Coping with sexual difficulties in women

Cancer and its treatment may affect your sex life, both physically and emotionally.

You may not feel like having sex. You may be worried about sex being painful. Trying relaxation techniques and different types of sexual touching may help.

Treatment may cause physical changes to your vagina or vulva. This may make sex painful. Your specialist may suggest creams, lubricants and medicines to help with this.

Breast changes can alter your body image and self-confidence. Some women decide to wear a false breast or have breast reconstruction.

You may have bowel and bladder problems after cancer treatment. You may have a stoma. These changes can have a big impact on your sex life. Talk to your doctor or specialist nurse. They may be able to treat the side effects with medicines or suggest ways to help you cope.

If you’re having sexual difficulties, it’s 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.

If you don't feel like having sex

If you have a partner, it’s important to let them know if you don’t feel interested in sex. Explaining why you don’t feel like having sex can reassure them that it isn’t because you no longer find them attractive. You can show your partner how much you care about them in other physically affectionate ways. Being more relaxed and intimate with your partner may gradually lead to more sexual contact.

If your partner is feeling frustrated, it may be helpful for them to reduce the frustration through masturbation, either with you or alone.

If you have fatigue and don’t have much energy, it might help to have sex in different ways. Less energetic sexual positions, where your weight is well supported, can reduce strain. You may also prefer quicker sexual contact rather than longer sessions. These are things you can talk about together.

If tension is building between you, it may be helpful to get support from a counsellor or sex and relationship therapist. They specialise in offering people help in these circumstances.

Tips to help you communicate

Lead Cancer Nurse Lynne Dodson discusses the importance of communicating any sexual issues you may have as a result of cancer.

About our cancer information videos

Tips to help you communicate

Lead Cancer Nurse Lynne Dodson discusses the importance of communicating any sexual issues you may have as a result of cancer.

About our cancer information videos


Pain during sex

Pain can reduce sexual feelings and desire. Pain often leads to a fear of pain, and this can cause tension. Tension can be distracting and stop you becoming aroused. It can also cause further pain.

You may have pain during penetrative sex after pelvic surgery or radiotherapy. It can also happen if you’re having treatment that reduces the amount of natural lubrication you produce, such as hormonal therapy or chemotherapy.

There are many reasons for pain during sex. It’s important to let your partner know what’s 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 to:

  • have sex after taking painkillers and waiting a short time for them to work
  • learn some relaxation techniques to use before having sex
  • take control of the depth and speed of penetration
  • try to ensure you and/or your partner are close to orgasm before penetration
  • try different types of sexual contact that you don’t find painful – this could be sexual contact without penetration
  • use pillows and cushions to help you feel more comfortable and supported
  • have sex side by side, to reduce body weight on a sore area.

Sex and Cancer - Scott and Rebecca's story

Scott and Rebecca tell their story of how cancer has affected their sexual relationship.

About our cancer information videos

Sex and Cancer - Scott and Rebecca's story

Scott and Rebecca tell their story of how cancer has affected their sexual relationship.

About our cancer information videos


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’d like to take sex gently to start with. Try not to put too much pressure on yourself to expect the same levels of sensation as you had before your treatment. A sex therapist or counsellor may be able to help you with these issues.


Changes to the vulva

Your treatment may have changed the way your genital area looks or feels. Many women worry that they won’t be able to have orgasms if their clitoris has been removed. This isn’t necessarily the case, although you may need to be patient while you try to find different 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’s fine to say no to any kind of sexual contact that doesn’t feel right.

Some women find that penetration isn’t 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’s important to tell your specialist nurse or medical team about it.


Changes to the vagina

Surgery, chemotherapy, hormonal therapy or radiotherapy to the pelvic area may cause vaginal changes. These changes include dryness, narrowing, shortening, ulcers and infection. They may lead to pain during penetrative sex.

Vaginal dryness

Treatment can reduce the amount of natural lubrication in the vagina, which makes having sex 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’ve 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. There are creams that you can buy or your doctor can prescribe, which you can apply regularly to help draw more moisture into the vaginal tissue. 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, which you apply once every three days.

You can also use lubricants when you have sex to make it feel more comfortable and pleasurable. Water-based or oil-based lubricants include Senselle®, Astroglide®, Sylk® and Durex Lube®. You can buy these from chemists or some supermarkets. You can buy organic lubricants online, such as Yes® and V Gel®.

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, so it’s important to try to prevent your vagina from narrowing.

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 they’re commonly used, there isn’t strong evidence about 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 how best 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.

