Vaginal cancer treatment can have an effect on your sex life and relationships. These treatments include surgery and radiotherapy.
For many people, this can start soon after treatment and can be permanent.
Having investigations and the emotions you feel with having vaginal cancer can also change the way you feel about your sex life. But there are ways to manage the problems that can cause these changes.
Talking about sex and how you feel
Before and after your treatment your nurse and doctor talk to you about the possible side effects. Including how treatment might affect your sex life.
Some people may feel embarrassed talking about this. The people looking after you are very experienced and are used to talking about sexual problems. Being prepared can help you cope with these conversations.
Do not be afraid to ask questions. They understand how worried you are and will want to help and reassure you.
Having sex after treatment
It’s difficult to know exactly how the side effects of treatment will affect your sex life. It depends on the type of treatment you have. For example, your vagina may be shorter after surgery or you might have vaginal dryness from radiotherapy. Both can cause discomfort during sex.
The vaginal area may also feel numb or you may not get as much satisfaction as you did before treatment. Sometimes people might feel differently about their appearance after their treatment.
Your doctor and specialist nurse can help you cope with any side effects or emotions you may have. They can also put you in touch with a specialist sex counsellor.
Other effects of treatment can include:
• fibrosis and narrowing of the vagina
• tiredness and fatigue
• pain when having sex
• delicate skin inside the vagina
• the need to pass urine more frequently or urgently
• no control over passing urine
• loose poo (diarrhoea)
Sex after radiotherapy
After radiotherapy, you usually need to use dilators to stop your vagina from shrinking and narrowing. The dilators keep the vaginal opening stretchy so you can continue to have sex. It also allows doctors to examine you during follow up appointments without it being uncomfortable.
Your nurse will explain how you when you use them.
Your doctor or specialist nurse might prescribe or suggest gels and creams to moisturise the vagina and prevent soreness.
Other ways that may help to reduce pain include:
- pelvic floor exercises (these strengthen the muscles in the pelvis)
Remember that your specialist nurse can help you cope with any side effects you may have.
You will have an early menopause if you have both your ovaries removed. If you haven't had your menopause your surgeon might try to leave one ovary, but this is not always possible.
The symptoms of menopause due to cancer treatment are the same as those of a natural menopause. But they can be more intense if it comes on suddenly. You might have:
- hot flushes and sweating
- vaginal dryness
- low mood or depression
- loss of confidence and self esteem
- thinning bones
- loss of interest in sex
You might be able to take hormone replacement therapy (HRT) to help with these symptoms. HRT comes as tablets, skin patches, or implants that you change every few months. They give you the female sex hormones that your ovaries are no longer producing.
Sex after vaginal reconstruction
Vaginal reconstruction means creating a new or artificial vagina after you have had surgery to remove your vagina (vaginectomy). One of the aims of reconstruction is to try to make vaginal sex (intercourse) possible after surgery.
There are some possible problems with this surgery, these can include:
- a drop in sexual desire or pleasure
- changes in sensation during sex
- problems reaching orgasm
- numbness in your genital area
- a narrowing of the vaginal opening because of scar tissue
Your doctor and nurse can give you vaginal dilators to use.
Skin graft and sensation
If you have vaginal reconstruction using skin and muscle taken from your thigh, you might feel a strange sensation in your inner thighs when you have sexual intercourse. This is described as feeling as if your inner thighs are being stroked.
It happens because the nerves that supplied the thigh tissue, now form the walls of the reconstructed vagina. Your brain picks up this message and thinks that the leg is being touched. This can feel very strange and may be very off putting at first. Over time, most people get used to it and it can even become sexually stimulating.
Some people say they don’t feel they can contract the muscles around the entrance to the vagina as easily as before their surgery. You and your partner may need to experiment and try different sexual positions. With time and patience, you may be able to find some positions that you both enjoy.
You may have a small amount of bleeding or spotting after sex. This is nothing to worry about. But if the bleeding becomes heavy, then see your doctor.
Worrying about sex
It is understandable to feel nervous about having sex again after treatment, but try not to worry. You may need more time to come to terms with what has happened to you. If you are worried, anxious or depressed, you probably won't feel like having sex.
It can help to talk things over with your partner. Together you should be able to work out what is best for you both.
There are sex therapists you can see if you would like to. Talk to your GP or specialist nurse. They can put you in touch with a therapist.