Late effects and sex life

For some people the effects of pelvic radiotherapy on their sex life that began during treatment may not improve even after treatment has ended. Other effects on your sex life may not develop until months or years later.

Some people’s interest in sex may be reduced after treatment. Low sex drive can be caused by:

  • tiredness
  • how you feel about yourself sexually
  • changes to the vagina

Women may find it harder to get aroused or take longer to orgasm. This may be because of the effects of radiotherapy on the nerves in the pelvic area or it may be due to the way you feel about yourself sexually.

You may have some changes in sensation, which could be due to vaginal dryness or narrowing. There are treatments that your doctor can suggest to improve these. Less commonly, women may suffer from vaginal bleeding. This can usually be reduced by using creams or lubricants.

There are organisations that may help if you are having problems in your sex life. For example, the College of Sexual and Relationship Therapists and The Sexual Advice Association.

Your sex life

Pelvic radiotherapy can cause changes that affect your sex life and the way you feel about yourself as a woman. Physical changes can make having sex difficult, reduce your sex drive (libido) and affect the way you feel about your body (your body image). Tiredness, a low mood or anxiety can also lower your sex drive.

For some women, these difficulties are temporary and gradually improve over time. But even permanent changes can be improved.

Getting help

It can be difficult to talk about your sex life and any problems you’re having. But doctors and specialist nurses are used to dealing with intimate problems. They can often give you advice and support if things aren’t going well.

Your hospital doctor, specialist nurse or GP can also refer you to a counsellor or sex therapist. A sex therapist can help you adjust to physical changes and explore different ways of getting sexual satisfaction. If emotional problems are affecting your sex life, ask your doctor to refer you to a counsellor or doctor who specialises in emotional support.

If you have a partner, talk to them about the effect that treatment is having on your sex life. It’s good to look at ways of overcoming any problems as a couple. You can talk to a sex therapist or counsellor in detail about the effects these changes are having on you and your partner.

There are organisations that can also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a list of qualified practitioners and the Sexual Advice Association offers a confidential helpline.

Low sex drive (libido)

If you have a partner and your sex drive is low, let them know how you feel. Explaining why you don’t feel like having sex can reassure them that the reason isn’t that you no longer find them attractive. You can show your partner how much you care in other sensual and physically affectionate ways.

If sexual difficulties don’t improve, it may be a good idea to ask for advice rather than letting things drift between you.

One way to improve things may be to treat any late effects of pelvic radiotherapy that are causing you problems. For example, treatments for vaginal dryness will make sex more comfortable and improve your sex drive. And if you don’t have much energy, it can help to have sex in different, less energetic ways or to have quicker sexual contact.

Managing menopausal symptoms may help improve your sex drive. If you’ve had an early menopause, talk to your cancer doctor about taking hormone replacement therapy (HRT).

Occasionally, doctors may prescribe the hormone testosterone for women who are distressed by their low sex drive. We normally think of testosterone as a male hormone, but women also produce it in small amounts. Doctors usually only consider prescribing it if other treatments haven’t worked.

If you have urinary or bowel problems, our sexuality and cancer information has tips about ways of adapting to having sex.


Changes to the vagina

Radiotherapy can make the vagina become narrower and less stretchy. The vaginal walls may also be dry and thin, and can stick together. This can make it uncomfortable to have penetrative sex. It can also make it uncomfortable to have an internal examination. So it’s important to try to prevent the vagina narrowing.

Your hospital team may recommend that you use vaginal dilators. This is to help stop the vagina narrowing. Dilators are tampon-shaped plastic tubes of different sizes that you use with a lubricant. Although they’re commonly used, there isn’t strong evidence to say 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 the best way to use them in your situation.

Other ways to help stop the vagina narrowing include:

  • 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.

After I had brachytherapy I had no long-term damage. However, I had to use dilators once a week for five years.

Joan


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 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.


Changes in sensation

After radiotherapy, some women find it harder to get aroused or take longer to orgasm. This might be because of the effects of radiotherapy on the nerves in the pelvic area. If you’ve had surgery to the pelvic area, this can also affect the nerves. But it can also be due to a difference in the way you feel about yourself sexually. If this is the case for you, a sex therapist or counsellor may be able to help you.

There are organisations that can also be a source of help for you. For example, the College of Sexual and Relationship Therapists provides a list of qualified practitioners and the Sexual Advice Association offers a confidential helpline.

We have more information on sexuality and cancer, which gives more detailed information on dealing with the physical and emotional effects that cancer and its treatment may have on your sex life.

Pelvic radiotherapy may also have an effect on your fertility, which can be very hard to cope with.

Back to Late effects of pelvic radiotherapy

About late effects

Some people may have long term or late effects of pelvic radiotherapy. These can usually be treated or managed successfully.

Bladder changes

Late effects on the bladder can usually be managed or treated successfully. Talk to your doctor about any symptoms.

Bowel changes

Late bowel effects of pelvic radiotherapy are usually managed or treated successfully. Talk to your doctor if you notice any symptoms.