Pelvic radiotherapy: sex life and fertility for women

Pelvic radiotherapy may affect your sex life, or your ability to get pregnant and carry a pregnancy (your fertility). If you are worried about fertility, talk to your cancer doctor before you start treatment. There may be ways they can protect or preserve your fertility.

If you have not been through the menopause, pelvic radiotherapy usually causes early menopause. Your periods eventually stop. You may get symptoms that include vaginal dryness or less interest in sex. Ask your doctor or nurse for support and advice.

You should use contraception to prevent pregnancy during radiotherapy and for a time after. Radiotherapy can harm an unborn baby. This is important even if it is likely radiotherapy will stop your periods or affect fertility.

Ask your team for advice about contraception. They may advise you to wait a few weeks after radiotherapy before having sex to allow side effects to improve.

It is normal to feel nervous about having sex after pelvic radiotherapy. Take your time and make sure you are relaxed. Lubricants or creams may help. If you have problems that do not improve, talk to your cancer doctor or nurse.

Effects on your sex life

It can be difficult to talk about your sex life. But if you have any problems during or after your treatment, there are usually things that can help. You may have side effects that:

  • mean you do not feel like having sex
  • make having penetrative sex uncomfortable or painful.

Do not let embarrassment stop you from getting information that can help. Your team can give you advice and support. If you need expert advice, they can often arrange this for you.

If you identify as lesbian, gay, bisexual, transgender or LGBT+, you may worry about your healthcare team treating you insensitively. Many sexual difficulties caused by pelvic radiotherapy are similar whatever your sexuality. But you may have some specific questions. Having your sexual or gender identity acknowledged may help you feel more supported. It also means your healthcare team can give you the right information and advice.

If you feel unable to talk to your healthcare team about your sexuality, contact the LGBT Foundation. They have a helpline that can give you confidential advice and support.

We always cuddled, we were affectionate, so it didn’t affect our relationship. We always talked about it, which I think is important.

Nikita


Having sex after treatment

Your team may advise you to wait a few weeks after radiotherapy before having sex. This is to allow any irritation in the area and side effects to improve. Ask your doctor or nurse for advice about this, as it can depend on the treatment you are having.

It is normal to feel nervous about having sex after pelvic radiotherapy. You may have ongoing side effects. Or you may be coping with changes that affect your feelings about your body. If you are ready to have sex, take your time and make sure you are relaxed. Lubricants or creams may help to make penetrative sex feel more comfortable. If you have any problems that do not improve, talk to your cancer doctor or nurse.

We have more information about cancer and your sex life.

Sex and cancer - tips for women

Isabel White gives advice and demonstrates the tools available to women to help with possible sexual side effects of cancer treatment.

About our cancer information videos

Sex and cancer - tips for women

Isabel White gives advice and demonstrates the tools available to women to help with possible sexual side effects of cancer treatment.

About our cancer information videos


Contraception

It is important that you do not get pregnant during your treatment. This is because radiotherapy can harm an unborn baby. You should use contraception to prevent pregnancy during your treatment and for a time after.

This is important even if you have been told that radiotherapy will stop your periods or make you unable to get pregnant. It is difficult to know exactly when your fertility will be affected. Even if your periods stop, you may still be able to get pregnant.

There are different types of contraception. The best ones to use during pelvic radiotherapy are a condom or cap (diaphragm). The contraceptive pill is less effective during treatment if you have side effects such as diarrhoea.

Ask your doctor or nurse if you have any questions about contraception.


Early menopause

If you have not been through the menopause, pelvic radiotherapy will usually cause an early menopause. This is because this treatment stops the ovaries working. You will not be able to get pregnant anymore, and your periods will eventually stop. For a time, you may get menopausal symptoms. These may include the following physical side effects:

  • hot flushes and sweats
  • vaginal dryness
  • passing urine (peeing) more often
  • aches and pains.

You may also have:

  • a lower interest in sex
  • sleep problems
  • mood swings and lower confidence
  • poor concentration and effects on memory.

Sometimes, you can have surgery to move the ovaries away from the treatment area before pelvic radiotherapy. This is called ovarian transposition. It may protect the ovaries and make the menopause less likely. Your doctor can give you more information about this surgery.

An early menopause may also cause a higher risk of some longer-term health problems. These may include:

As a result of my treatment, I’ve gone through the menopause. It hasn’t really affected my sex drive. It’s more of a problem that I’ve felt fatigued, stressed and anxious.

Vicky


Coping with menopausal symptoms

Having an early menopause can be difficult to cope with, and sometimes distressing. But there are things that can help. Ask your doctor or nurse for support, and advice about treatments and managing menopausal symptoms.

They may suggest a drug to reduce hot flushes and sweats, such as:

  • hormone replacement therapy
  • an anti-depressant drug, such as venlafaxine
  • clonidine, which is usually used to control blood pressure
  • gabapentin, which is usually used to treat epilepsy or nerve pain.

Lubricants or creams can reduce discomfort from vaginal dryness.

Some women find they can do things to reduce hot flushes. These things include using relaxation techniques such as slow, controlled breathing, yoga or acupuncture. Regular exercise such as running or swimming may also help.

Ask your team for more advice if you are finding it difficult. Or contact our cancer support specialists. We have more information about coping with early menopause.


Hormone replacement therapy (HRT)

HRT is treatment to replace the hormones that the ovaries stop producing during the menopause. You can take HRT as pills, patches or vaginal creams.

HRT does not reverse the menopause or make you able to get pregnant. It can improve some menopausal symptoms. It can also reduce your risk of bone thinning (osteoporosis) and heart problems.

HRT is not suitable for everyone. It may increase the risk of some types of cancer coming back. Your cancer doctor or nurse can give you more information.


Effects on fertility

Pelvic radiotherapy usually affects the ovaries and the lining of the womb. This often means you will not be able to get pregnant, or carry a pregnancy after treatment. Your team will give you information about this.

If you would like to have children in the future, talk to your doctor or specialist nurse before you start treatment. There may be options of preserving your fertility, including the following:

  • You may meet with a fertility specialist to discuss the possibility of storing embryos, eggs or ovarian tissue. It may be possible to use these to start a pregnancy that another woman carries (a surrogate).
  • You may have surgery to move the ovaries away from the area having treatment. This is called ovarian transposition. It is sometimes possible to use eggs from the ovaries after radiotherapy to start a pregnancy. But this is very rare.

Losing your fertility can be hard to cope with, especially if you had planned to have children. It can help to get the right support. If you have a partner, it may be a good idea to include them too.

Your doctor or nurse can usually arrange for you to talk to a fertility counsellor or therapist. Talking to other people who are in a similar position may be helpful. Organisations such as the British Infertility Counselling Association (BICA) can offer support and counselling. If you are not sure where to start or just want to talk, you can contact our cancer support specialists.

I was going to have ovarian transposition to save some eggs. We needed to start treatment quickly, so there wasn’t enough time to undergo IVF and remove eggs before starting radiotherapy.

Danielle

Back to Pelvic radiotherapy explained

What is pelvic radiotherapy?

The pelvis is the lower part of the tummy between the hips. Radiotherapy to this area is called pelvic radiotherapy.

Side effects during treatment

You may have side effects during and shortly after your treatment. The healthcare team will help you manage these.

After pelvic radiotherapy

Your radiotherapy team will explain any follow-up you need, how they can help and how you can help yourself.