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 5 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 the 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.

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