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Sexual problems for women
Cancer and its treatments can affect a woman’s sexual function. This may include painful intercourse or vaginal dryness or shortening. Many sexual problems related to cancer can be treated or managed.
Sexual problems can be caused by:
- certain types of cancer, including uterine, ovarian, cervical, bladder, vaginal, vulvar and colorectal cancers
- surgery to remove a tumour
- radiation therapy to the pelvis
- hormonal therapy
- treatment-induced menopause
- vaginal dryness
- vaginal stenosis, which is when the vagina becomes narrower and shorter
- bladder or vaginal infection
Emotional factors, such as the following, can also affect sexual function:
- changes in self-image
- anxiety, depression and stress
- fear of pain
- unhappiness and embarrassment because of physical changes
Types of sexual problems
Symptoms can vary depending on the cause and type of sexual problem. Tell your healthcare team if you have any of these sexual problems.
Vaginal dryness occurs when the vagina doesn’t make the normal amount of moisture or lubrication. Sexual intercourse can be difficult or painful when the vagina is dry. Cancer treatments like surgery, chemotherapy or radiation therapy can cause a woman to go into menopause. One symptom of menopause is vaginal dryness.
Vaginal stenosis is when the vagina becomes narrower and shorter. Radiation therapy to the pelvic area or some types of surgeries that involve the vagina can cause stenosis. Vaginal stenosis can make intercourse painful.
Painful intercourse is also called dyspareunia. It can make a woman less interested in or afraid to have sex. If a woman is worried that intercourse will be painful, she may find it harder to become aroused. This may lower the amount of natural lubrication her body makes, which can lead to more pain and tension.
Your doctor will try to find the cause of your sexual problem. This may include:
- physical exam
- pelvic exam
Managing sexual problems
Once the type and cause of the sexual problem is known, your healthcare team can suggest ways to manage it. Information and counselling can help. You team can also suggest relaxation exercises and techniques to reduce anxiety that may help.
The following measures may also help you manage sexual problems. Learn more about sexuality and cancer.
Try different positions
Note that deep pelvic thrusts may be painful for women with vaginal stenosis. Talk to your partner about your discomfort and what positions are painful. Try exploring other positions that may be more comfortable. Changing position may provide more control over the depth of penetration.
Your healthcare team may suggest different medicines depending on what is causing the sexual problem. For example, they may prescribe medicines to treat an infection. They may also prescribe pain-relieving medicines that you can take before sexual activity.
In some cases, the healthcare team may suggest creams or medicines, such as hormone creams or hormone replacement therapy (HRT). These drugs are only used if you have cancer that isn’t affected by hormones.
Using moisturizers regularly can help keep the vaginal tissues moist and relieve vaginal dryness. Moisturizers cover the tissues in the vagina with thin, mucus-like coating. Once applied, the moisturizer will last 3–4 days.
Drugstores carry different brands of moisturizer. You may want to ask your healthcare team to recommend a moisturizer and try several to find out which ones work best for you.
Lubricants are used during sex to make it more comfortable. They may have a water, silicone or oil base.
You may want to ask your healthcare team to recommend a lubricant and try different types to see which ones work best for you. Don’t use lubricants with perfume or colouring because they can irritate tissue in the vagina. Don’t use oil-based lubricants with latex condoms. Oil-based lubricants can make latex condoms break.
Women who have had surgery or radiation therapy to the pelvis often develop vaginal stenosis and need to stretch the vagina. Vaginal dilators are plastic or rubber tube-like devices used to stretch vaginal tissues and to prevent the vagina from shrinking. When the dilator is in place, it feels much like a large tampon.
Some women who have surgery to rebuild or reconstruct the vagina using skin grafts may need to wear a special type of dilator all day or night for a while.
If you have vaginal stenosis after radiation therapy ends, it is very important to stretch the vagina with a vaginal dilator and by having sex a few times a week for 6–12 months. Using the dilator may not be necessary over the long term, but if you aren’t having sex regularly, you will need to continue using it. It will keep the vaginal walls stretched and open, which helps with pelvic exams.
Scarring in the pelvis can develop over many years, so some women need to continue to stretch the vagina for the rest of their lives.
Talk to your doctor or healthcare team about vaginal dilators and how they can help you. They can tell you where to get a dilator, what size to get and how to use it.
Relaxation and exercise
Relaxation techniques, warm baths, massage or gentle touching can help decrease pain. They can also help you relax.
Kegel exercises help relax and strengthen the pelvic floor muscles. These exercises use the same muscles that stop the flow of urine during urination. They can be done while you are sitting, lying or standing. Concentrate on drawing in or tightening the muscles around the anus, but do not contract the abdominal, back or thigh muscles. Keep the muscles tight for 3–6 seconds and then release slowly. Repeat 5–10 times. Gradually increase holding the squeeze for 6–10 seconds and the number of sessions.