About Gynecologic Cancer and Sexuality

Treatment for gynecological cancers can affect the body not only physically, but can also affect a woman emotionally, spiritually, alter self image, and affect sexual wellness and relationships. These changes are real and it is normal for a woman to have concerns after treatment for cancer.

As part of your healing after treatment, it is important to be aware and acknowledge how you are feeling and find ways to discuss these feelings with your partner, loved ones and healthcare team. It is important to understand and address concerns so that they do not have a long-term effect on you and those close to you. The following are some questions that may arise concerning sexuality and gynecological cancer. 

Will I be able to have sexual relations with my partner?

A big concern for women following treatment is if they will be able to maintain what they believe to be a good quality of life, which for many, includes a satisfying sexual relationship. Following treatment most patients find that they are able to resume sexual relations with their partner. Often patients prefer to wait for the immediate effects of cancer therapy (fatigue, nausea, pain, etc) to subside before returning to normal sexual activity. During this period many couples maintain intimacy through touching, stroking, cuddling, and other "outercourse" activities.

Once you resume intercourse, you may find that your usual sexual techniques or positions are not comfortable. Experimenting either alone or with your partner can help you discover new methods. You have to find what works best for you. Be patient, and don't give up. It can take time to regain sexual arousal and satisfaction. It's important to let your partner know how you feel and what they can do to help. 

Of note, you should speak with your provider about when it will be safe for you to introduce anything into your vagina. You body may need time to heal after a surgical procedure or radiation. 

Will my sexual desire change?

It is possible that you and your partner may need to have less sexual activity for a period of time and to find different ways of expressing intimacy. There are many physical reasons for a decrease in sexual desire. The presence of pain can lead to a decrease in sexual desire. Treatment can reduce hormone levels that can lead to a decrease in desire. Other reasons include nausea or fatigue related to chemotherapy.

Emotional issues can be a factor as well. Because of the physical change in your body, your feelings about yourself may change which may lead to a loss of desire. Becoming more comfortable with yourself and accepting of your physical changes is key. Remember that you as a person have not changed. Recognizing how you and your partner are feeling, and accepting these feelings, is part of the process of recovery. Many of the factors that contribute to a personal change in sexual desire resolve over time.

What are the immediate effects of gynecologic cancer therapy?

Everyone experiences some inflammation in the pelvis after surgery or radiation therapy. Muscles, nerves, and organs may all be affected. Irritation of the pelvis may cause every day activities such as urinating, having bowel movements, or walking to become painful. Women often find intercourse uncomfortable after treatment. Often these side effects lessen over time.

Radiation treatment may cause a decrease in vaginal lubrication, creating a need for externally applied lubricants. Surgical removal of or radiation of ovaries can decrease the production of estrogen (a female sex hormone). The loss of estrogen can cause shrinking, thinning, and loss of elasticity of the vagina, vaginal dryness, hot flashes, urinary tract infections, mood swings, fatigue, and irritability. Talk to your doctor about the possibility of hormone replacement therapy.

Once cancer therapy has ended, inflammation gradually subsides. Medications can be helpful in controlling discomfort until this occurs. The immediate effects of therapy may last up to three months and should diminish with time. If you continue to experience discomfort or other symptoms beyond this period, please tell your provider.

What if intercourse is painful?

A discussion with your provider can help to find the reasons for the pain and help you manage it. Painful intercourse may occur for a number of reasons. The vaginal lining may be thin or lack lubrication. Radiation therapy can cause the vagina to contract (shrink), limiting penetration during intercourse. The vaginal wall may be close to the bowel causing pain with some sexual positions. It is important to be open and honest with your care team so that this issue can be treated.

Can I have children?

Prior to receiving treatment, your care team should discuss with you your plans for having children in the future. Even if you are unsure or think that you don’t want to have children this is an important discussion to have because some treatments can cause you to be unable to have children in the future. If after treatment normal conception is not possible, you might be a candidate for assisted reproductive techniques.

Is it normal to feel sad?

Yes, feeling sad is normal. Depression can occur as a result of your cancer experience. Your feelings about yourself and your life can change significantly during the experience. Depression can be treated with counseling and/or medication to help you regain a sense of control and enjoyment in your life. It is important to tell your doctor or nurse about how you feel so they can help you.

How will my partner feel?

Gynecologic cancer brings on many stresses for both you and your partner. It is very important to talk honestly with your partner. It is also important to acknowledge feelings you may have about the changes in your body. Just as you want your partner to understand and accept the changes you are experiencing, you will need to assure your partner that you accept their fears, concerns and feelings. This takes communication and work, but it can be done. If you and your partner are experiencing challenges with these conversations you can contact your care provider for recommendations for counseling.        

Sexuality can be a challenging topic for people to talk about. It is important to maintain open conversations with your loved ones and care team throughout and after treatment.