Sexual Health Q&A

How might treatment for gynecologic cancer affect a woman’s sex life?

Treatment for gynecologic cancer (cancers of the cervix, ovaries, uterus, vagina, and vulva) can have a significant impact on a woman’s sexual health. Fortunately, many issues can be treated.

Scientists have found that survivors of gynecologic cancer tend to have sex less often, especially if they are premenopausal.

Sexual relations may change for several reasons.

Hormones

Chemotherapy, radiation, and surgery can all affect the production of hormones, triggering early menopause.

Menopause is characterized by declines in the hormone estrogen. Typically, a woman’s ovaries gradually stop producing estrogen as she gets older (usually in her forties or fifties). The ovaries also stop producing eggs. Eventually, menstrual periods stop.

Cancer treatment can trigger this process as well, even in younger women. For example, a woman’s ovaries may be the target of radiation or she might have them surgically removed. Since the ovaries are responsible for estrogen production, menopause would occur.

Estrogen keeps the vagina moist and flexible. After menopause, many women experience vaginal dryness, which can make intercourse uncomfortable or painful. A water-based lubricant or a moisturizer may help.

Androgens, typically known as “male” hormones also decline. Since these hormones drive sexual desire, a woman may find that she’s less interested in sex. Some doctors prescribe low doses of androgens to remedy this, if it is safe to do so.

Anxiety

It’s not uncommon for cancer survivors to feel anxious. They may worry about the cancer returning or feel stress as they try to get their lives back to normal. Gynecological cancer can prompt a variety of questions and concerns:

• Is it safe to have sex?
• Will it hurt?
• Can radiation be transmitted to a partner during intercourse?
• Will a woman’s partner still find her attractive if her body has changed through surgery?
• Will her partner feel rejected if she doesn’t feel like having sex?
• If a woman is single, will potential partners lose interest if they know she has had cancer?
• What is the best way to tell a new partner about cancer diagnosis and treatment?

Since the answers to these questions are largely individual, a woman’s cancer care team can best address them. Patients are encouraged to ask. Cancer does not change a person’s need for intimacy and sexual connection – both are important.

Healthcare providers and support groups are great places to start. Peers may be able to recommend lubricants or new positions to make sex more pleasurable. They might suggest ways to navigate the dating world after cancer treatment.

In addition, counselors can help women work through body image and self-esteem issues that may result from treatment. Couples can benefit from therapy as well, especially if they have trouble expressing their sexual needs and feelings.  It’s important to consider the impact of cancer on the couple’s relationship, especially the length of time they were sexless, their commitment to return to normal sexual life, their level of interest in physical intimacy, and the quality of their non-sexual relationship.