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

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’re 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 out which ones are the most comfortable.

Sometimes the surgeon uses a stitch to close the neck of the womb (cervix) after surgery. If you or your partner can feel this during sex and find it uncomfortable, discuss it with your surgical team.

Bleeding and ulceration

Bleeding may be caused by the vaginal tissue sticking together or scar tissue making the vagina narrower. The blood vessels in the lining of the vagina can become fragile and bleed more easily, especially after sex.

Always let your doctor or nurse know if you have any bleeding. They will examine you and explain whether it’s caused by your treatment. If you don’t have much bleeding, once you know the cause you may find that it doesn’t trouble you much.

Using oestrogen creams or trying to prevent vaginal narrowing may help reduce any bleeding. Make sure you use lubricants during sex. You may want to try different techniques and positions that might reduce the bleeding.

If the bleeding doesn’t improve, a drug called silver nitrate may be applied to seal off the areas that bleed. Your doctors may also prescribe a drug called tranexamic acid.

Occasionally, bleeding may be due to a sore (ulcer) in the vagina that’s developed after pelvic radiotherapy. This can take weeks, or sometimes months, to heal. You’ll probably be advised to avoid penetrative sex until it heals.

Vaginal infection

You may get vaginal thrush infections during radiotherapy or chemotherapy. If your vagina is dry, you are more likely to get infections. This is because there are changes in the acidity of the vaginal area.

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 haven’t had thrush before, see your GP first.

Always see your GP if:

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

If you’ve had sexual contact, your partner may also need treatment.


Menopausal changes

Your doctor may be able to give you hormone replacement therapy (HRT), which can help make menopausal changes easier. If you’ve had breast cancer or a hormone-sensitive gynaecological cancer, you may be advised not to take HRT. Your doctor will let you know if HRT is suitable for you.

Some complementary therapies can help reduce menopausal symptoms. It may be helpful to discuss this with your doctor or specialist nurse. We have more information about cancer and complementary therapies.

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.


Urinary problems

After cancer treatment, people occasionally have problems with leaking urine (incontinence) or having difficulty passing urine.

You may have to wear incontinence pads or have a urinary catheter, which can lead to feelings of embarrassment. You may feel unclean or unattractive, and you may avoid intimate contact.

Although it may seem embarrassing, it’s a good idea to discuss incontinence with your sexual partner. Be honest with them – tell them that a little urine may leak during sex. You may want to let them know that urine is sterile and it won’t cause an infection for them. It can also help to have towels and tissues nearby in case there’s any leakage. Good personal hygiene will help you feel more confident.

If you don’t have a catheter

Avoid drinking too many fluids for an hour or so before you have sex. Make sure you pass urine beforehand so your bladder is as empty as possible. It’s sometimes possible to make sure your bladder is empty by putting in a catheter – your nurse or a continence adviser can discuss this with you. You may also want to have a shower or bath before having sex, which you could do alone or with your partner.

Some women find that penetrative sex makes the incontinence worse. If this happens, you can explore other ways of getting sexual pleasure, such as foreplay, massaging and oral sex. Trying different sexual positions may also help.

Your doctor or specialist nurse can give you advice on different ways of coping with incontinence. They can also refer you to a continence adviser for further support.

If you have a catheter

Sex is still possible if you have a urinary catheter in place. Your nurse or a continence adviser can discuss this with you.

You can tape the catheter out of the way on your leg or hip. Try different sexual positions to find the ones that are more comfortable for you and that don’t put pressure on the catheter.

In some situations, it may be possible to remove the catheter during sex. Your nurse or a continence adviser can show you how to do this.


Bowel problems

Bowel problems can sometimes be a side effect of cancer treatment, especially pelvic radiotherapy. These problems include loose bowel motions (diarrhoea) and needing to open the bowels with very little or no warning (faecal incontinence). These effects may be temporary, but they can sometimes be permanent.

Having problems with your bowels can have a huge impact on your life. It may make you feel less interested in sex, and it can also make you feel embarrassed and affect your confidence. You may feel unclean or unattractive, and you may avoid intimate contact.

You can discuss any bowel problems with your doctor or specialist nurse, or with a dietitian. They may be able to reduce the side effects using a combination of medicines, dietary changes and exercises, and can help you cope with the way the problems are making you feel.

