Potential problems for women

This information has been reviewed by:
Dr Amanda Hordern, PhD, & Doreen Akkerman, AM

Premature menopause

Vaginal dryness and narrowing

Loss of your uterus and other changes to sexual organs

Loss of a breast or other part of your body

Fertility problems

Premature menopause

Some cancer treatments can affect the ovaries and may cause temporary or permanent failure of the ovaries (menopause). Sometimes the ovaries are removed altogether. In either case, much of a woman's oestrogen production is lost and menopause symptoms occur. The common symptoms are hot flushes and sweats, as well as vaginal dryness. Symptoms are usually more severe than those from natural menopause.

Tips

• Try to identify causes of hot flushes, such as alcohol, hot drinks and anxiety, and avoid these.
• Regular exercise and learning relaxation techniques can help reduce hot flushes.
• Oestrogen can be used as a vaginal cream or vaginal suppository to help with vaginal dryness and urinary frequency. This is often helpful for women who have had certain types of cancer. You will need to discuss this with your doctor to see if it is safe for you.
• Vaginal lubrication and a vaginal moisturiser can help with dryness.
• Moderate to severe symptoms can be treated with different hormones. Sometimes low dose testosterone is also included for women who have persistent loss of libido.
• If your doctor does not advise hormones for you, hot flushes can be treated in other ways. Talk to your doctor about this.
• Use a water or silicone-based lubricant, because these are less irritating when touching or stroking your genitals as part of sexual play or having sexual intercourse.

Vaginal dryness and narrowing

Cancer treatments may cause a variety of changes that might lead to vaginal dryness, shortening or narrowing, ulcers and infection. These changes may lead to pain on intercourse. Vaginal narrowing may happen after radiotherapy to the pelvis and together with shortening sometimes after surgery.

Tips

• You may need extra lubrication to make intercourse comfortable. Choose a water-based gel that has no perfumes or colouring added to reduce irritation. Before intercourse, spread the lubricant around and inside the entrance to your vagina. A vaginal moisturising cream used several times a week may also help keep your vagina lubricated. Some do not contain oestrogen.
• For severe dryness, try an oestrogen suppository or tablet and use a gel around the vulva.
• If your vagina has narrowed, your doctor may offer you treatment with graduated vaginal dilators. These are plastic or glass tubes of varying sizes, which can be inserted for short periods of time into your vagina, by yourself or with your partner's assistance.
• The dilators prevent the side walls of the vagina from sticking together. Alternatively, try a vibrator or regular gentle sexual intercourse to overcome the problem.
• If your vagina has shortened through surgery, experiment with different positions very gently until you find what works for you.

Loss of your uterus and other changes to sexual organs

Hysterectomy is the surgical removal of the uterus. Because the uterus is removed, no menstrual bleeding will take place.
Hysterectomy does not change your ability to feel sexual pleasure. Although your vagina is shorter, the area around the clitoris and the lining of the vagina remain as sensitive as before. You do not need to have a uterus or cervix to reach orgasm.

Vulvectomy results in major body image changes and changes to sexual practices. To prepare you for these changes, it is important that you are referred to a sexual counsellor before having this surgery. If you have already had this surgery and are still experiencing difficulties, ask for a referral to a sexual counsellor.

Tips

• It is usual for women to have counselling before and after surgery that will result in changes to your body image. It might be helpful for your partner to have counselling also. Your doctor can refer you to a counsellor at any time.
• You may want to concentrate on sexual massage, stroking nipples and other erogenous areas of your body rather than penetrative intercourse.
• It is important to realise that you are loved for who you are, not for particular body parts. However, communicating with your partner about the changes and different ways of enjoying intimacy is important.

Loss of a breast or other part of your body

If you have had breast surgery or radiotherapy to the breast, your sexual arousal patterns may change, particularly if you were previously aroused by breast massage and nipple stimulation. The loss of any body part can affect a woman's self-confidence and sexual confidence.

Tips

• Women who lose a part of their body to cancer, especially if it is a breast or part of the genitals, sometimes miss the pleasure they felt from the stroking of that area during sex. Ask your partner to stroke your whole body, including kissing your neck, or touching your inner thighs or genital area.
• If you've had a limb removed, try wearing your prosthesis during sex, or remove it and support your affected limb or limbs with pillows.
• Setting the scene with soft lights, favourite music, or by dressing up may help get you in the mood. The use of fantasy is a powerful way to gain sexual confidence.
• Setting time aside to experiment alone or with a partner may improve your overall confidence.

Fertility problems

If your uterus has been removed as part of treatment, you will not be able to become pregnant. Other treatments can also make it difficult to become pregnant, such as radiotherapy to the pelvic area or some types of chemotherapy.

Tips

• If chemotherapy means that you may not be able to conceive a child, talk with your doctor about your options, including the possibility of storing eggs or part of an ovary. Note that this is a very new technique. Its success has not been fully established and is only available in some treatment centres. Furthermore, this technique may only have limited success.
• Talk to your doctor about when it is safe to become pregnant, because it is important not to get pregnant while having chemotherapy, radiotherapy or hormone treatments such as tamoxifen.
• Some women's fertility may not be affected, so if you do not wish to become pregnant, contraception must be used.