Female pelvic or hormone changes and sex

Side effects of cancer treatment can affect your sex life. This page is about side effects that may happen if cancer treatment directly affects your pelvic area or hormone levels.

You may find our information about the body and sex helpful while reading this page.

Not everyone will have the side effects we mention here. You may have side effects or questions we do not cover. It is also important to remember that your sexual well-being and relationships can be affected by more than just these physical changes. We have more information about cancer and relationships and the emotional effects of cancer. We also have information about:

Your cancer team can answer any questions you have about your treatment. They will explain what to expect.

Changes in sexual sensation

Sometimes radiotherapy or surgery to the pelvic area can affect tissues and nerves in this area. You may find sex feels different or that it is harder to get aroused or orgasm.

You may want to take time to explore and touch your body. Find out what feels different and what feels good now. If you have a partner, it can help to explain how you are feeling and how things have changed. Do not put pressure on yourself to expect the same sensations you had before your treatment.

Problems with arousal or orgasm can also be linked to how you are feeling. A sex therapist or counsellor may be able to help you adjust to sensation changes or cope with difficult feelings.

Changes to the vagina

Some cancer treatments can directly affect the vagina. These treatments include surgery and radiotherapy to the pelvis. Other cancer treatments may cause menopausal symptoms, which include vaginal changes.

Pain during vaginal sex

Ask your cancer team, GP or sexual health service for advice if you have pain during vaginal sex. This includes using fingers, hands or sex toys inside the vagina. A doctor or nurse can examine you and give you advice. There can be many reasons for this type of pain. Often it is simple to treat.

If you are with a partner, explain how you are feeling about vaginal sex. It may help to experiment with positions. There are other ways to give and receive pleasure.

It may help to:

  • learn relaxation techniques to use before sex
  • use exercises during penetration to relax the pelvic floor muscles – a physiotherapist can give you information about these
  • use a lubricant if your vagina feels dry
  • take control of the depth and speed of penetration (being on top or on your side may help)
  • only start vaginal sex when you or your partner are already close to orgasm.

Vaginal dryness

When you are aroused, the vagina usually produces some natural fluid. Without this, vaginal sex may feel uncomfortable or painful. Vaginal dryness can happen during cancer treatment because you are tired, stressed or less interested in sex. It may also happen if your treatment has caused menopausal symptoms.

You could use the following products to help with vaginal dryness and make sex more comfortable:

  • Lubricants  Lubricants are a gel or liquid you apply before or during sex to make the vagina wetter.
  • Vaginal moisturisers  A vaginal moisturiser is a cream you apply regularly to draw moisture into the vaginal walls.
  • Vaginal oestrogen  You can have vaginal oestrogen as a cream, small pellet (pessary) or ring. This releases the hormone oestrogen into the vagina if you have had the menopause. This is not suitable for everyone or after some types of cancer.

Your GP or cancer team can prescribe these products. You can also buy lubricants and moisturisers from a pharmacy or other shop, or online.

Some products, such as oil-based lubricants, will damage latex condoms or caps (diaphragms) and make them less effective. Always check the instructions. And if you are not sure, ask your GP, cancer team or pharmacist for advice.

If you have had the menopause, hormone replacement therapy (HRT) will also help with vaginal dryness. Your cancer team or GP can explain if HRT is suitable for you. This may depend on the type of cancer you have had.

Vaginal narrowing

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

Your cancer team may give you vaginal dilators to help prevent narrowing. Dilators are tampon-shaped plastic tubes of different sizes. You use these regularly inside the vagina with a lubricant, to gently push the walls of the vagina apart.

Dilators are often used, but there is no strong evidence about how effective they are. Rarely, they may cause damage to the vagina, especially if they are not used correctly. Your cancer team will explain how to use them safely.

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

  • receiving vaginal sex
  • using a dildo or vibrator inside the vagina
  • using lubricant and fingers inside the vagina.

Vaginal shortening

Surgery to remove the womb and cervix may shorten the vagina slightly. After you have healed, this will not usually affect whether you can receive vaginal sex. The vagina is naturally stretchy, and expands when you are aroused. You may not notice any difference in how sex feels.

If you do find vaginal sex uncomfortable, try different positions. You may want to take control of the depth of penetration. If your partner wears a penis ring (also called a constriction band) to increase pleasure or help with an erection, this may help you both judge the depth.

Vaginal bleeding

After pelvic radiotherapy, the walls of the vagina can become fragile. They may bleed easily after vaginal sex. Always let your cancer team or GP know if this happens. They will check why you are bleeding and give you advice.

You can help protect the vagina by:

  • using a lubricant during vaginal sex
  • managing vaginal dryness
  • preventing vaginal narrowing
  • trying different sexual positions.

If bleeding does not improve, your doctor may suggest treatments. These include using a chemical called silver nitrate on bleeding areas to seal them off. They also include taking tablets called tranexamic acid to help reduce bleeding.

Vaginal infection

Thrush is a common infection that can affect the vagina. You are more likely to develop thrush:

  • during pelvic radiotherapy
  • during chemotherapy
  • if the vagina is dry.

Symptoms of thrush include a creamy-white discharge and itching. Your cancer team, GP or sexual health service can give you tablets, cream or pessaries to treat the infection. Or you can buy them from a pharmacy or supermarket.

If you have not had thrush before, you should ask a health professional for advice about treatment. Always ask for advice if:

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

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

Changes to the vulva

Surgery or radiotherapy to the vulva can change the way your vulva looks and your sensation in this area. You may feel self-conscious about close physical contact. You might also worry about how sex will feel.

You may have numbness where part of the vulva was removed during surgery. Or you may have less feeling in the tops of your legs. Sensation may come back as you recover, but some changes may be permanent.