There are things you can do that may help the way your bowel problems affect your sex life:

  • Find out which foods cause the diarrhoea or make it worse, and avoid them for several hours before you have sex.
  • Empty your bowels just before you have sex.
  • Good personal hygiene will help boost your confidence.
  • Using scented candles may help if you’re concerned about smells.
  • Let your partner know that you may have to rush to the toilet.
  • Make sure you can get to the toilet quickly and easily.
  • Have tissues and towels nearby during sex.
  • You could use an anal plug. They’re available from the Bladder and Bowel Foundation.


Stomas

Having a stoma can make some sexual positions uncomfortable. It can affect your confidence and the way you feel about your body. You should reassure your partner that sex will not harm the stoma. It is not recommended that a stoma is used for penetrative sex, although in some situations this may be possible. Your doctor or specialist nurse can discuss this with you further.

Make sure the bag fits well and doesn’t leak. It’s a good idea to empty the bag before sex, although this can sometimes make it difficult to be spontaneous. 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 advise and help you with all the sexual effects a stoma may cause. Information is also available from the Ileostomy and Internal Pouch Support Group or the Sexual Advice Association.


Breast changes

Having a mastectomy or lumpectomy may affect your body image and make you feel less feminine. Both operations can change your body in a way that can affect sexual arousal in many ways. This is particularly true if you were previously aroused by having your breasts or nipples touched.

After a mastectomy, unless you’ve had breast reconstruction, you’ll be given a soft, lightweight false breast (prosthesis), which you can put inside your bra. This is sometimes called a ‘cumfie’ or ‘softie’. It’s designed to be worn immediately after the operation when the area feels tender. When your wound has fully healed, you will be fitted with a permanent false breast (prosthesis).

You can get different types of prosthesis from the NHS and Breast Cancer Care, who can give you a list of suppliers. Some women say they feel sexier having sex with their bra on after a mastectomy. This helps hides scars and holds the false breast if there is one.

Crop tops or an all-in-one body suit with poppers in the crotch can also be comfortable without you having to be completely hidden.

It’s often possible for women who have had a mastectomy to have their breast reconstructed. You may have a breast reconstruction done at the same time as the mastectomy, or months or years after the operation. There are different methods of breast reconstruction and your surgeon can discuss the options that may be suitable for you.

The nipple on a reconstructed breast will also feel different. You might have a prosthesis, or you may have a nipple tattooed on your reconstructed breast a few months after your reconstruction.

Any of these body changes can have an impact on your sex life. It might help to explore different erogenous zones on your body, either alone or as a couple. Or you could work with a psychosexual counsellor to learn how to cope with your new body image and sensation issues.

Sex and Cancer - Helen's story

Helen talks about her experience of having a mastectomy and the impact it had on her confidence and relationships.

About our cancer information videos

Sex and Cancer - Helen's story

Helen talks about her experience of having a mastectomy and the impact it had on her confidence and relationships.

About our cancer information videos


Changes to your face and speech

Having facial surgery may change the way you feel about yourself and cause low self-esteem. There are a number of organisations that give help and advice to people trying to cope with a facial disfigurement. These include Let’s Face It and Changing Faces.

It’s usually possible to speak after a laryngectomy, using an aid or oesophageal speech. Oesophageal speech is a way of speaking that you can be taught if your voicebox has been removed.

However, speaking using an aid or oesophageal speech can sometimes be difficult or distracting during sex. Communication between partners is very important. It may help to discuss what you’d both like before starting sex, and to find ways of signaling messages to each other.


Limb amputation

Even if you thought you had a good idea of what to expect before surgery, it can be very difficult to come to terms with a major body change such as amputation. The feeling of looking different from other people can affect your self-confidence.

You may be happy to have sex wearing your prosthesis, which can help with positioning and movement. However, some people find the straps used to secure the prosthesis are uncomfortable and get in the way. You can try different sexual positions, and you can use pillows to help with positioning and balance.

You may have problems with pain that feels like it’s coming from the part of your body that’s been amputated. This is called 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.


Lymphoedema

Lymphoedema can affect your sex life and change the way you see and feel about your body. These things might make sex more comfortable and enjoyable:

  • Find sexual positions that don’t put weight on the area affected by lymphoedema.
  • Have sex at times when the swelling is better. For example, many people find their swelling is better in the morning or after they’ve worn a compression garment for a few hours.
  • If you have genital lymphoedema, use extra lubricant to reduce friction to the skin.
  • If you feel self-conscious, have sex while partly dressed or in dimmed light.

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The female body and sex

Cancer can affect your sexual desire and arousal. Knowing women’s sexually sensitive areas and how your body behaves may improve your sex life.