Effects of surgery on women

Any surgery can have an impact on your sex life. Having operations to the sexual areas of the body can cause certain changes:

  • Hysterectomy – surgery to remove your womb and cervix. This may affect the way a woman feels during orgasm.
  • Radical trachelectomy – surgery to remove the cervix and some surrounding areas. This will make the vagina shorter.
  • Oophorectomy – surgery to remove an ovary. This will cause menopausal symptoms such as a lowered sex drive.
  • Cystectomy – surgery to remove the bladder. The surgeon may also remove some surrounding areas, such as the womb, ovaries and part of the vagina.
  • Abdominal-perineal resection – surgery to remove cancers in the rectum. This may make vaginal sex uncomfortable.
  • Lumpectomy or mastectomy – surgery to remove part or all of the breast. This will affect the way you look and may affect the way you feel about yourself as a woman.
  • Surgery affecting visible areas, such as your face can affect your sexual self-esteem.

Your surgeon and specialist nurse will talk to you about the surgery and how it might affect you.

Effects of surgery on sexuality

Any type of surgery can affect your sexuality and sex life, even if it doesn’t involve the sexual areas of your body. But surgery that directly affects these areas may cause quite noticeable changes. Your surgeon and specialist nurse will talk to you about the surgery and how it might affect you.


Hysterectomy

This is an operation to remove your womb and cervix. There are different types of hysterectomy, and they have different effects on sexual function. During a radical hysterectomy, the surgeon stitches up the top end of the vagina. This makes it roughly a third shorter than it was before. A simple hysterectomy is unlikely to affect the length of the vagina.

Having a hysterectomy may affect the way a woman feels during orgasm. This happens because after the womb is removed, there are no longer any womb (uterine) contractions during orgasm. It also happens because some of the nerves leading to the clitoris can be affected by the surgery.


Radical trachelectomy

If you are diagnosed 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. After a trachelectomy, the vagina will be slightly shorter than before.


Oophorectomy

This is an operation to remove an ovary. The ovaries produce most of the oestrogen in your body.

If both ovaries are removed (a bilateral oophorectomy), it’s sometimes called a surgical menopause. This is because it will cause you to start the menopause if you haven’t had it already.

If you have both ovaries removed, it will make you infertile.

You will also have menopausal symptoms, such as a dry vagina and a lowered sex drive. You’ll probably notice the menopausal symptoms happening more quickly than the gradual onset that happens with a natural menopause.


Cystectomy

A cystectomy is an operation to remove the bladder. During a radical cystectomy, your surgeon may also remove your womb, 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.

During the operation, your surgeon may do a reconstruction of your vagina. This may make it shorter or narrower than it was before.

Having your ovaries removed will cause an early menopause and menopausal symptoms if you haven’t already reached your natural menopause.

If you have your urethra removed, the end where it opens outside the body is also often 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. Your surgeon can advise you about this.

When the bladder is removed, your surgeon can often make a ‘new’ bladder using part of your bowel. If this isn’t possible they will make an opening in the wall of the abdomen (a stoma) so that urine can drain into a bag.


Abdomino-perineal resection (AP resection)

This is an operation to remove cancers in the rectum. During the operation, the anus, rectum and part of the lower end of the large bowel (sigmoid colon) are removed. The surgeon makes an opening in the wall of the abdomen (a stoma) so that your bowel motions can drain into a bag.

Sometimes the womb, ovaries and part of the vaginal wall are also removed during an AP resection. If your ovaries have been removed, you will start the menopause. You may have menopausal symptoms that make sex difficult, such as a dry vagina or lowered sex drive.

After an AP resection, you may find that penetrative sex is uncomfortable in some positions. This is because the rectum normally cushions the vagina, and also the shape of the vagina may be different after an AP resection.

Having an AP resection will mean that if you used to have anal sex, you will no longer be able to. It may be possible to keep the rectum, although this will depend on your individual situation and it can increase the risk of the cancer coming back. You can discuss this with your surgeon before surgery.


Stoma

Sometimes surgery for bowel cancer, bladder cancer or advanced cervical or ovarian cancer involves having an opening made in the abdominal wall. This is called a stoma. A stoma allows waste from your body (either urine or bowel motions) to drain into a bag that covers the stoma.

A stoma and colostomy bag
A stoma and colostomy bag

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If you have a stoma, there’s a high chance of permanent damage to the blood supply and the nerves in your genital area. It’s not clear how this type of operation affects arousal and orgasm. Your surgeon or specialist nurse will be able to give you more information about this before your operation.


Vulvectomy

A vulvectomy is an operation where all or part of the vulva is removed. This is a rare operation that you may need if you have cancer of the vulva. Removing the vulva will affect sexual sensations, especially if the clitoris has been removed.


Pelvic exenteration

This is a major but rare operation to treat advanced pelvic cancers. During the operation, all the structures in your pelvis are removed. This can include the womb, cervix, ovaries, vagina, bladder and rectum.

If you have both the rectum and bladder removed, you may need two stomas. You may also have a ‘new’ vagina reconstructed, which may be shorter and narrower than it was before.

We have more information about pelvic exenteration in women.


Mastectomy and lumpectomy

A mastectomy is an operation to remove the whole breast. A lumpectomy removes just the breast cancer and an area of surrounding tissue. It doesn’t remove the whole breast. A lumpectomy is also called a wide local excision.

After a mastectomy or lumpectomy, there will be a scar. It will be red at first, but this usually fades to a silvery white line over a few weeks or months. It’s common to have some swelling around the operation site to begin with.

Both operations can affect the sensations in your breast and nipple. They can also affect the way you feel about your body.

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


Laryngectomy

A laryngectomy is an operation to remove the voicebox (larynx). This can change the way you talk and breathe. It can have an effect on your sexuality by changing how you communicate before or during sex.


Facial surgery

Surgery for head and neck cancers can sometimes leave scars or be disfiguring. If you have surgery to the jaw or tongue, it may change the way you speak, which can affect the way you communicate. Surgery may also affect the way a person kisses or gives oral sex.

Newer surgical techniques and advances in plastic surgery are trying to improve any lasting problems.


Limb amputation

Very occasionally, when treating some types of cancer (such as primary bone cancer), a surgeon may need to amputate the affected arm or leg. The limb will often be replaced with an artificial arm or leg (a prosthesis).


Removal of lymph nodes

If you’ve had lymph nodes removed as part of your treatment, you may get 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.

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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.