• Reclaiming Sexuality After Gynecologic Cancer

    IMAGE Women who are treated for gynecologic cancers— cervical , uterine , ovarian , endometrial, or vulvar—are often caught off-guard by the impact that surgery, pelvic radiation , and chemotherapy can have on their sex lives.
    "Neither my gynecologic oncologist nor my radiation oncologist discussed any sexual side effects prior to treatment," says Katie, 31, who had a hysterectomy and radiation treatments for cervical cancer. "My libido fell off the radar screen almost immediately, and even after five years, it is becoming increasingly hard to find."
    While not all women experience dramatic shifts in sexual functioning and desire after being treated for gynecologic cancer, almost all will notice changes that affect their sexuality. Knowing what to expect up front can help women hold on to the pleasure and comfort that sexual activity can provide.

    Early Menopause

    Pelvic radiation, chemotherapy, and surgeries that involve removal of the ovaries can plunge women into sudden, early menopause. This can include symptoms like hot flashes, night sweats, and mood swings which can be more difficult with added stress of cancer treatments. Hormone replacement therapy (HRT) can help some women with menopausal symptoms but may not be appropriate in certain types of cancer.
    The lack of estrogen caused by early menopause can also leave vaginal tissues dry, making sexual intercourse uncomfortable or painful. Many women find that using a lubricant makes intercourse much more comfortable.

    Vaginal Changes

    Surgery for cervical cancer can shorten the vagina and change sexual sensation. Treatment for vulvar cancer usually involves removing at least some of the external genitalia, changing a woman's appearance. Radiation can also cause vaginal burns (which will heal), or scarring or narrowing of the vagina (which are permanent).
    It is standard treatment to give women dilators when they are going through radiation therapy. The dilators are torpedo-shaped objects used with lubricant in the vagina to help keep scarring and narrowing to a minimum. This is a lifelong regimen. Women who neglect it can develop adhesions in the vagina. These can make future intercourse and pelvic examinations more painful.
    You may also consider kegel exercises. The exercises strengthen the pelvic floor and allow you to have more vaginal muscle control. Kegels can also increase you and your partner's sexual pleasure as you regain muscle tone and control.

    Loss of Libido

    It is very common to lose your sexual desire during cancer treatments. Libido can be sapped by fatigue, nausea, depression, and diarrhea caused by chemotherapy and radiation. Body image issues often arise as women are faced with surgical scars, loss of head and pubic hair from chemotherapy, loss of fertility, and removal of their reproductive organs or genitalia.
    "I think when you've had so much attention directed toward that portion of your body, it's hard not to think of the disease when you're making love," explains Katie.
    While some physical side effects are unavoidable, there is plenty that women undergoing treatment for gynecologic cancer can do to ensure a satisfying and pleasurable sex life:

    Maintaining and Reclaiming Sexual Pleasure

    Ask About Sex

    If sex is a priority for you, you may have to be the one to raise the issue with your healthcare team. Many women assume they need to abstain from intercourse or any sexual activity during treatment, and sometimes they do. However, in many cases, maintaining sexual relations during treatment can not only provide emotional support and intimacy, but may also help keep sexual functioning intact.
    Sexuality is something that should be included in the treatment protocol. In fact, there is evidence to support that long-term survivors of vaginal and cervical cancer report less sexual complications if they have discussions with their doctor.

    Ease Back Into Sex

    If you have taken a break from sexual activity during treatment, it is normal to feel anxious. Ease back into sex gently. Set aside a block of time for you and your partner to relax and explore one another. Keep in mind that sexuality can be expressed through touch. If you cannot have sexual intercourse and regardless of the cancer treatment you have had, touching is something you can always do.

    Try Something New

    Realize that you and your partner will probably have to make some permanent adjustments in your sex routine. Be adventurous in trying new positions that may be more comfortable. And expand your repertoire beyond intercourse to include more touching, cuddling, and other forms of sexual intimacy. Women who have pain or diminished sensation with vaginal intercourse can experience pleasure and orgasm through other types of sexual touching.

    Speak Up

    Communicate with both your doctor and your partner about any pain or discomfort you are having during sexual activity.

    Seek Help

    Ask your physician, a psychologist, or a social worker for a referral to a support group for women who have been treated for gynecologic cancers. They can be a great source of practical information and a place to feel connected to people who understand what you are going through.

    RESOURCES

    American Cancer Society http://www.cancer.org/

    Women's Health from the United States Department of Health and Human Services http://womenshealth.gov/

    CANADIAN RESOURCES

    The Society of Obstetricians and Gynaecologists of Canada http://sogc.org/index%5Fe.asp

    Womens Health Matters http://www.womenshealthmatters.ca/

    References

    Breast Cancer in Women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 6, 2012. Accessed December 10, 2012.

    Cervical Cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 28, 2012. Accessed December 10, 2012.

    Ekwall E, Ternestedt BM, Sorbe B. Important aspects of healthcare for women with gynecologic cancer. Oncol Nurs Forum . 2003;30(2):313-9.

    Sexuality and Reproductive Issues. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/supportivecare/sexuality/Patient/. Accessed December 10, 2012.

    Sexuality for the Woman with Cancer. American Cancer Society website. Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffectsinwomen/sexualityforthewoman/index. Accessed December 10, 2010.

    Stead ML. Sexual function after treatment for gynecological malignancy. Curr Opin Oncol . 2004;16(5):492-5.

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