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Cervical cancer


Managing side effects


It will take some time to recover from treatment for cervical cancer. You may find the cancer affects you physically and emotionally. Some women have many side effects, while others don’t have any. Side effects may last from several weeks to a few months or, less commonly, many years or permanently.

Bladder changes

Bladder control may change after surgery or radiation therapy. You may find that you need to pass urine more often or in a hurry. Or you may leak a few drops of urine when you cough, sneeze, laugh, strain or lift. This is called urinary incontinence and there are ways to manage it:

The blood vessels in the bowel and bladder can break more easily after radiation therapy. This can cause blood to appear in urine or faeces (poo), even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment. 

Bowel changes

After surgery or radiation therapy, you may notice changes in your bowel habits. You may have constipation or diarrhoea, or feel pain in your abdomen from trapped wind. Radiation therapy can also damage the lining of the rectum, causing inflammation and swelling known as radiation proctitis.

The risk of developing radiation proctitis is low, however it can cause a range of symptoms including blood in bowel movements, frequent diarrhoea, the need to empty the bowels urgently and loss of control over the bowels (faecal incontinence).

You may develop some of these symptoms for other reasons. Let your treatment team know if you develop any of these symptoms.

Tips for managing bowel changes

  • Drink peppermint or chamomile tea to reduce abdominal or wind pain.
  • Drink plenty of water to replace fluids lost through diarrhoea or to help soften faeces if you’re constipated.
  • Avoid alcohol and cut down on coffee, cola and other drinks that contain caffeine.
  • See a women’s health physiotherapist for information about exercises to strengthen your pelvic floor and anal muscles. These exercises can help you control your bowels. 
  • Talk to your doctor or a dietitian about what to eat, or ask about suitable medicines. They may suggest you take a soluble fibre supplement to help with any changes and improve bowel control.

 

Fatigue

It is common to feel tired and lack energy during and after treatment, particularly if you’ve had both radiation therapy and chemotherapy. The tiredness may continue for several months, or even a year or two, after treatment has finished.

Feeling tired is not only a side effect of the treatment itself. Travelling to hospitals and clinics for treatment can be exhausting. If you work during your treatment or if you have a family to care for, this can make you feel especially tired.

Learn more

Fertility

If your uterus is removed or you have radiation therapy to the uterus and cervix, you will not be able to conceive children or carry a pregnancy. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you.

Being told that your reproductive organs will be removed or will no longer work can be devastating. Even if your family is complete or you did not want children, you may still feel a sense of loss and grief. These reactions are common. Speaking to a counsellor or gynaecological oncology nurse about your feelings and individual situation can be helpful.

Ways to preserve fertility

  • If you have not already been through menopause, ask about ways to preserve your fertility. One option may be to store eggs or embryos for use in the future. These can be implanted in your body, if you still have a healthy uterus, or into a surrogate.
  • Having a trachelectomy, where only the cervix is removed, may be an option. It will still be possible to become pregnant after this procedure, but you will be at higher risk of having a miscarriage and having the baby prematurely. Your doctor can discuss these risks with you.  

 

Lymphoedema

Surgery or radiation therapy to the pelvic area can stop lymph fluid from draining normally, causing swelling in the legs or genital area. This is known as lymphoedema. Lymphoedema may appear during treatment or months or years later.

It is important to look after your skin, avoid injury or infection to the lower limbs, and manage lymphoedema symptoms as soon as possible. Mild lymphoedema is usually managed with exercise, skin care and a compression stocking or sleeve. A physiotherapist trained in lymphoedema management can give you further advice.

Learn more

Menopause

If your ovaries have been damaged by radiation therapy or chemotherapy, or they’ve been surgically removed, your body will no longer produce the hormones oestrogen and progesterone. When this happens, periods stop. This is called menopause and it is a natural and gradual process that usually starts between the ages of 45 and 55.

The symptoms of menopause caused by cancer treatment are usually more severe than during a natural menopause because the body hasn’t had time to get used to a gradual decrease in the hormone levels. Symptoms can include hot flushes, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. Menopause may cause other changes in the body over time, such as:

  • low libido – you may be less interested in sex
  • osteoporosis – your bones become weak and brittle and may break more easily
  • high cholesterol – having high levels of cholesterol (a fatty substance found in the blood) can increase your risk of heart disease and stroke.

Menopause hormone therapy (MHT), previously known as hormone replacement therapy (HRT), is medicine that replaces the hormones usually produced by the ovaries. It has been shown to treat menopausal symptoms and help prevent osteoporosis. There are also non-hormonal drugs that can help. Talk to your doctor about the risks and benefits of MHT, and other ways to deal with the symptoms of menopause. 

How to manage menopausal symptoms

  • Talk to your doctor about having a bone density test or taking medicines to prevent osteoporosis. Regular exercise will help keep your bones strong. 
  • Ask your doctor to check your cholesterol levels. If they are high, regular exercise and a balanced diet may help reduce them. If levels don’t improve, talk to your doctor about cholesterol-lowering drugs.
  • Your doctor can suggest dietary changes and suitable exercises.
  • If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848.
  • Try meditation and relaxation techniques to help reduce stress and lessen symptoms. Listen to our Finding Calm During Cancer podcast.
  • If you have ongoing symptoms, ask your doctor for a referral to a specialist menopause clinic. 

 

Impact on sexuality and intimacy 

Having cervical cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many things, such as your treatment and its side effects, whether you have a partner, and your overall self-confidence.

Low libido

A lack of interest in sex or loss of desire is common during and after treatment. This may be because of the worry of having cancer and the side effects of treatment.

