could include oral sex, mutual touching, using sex toys such as a dildo or vibrator, watching erotic films or reading erotic books.

When trying new things, it is usually best to do so gradually. That way you and your partner can make sure you both feel comfortable.

Back to Effects of treatment on a woman's sex life

Effects of surgery on women

Any surgery can affect your sexuality. Surgery to any sexual areas of the body may cause noticeable changes.