About Gynecologic Cancer and Sexuality

If you have a gynecological cancer, treatment can affect your body in many ways. Cancer treatment can change how you feel physically. It can also affect you emotionally, spiritually, and sexually. It can change your self-image and can affect your relationships. It is normal to have concerns about these things after cancer treatment. 

As part of your healing after treatment, try to be aware of how you are feeling.  Try to find ways to talk about these feelings with your partner, loved ones, and healthcare team. Be sure to talk about your concerns so that they do not have a long-term effect on you and those close to you. The following are some questions that you may have about sexuality and gynecological cancer.

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

A big concern for women after treatment is whether they will be able to have a good quality of life, which for many includes a satisfying sexual relationship. After treatment, most patients prefer to wait for the short-term effects of cancer therapy (fatigue, nausea, pain, etc) to get better before returning to sexual activity. During this time, couples can be intimate 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. Trying new things, either alone or with your partner, can help you both with intimacy. 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. 

Talk with your provider about when it will be safe for you to place anything into your vagina. Your body may need time to heal after a surgical procedure or radiation.

Will my sexual desire change? 

There are many physical reasons for decreased sexual desire, such as pain, nausea, and fatigue. Treatment can also lower hormone levels that can cause decreased desire. 

You and your partner may need to lessen how often you have sex after treatment until you both feel comfortable. You may also find different ways of being intimate. As long as you are both open about your feelings, there are ways to connect. 

Emotional issues can be a factor as well. Because of the physical change in your body, your feelings about yourself may change. Becoming more comfortable with yourself and accepting of your physical changes is key. Recognizing how you and your partner are feeling, and accepting these feelings, is part of the process of recovery. Many of these issues that can change your sexual desire get better over time. 

What are the immediate effects of gynecologic cancer treatment?

After surgery or radiation therapy, you will have some inflammation (swelling and irritation) in the pelvis. Muscles, nerves, and organs may be affected. Irritation of the pelvis can cause everyday activities such as urinating, having bowel movements, or walking to become painful. You may find intercourse uncomfortable after treatment. Often these side effects get better over time.

Radiation treatment can cause a decrease in vaginal lubrication. You may need to use a lubricant gel. Surgery or radiation of the 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. Your care team will talk with you if you need hormone replacement therapy.

Once cancer therapy has ended, inflammation gets better over time. Medications can help control discomfort. The immediate effects of therapy may last up to three months. If you have discomfort or other symptoms beyond this period, please tell your provider.

What if intercourse is painful?

If you find intercourse painful, talk with your provider to find the reasons for the pain. Painful intercourse may happen for a few reasons:

• The vaginal lining may be thin or not have enough lubrication.
• Radiation therapy can cause the vagina to contract (shrink), making penetration during intercourse difficult.
• 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?

Before treatment, your care team should talk with you about your plans for having children in the future. Even if you are unsure or think that you don’t want to have children, it is important to have this talk because some treatments can cause you to be unable to have children in the future. Talk with your care team about any questions or concerns you may have about your ability to have children.

Is it normal to feel sad?

Yes, feeling sad is normal. Depression can be caused by your cancer diagnosis and treatment. Your feelings about yourself and your life can change a lot during this experience. Depression can be treated with counseling and/or medication to help you regain a sense of control and enjoyment in your life. Please talk to your care team 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 recognize feelings you may have about changes in your body. Just as you want your partner to understand and accept the changes you are going through, you will need to make sure your partner knows that you accept their fears, concerns, and feelings as well. This takes communication and work, but it can be done. If you and your partner are having a hard time with these conversations, you can call your care provider for counseling recommendations.

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