If you do not feel like having sex, or if you find it uncomfortable, let your partner know. It normally takes some time for sex to be comfortable again. You can also try other ways to be intimate, such as massage and cuddling. 

Vaginal changes

The main side effect of treatment for cervical cancer will be to the vagina. If the ovaries have been affected by surgery or radiation therapy, they will no longer produce oestrogen. This will cause your vagina to become very dry and it may not expand easily during sexual intercourse.

Radiation therapy to the pelvic area can also cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina. This is known as vaginal stenosis. If vaginal changes make sexual penetration difficult or painful, you may have to explore different ways to orgasm or climax.

Managing changes in your sex life 

Sexual changes
  • Give yourself time to get used to any physical changes.
  • Talk to your doctor about ways to manage side effects that change your sex life. They may suggest using hormone creams and vaginal moisturisers to help with vaginal discomfort and dryness.
  • You can get a prescription for hormone creams from your doctor or buy vaginal moisturisers over the counter from pharmacies.
  • Discuss changes to your libido with your partner so they understand how you’re feeling. You may both need to be patient.
  • Consider touching, hugging and kissing. This is a chance to feel close to your partner without expectations of sexual penetration.
  • Explore other ways to climax, such as caressing the breasts, inner thighs, feet or buttocks.
  • Use water- or silicone-based vaginal lubricants without perfumes, oils or glycerines. 
Changes to the vagina
  • Try to keep the vagina open and supple. This will make sexual intercourse more comfortable. Even if you don’t plan to be sexually active, it also makes it easier for your doctor to do regular cervical screening tests, as well as vaginal examinations to check whether the cancer has come back.
  • Your doctor or nurse may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple.
  • Dilators are tube-shaped devices made from plastic or silicone. They are designed to gently stretch the vagina. They come in different sizes – it is important to seek advice from a health professional about the correct size.
  • Wait until any soreness has settled before you start using a dilator. This is usually 2–6 weeks after your last session of radiation therapy.
  • Used with lubricant, the dilator is inserted into the vagina for short periods of time.
  • Using a dilator can be challenging. Your doctor or a physiotherapist can provide practical advice on how to use them.
  • Having regular gentle sexual intercourse can also help widen the vagina. Use a lubricant to prevent discomfort caused by vaginal dryness.
  • If you need more support resuming sexual activity, ask your doctor for a referral to a sexual therapist or psychologist.  

 

Follow-up appointments

After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread. For the first few years, you will probably have a check-up every 3–6 months.

During check-ups, you will usually have a pelvic examination, and you may have a follow-up HPV test or liquid-based cytology (LBC) test, blood tests, x-rays, a CT scan or PET–CT scan.

For some people, cervical cancer does come back after treatment, which is known as a recurrence. This is why it is important to have regular check-ups and to report any symptoms immediately. If the cancer does recur, you will usually be offered further treatment to remove the cancer or help control its growth.

If you had radiation therapy the first time you had treatment, you may not be able to have further radiation therapy. New drug treatments to treat the recurrence may be available through clinical trials.

Question checklist

Asking your doctor questions will help you make an informed choice about your treatment and care. You may want to include some of the questions below in your own list:

Diagnosis
  • What type of cervical cancer do I have?
  • Has the cancer spread? If so, where has it spread? How fast is it growing?
  • Are the latest tests and treatments for this cancer available in this hospital?
  • Will a multidisciplinary team be involved in my care?
  • Are there clinical guidelines for this type of cancer?
Treatment
  • What treatment do you recommend? What is the aim of the treatment?
  • Are there other treatment choices for me? If not, why not?
  • If I don’t have the treatment, what should I expect?
  • How long do I have to make a decision?
  • I’m thinking of getting a second opinion. Can you recommend anyone?
  • How long will treatment take? Will I have to stay in hospital?
  • Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
  • How will we know if the treatment is working?
  • Are there any clinical trials or research studies I could join?
Side effects
  • What are the risks and possible side effects of each treatment?
  • Are the side effects immediate, temporary or long-lasting?
  • Will I have a lot of pain? What will be done about this?
  • Can I work, drive and do my normal activities while having treatment?
  • Will the treatment affect my sex life?
  • Will the treatment affect my ability to have children? What options do I have to preserve my fertility?
  • Should I change my diet or physical activity during or after treatment?
After treatment
  • How often will I need check-ups after treatment? Who should I go to?
  • If the cancer returns, how will I know? What treatments could I have?

 

Understanding Cervical Cancer

Download our Understanding Cervical Cancer booklet to learn more

Download now

 

Expert content reviewers:

Dr Pearly Khaw, Lead Radiation Oncologist, Gynae-Tumour Stream, Peter MacCallum Cancer Centre, VIC; Dr Deborah Neesham, Gynaecological Oncologist, The Royal Women’s Hospital and Frances Perry House, VIC; Kate Barber, 13 11 20 Consultant, VIC; Dr Alison Davis, Medical Oncologist, Canberra Hospital, ACT; Krystle Drewitt, Consumer; Shannon Philp, Nurse Practitioner, Gynaecological Oncology, Chris O’Brien Lifehouse and The University of Sydney Susan Wakil School of Nursing and Midwifery, NSW; Dr Robyn Sayer, Gynaecological Oncologist Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Megan Smith, Senior Research Fellow, Cancer Council NSW; Melissa Whalen, Consumer. 

Page last updated:

The information on this webpage was adapted from Understanding Cervical Cancer - A guide for people with cancer, their families and friends (2021 edition). This webpage was last updated in October 2021.

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