Sometimes surgery causes tightening or scar tissue. This may mean you cannot have vaginal sex at first. There are treatments that can help with this. Tell your cancer team, GP or sexual health service if you are finding vaginal sex hard or painful.

It may take some months before you start to enjoy sex again. It is common to feel worried about it. If you feel ready, take time to explore and touch your body. Find out what feels different and what feels good now. If you have a partner, it can help to explain how you are feeling and how things have changed. A sex therapist may be able to help you adjust and cope with changes.

Changes to the clitoris

Some types of surgery can affect the clitoris. The head of the clitoris may be removed as part of surgery for vulval cancer. Or during surgery for bladder cancer, the end of the urethra near the clitoris may be removed. This can affect the blood supply to the clitoris and make it less sensitive during sex. You may worry you will be unable to orgasm after these types of operation.

Touching the clitoris can be an important way of reaching orgasm. If things feel different, you may need to experiment to find what feels good now.

The clitoris reaches down both sides of the vulva and back into the pelvis. Even if the head of the clitoris has changed, you may find these other areas are sensitive and lead to orgasm. Or you may want to try other types of sexual touching. There are lots of ways to give and receive sexual pleasure. A sex therapist can give you advice and support.

Changes to the womb

Some people feel the womb muscles contract strongly during orgasm. Surgery to remove the womb should not affect your ability to reach orgasm, but your orgasms may feel different to before.

Often it can help to know this change may happen. But if it affects your relationships or how you feel about having sex, it may help to talk to a sex therapist.

Changes after a stem cell transplant

Sometimes after a donor stem cell transplant, the donor’s cells attack the body’s own cells. This is called graft-versus-host disease (GVHD). It can happen soon after transplant or months or years later. Sometimes GVHD can be an ongoing problem.

The symptoms of GVHD depend on the area of the body affected. For example, GVHD often affects the skin and causes an itchy rash. Or if the bowel, stomach or liver are affected, you may have sickness and diarrhoea.

GVHD can also affect the vagina and cause dryness, irritation and bleeding. This can change how you feel about your body and sex. It can also make receiving vaginal sex hard.

Tell your cancer team if you have vaginal changes after your treatment. You may need steroids and other drugs to treat GVHD. Your doctor may also suggest using vaginal lubricants, moisturisers or hormone replacement therapy to improve vaginal changes.

Menopausal changes

Some cancer treatments affect the way the ovaries or pituitary gland work. This may cause menopausal symptoms.

Sometimes menopausal symptoms get better after cancer treatment ends. But some treatments cause a permanent menopause at a younger age than normal. This is called early menopause or premature ovarian insufficiency (POI). Your cancer doctor or specialist nurse can explain if this is likely with your treatment.

We have more information about coping with menopausal symptoms.

Bladder problems

Some cancer treatments can cause bladder side effects, such as leaking urine (pee) or difficulty passing urine. These can be short-term problems, but they can sometimes be permanent. They may make you feel self-conscious or embarrassed about being physically close with someone. They may make you less interested in sex.

There are often ways to manage bladder problems. Talk to your cancer team, your GP or a physiotherapist. They may give you medicines, or advice about pelvic floor muscle exercises that can help. They can arrange for you to see a specialist for treatment or more support if you need it.

It can be embarrassing, but it is a good idea to be honest about bladder problems with sexual partners. It may help them to know a little urine may leak during sex. Urine is sterile and will not harm them or cause infections.

Sometimes receiving vaginal sex can make bladder problems worse. If this happens, you could try other types of sexual touching. You could also experiment with other positions.

These tips may also help:

  • Try to avoid drinking lots of fluid for about an hour before you have sex.
  • Go to the toilet just before you have sex.
  • Have tissues and towels nearby during sex.
  • Try having sex in the shower.

We have more information about bladder problems

If you have a catheter

Sex is still possible if you have a catheter (a tube that drains urine out of the body). You can tape the catheter out of the way on your leg or hip. You may need to try different positions to find what is comfortable and to avoid pulling the catheter. Sometimes it may be possible to remove the catheter before sex.

Your specialist nurse, your sexual health service or a continence adviser can give you more information.

Changes to the anus or rectum

How changes may affect anal sex

Changes to the anus or rectum (back passage) may affect your sex life if you are the receptive partner for anal sex. This includes using fingers, a hand or sex toys inside the back passage.

Changes can be caused by some types of:

If you want to receive anal sex, your cancer team may advise you to wait for a time after treatment before you try. Your body needs time to recover and heal. It is important to ask them for advice. They can explain how long you should wait and if it is safe for you to receive anal sex.

When you feel ready to try, start slowly and gently. Use lubricant to help protect the anus and rectum. Take your time and build up to full penetration slowly.

Long-term changes and anal sex

Sometimes changes are longer-term and can mean anal sex is no longer possible or safe. A sex therapist may be able to help you cope and find different ways to enjoy sex. Your risk of having long-term changes depends on the treatment you had.

Radiotherapy to the rectum may make it less stretchy, more fragile and less able to heal. Your cancer team may suggest you avoid receiving anal sex to prevent damage to the rectum. Damage can become a serious problem if the tissues cannot repair.

Surgery can also cause long-term changes. If the anal opening was surgically closed as part of your operation, you will not be able to receive anal sex. If the rectum was surgically closed further inside your body, you may still be able to receive anal sex. But you will still need to wait until all the wounds have healed.

If receiving anal sex is part of your usual sexual activity, these changes can have a big impact on your sex life and relationships. It is important to get the right information from your cancer team about your treatment and how it may affect you.

How changes may affect vaginal sex

Anal and rectal changes can also affect how it feels to receive vaginal sex. This is because the rectum and vagina are close to each other in the body. You may find vaginal sex is uncomfortable in some positions. You may need to try different positions to find which ones are best for you.

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