Women's sex life and fertility

Radiotherapy to your lower tummy (abdomen) or pelvis can affect your fertility and sex life. 

There are options available for women to preserve their fertility. Your doctor should discuss this with you and the fertility clinic or assisted conception unit. 

Pelvic radiotherapy can cause many side effects to the vagina and the skin in that area. This can lead to pain, discomfort or bleeding, and may make intercourse painful. You also may not feel like having sex while you are having radiotherapy.

Fertility

The ovaries are in the lower part of your abdomen, in the area between your hips (the pelvis).

Radiotherapy to this area may affect your womb and can stop your ovaries from working. If you haven’t already been through the menopause this means your periods stop. You won’t be able to become pregnant which means you become infertile.

The risk of infertility depends on:

• the dose of radiation given to your ovaries
• your age as the risk is higher the older you are 
• whether you have chemotherapy with the radiotherapy

Finding out that treatment for your cancer may leave you infertile can be extremely distressing if you had hoped to get pregnant in the future. Your doctor and nurse will support you and talk about possible options.

It is sometimes possible to move the ovaries out of the treatment area before radiotherapy begins. This is called ovarian transposition. It is usually done by keyhole (laparoscopic) surgery. Ovarian transposition may prevent an early menopause.

You can see a fertility specialist before you start cancer treatment. They can talk to you about the possibility of freezing your eggs, embryos or ovarian tissue. You could possibly use your eggs in the future if you wanted to try to have a child through a surrogate. A surrogate is when another woman carries the developing baby.

Menopausal effects

Symptoms of the menopause often start during your course of radiotherapy or shortly afterwards. Symptoms include:

• hot flushes and sweats

• dry skin

• dryness in the vagina

• loss of energy

• irregular or no periods

• less interest in sex

• mood changes or feeling very sad

There are some things that can help to relieve menopausal symptoms. These include: 

• hormone replacement therapy (HRT) - replaces hormones that are at lower levels due to menopause

• hormone cream - oestrogen vaginal cream can help with vaginal dryness

Going into early menopause can be very upsetting. It can help to talk over your fears and worries with your partner or a friend. Try to talk to your radiotherapy team or specialist nurse if you are having problems. 

Some of the women’s organisations on our general organisations list can also give help and support.

Your sex life

Radiotherapy can cause vaginal dryness, fibrosis and narrowing of the vagina. The skin inside the vagina can also become thin, delicate and easily torn. This can lead to:

• pain
• discomfort
• bleeding
• intercourse being painful
• ulcers (sores) forming inside the vagina when the skin tears and can take a few weeks, or even months, to heal - this is rare

You may not feel like having sex while you are having pelvic radiotherapy. The treatment can make you feel very tired. And give you bladder inflammation (cystitis) and diarrhoea. You may also find that you feel too sore to have sex comfortably.

It is important to avoid pregnancy during radiotherapy, as it might harm the baby. Talk to your specialist about a suitable type of reliable contraception before starting treatment. 

Fibrosis

Pelvic radiotherapy can make the tissues in your vagina less stretchy. This is called fibrosis. Fibrosis can narrow the vagina. This makes it uncomfortable and difficult to have sex and vaginal examinations in the future. 

Using vaginal dilators after treatment might help to prevent this. The advice to start using dilators varies depending on the radiotherapy centre. Ask your radiographer, doctor or nurse about dilators. 

Using dilators

Dilators are smooth tube shaped objects with a rounded end, made of plastic or metal. They come in different sizes. You start with the smallest size first.

For the first 6 months 

Use dilators with a water soluble lubricating gel at least twice a week and up to twice a day, for 3 to 10 minutes each time.

Between 6 and 12 months

Use dilators once a week.

After 12 months

Use your dilators occasionally as long as you are not having any difficulty.

Alternatives to vaginal dilators

Sexual intercourse also helps to keep the vagina open. It is a good alternative to using dilators.

You might prefer to use your fingers or a vibrator to help stretch your vagina. If water soluble lubricants do not give enough lubrication for comfortable intercourse you may want to try a silicone based lubricant. These give more lubrication. And are usually fine to use after any vaginal irritation caused by radiotherapy has settled down.

A small amount of bleeding is usual when you first start using a dilator. But contact a health professional if you have a lot of bleeding or pain.