The brutal side effects of cancer treatment are widely known to most of us. Hair loss, nausea, pain, weight loss, diarrhoea and extreme fatigue are what we normally think about when we think of chemo and radiotherapy treatments, but in women, did you know vaginal dryness and other vaginal changes such as stenosis are common too?
Radiotherapy, Chemotherapy and other treatments
When used as a treatment for gynae cancers, radiotherapy can damage healthy cells, causing a number of problems with the vagina. Some women may see a shortening and tightening of the vaginal wall cells (stenosis), so the skin can lose its elasticity, become drier, thinner and more prone to damage, potentially making penetrative sex difficult.
Chemotherapy can also lead to changes in the vagina, as it can induce early menopause. This can lead to vaginal dryness, and a substantial decrease in sex drive. Increased risk of infection and pain can make maintaining a sex life tricky, and thrush is common for many women going through chemotherapy.
Radiotherapy, chemotherapy, and drugs such as Tamoxifen for breast cancer can also lead to early menopause or menopausal symptoms, which can further exacerbate vaginal symptoms. Menopause will also occur in women who have a complete or partial hysterectomy to remove cancerous tissue in their ovaries and uterus. Find out more about menopause dryness here
Emotional impact of cancer- Real Story
The devastating news of a cancer diagnosis and the following treatment can have a huge impact on the sufferer’s emotional wellbeing and self-esteem and can impact the way women see themselves- especially when it comes to women specific cancers, such as ovarian or breast cancer.
This was particularly true for Karen Hobbs, who in 2014 noticed some bleeding after sex. She was 24 at the time, so hadn’t yet been invited for a smear test, but when it didn’t stop after a few weeks, she made an appointment for a smear. Fast forward a cervical cancer diagnosis, a radical trachelectomy to remove her cervix and part of her vagina, and a long recovery, to Karen sitting with me in The Eve Appeal offices, cancer free.
“I feel a lot older than my age. I’ve got a lot more to say about my vagina than the average 27 year old…When you have cancer that’s so closely linked to your intimacy and sensuality, it’s really weird to see that part of your body as a medical thing and not a sexual thing.”
Staying intimate with your partner can feel like a huge task when you’ve also got the weight of cancer treatment to juggle, and for many women who are going through or have been through gynae cancer treatments like Karen, the problems they face can be just as much psychological as physical. Karen thinks women need to re-train their brain into thinking about their vaginas and vulva as sexual, rather than something medical. “[My vagina] very quickly became not a sexual part of my body. It was difficult to flip it and be a sexy person again.”
Gynae and oncology nurse specialist Tracie Miles describes a process called ‘desensitising’, when the woman or the couple will do everything but engage in penetrative sex. “It builds desire,” she explains. “Sensual massage is so important for couples and helps maintain the intimacy.” Importantly, Tracie says that sexuality doesn’t just stop with a cancer diagnosis. Maintaining intimacy with your partner is not only possible, but beneficial too. “We’re in a really exciting time in our understanding of sex and sexuality. It’s an emerging field, and what we’re learning can have a really positive impact on women with cancer and help them to hold onto this important part of themselves.”
As a cancer information officer for The Eve Appeal, Karen now responds to emails and takes calls from people who need advice on gynae health issues with the wonderful Ask Eve service, alongside Tracie. One of her calls recently was with an 88 year old woman who had been through treatment for gynae cancer and was scared of being sexual again.
“She’d been using dilators, but she hadn’t been able to cope with them so stopped. I suggested she think about using a vibrator instead, just a small one like a bullet or something, and that maybe she just start off by focusing on her clitoris and vulva with some lubricant. Just to give her pleasure rather than it being this medicalised thing.”
Tracie agrees. “By exploring just with touch, but without penetration, that can really help. Vibrators are great for this, but using the finger is great too. A good lubricant is vital, even just with external touching of the vulva and clitoris, to avoid any discomfort or pain, which can be very off-putting and uncomfortable.”
For Karen, having sex again after her surgery was painful and uncomfortable. “I was really nervous- my body looked different so I was really self-conscious, and I hadn’t had sex for a long time so I was scared it would hurt.”
Using lubricant is key
That’s where using a lubricant came in useful, particularly as she’d had quite a big surgery to remove her cervix and part of her vagina. “It felt really… different is the only word I can use to describe it. It doesn’t hurt anymore, but it does still feel different. Lube definitely helps.”
Karen didn’t need to have any radio or chemotherapy as her cancer was fully removed through surgery. But for women who have had these treatments, vaginal dryness can be a huge problem. Tracie recommends using a hormone free gentle lubricant like Sylk. “It just takes away the worry. Keeping your vagina well lubricated means that when it does come to having penetrative sex again, you’re not worrying it’s going to hurt so much. It helps keep things moving.”
Moving beyond cancer
Karen is now thankfully cancer free, but still requires regular check-ups. “I’m going on holiday- Vietnam! But I have to have my check-up first, so I hope that the result come through before we leave, otherwise I know I’ll be checking my phone and emails all the time instead of enjoying myself.”
I asked Karen what she wanted most. “Apart from not getting the cancer back, obviously… I’d like everything to feel a bit less, well, heavy. Everything has this undertone of cancer, that I’d love to just be able to have a laugh with my boyfriend, and for us to have a ‘normal’ sex life. Or for us to plan things without the heaviness of the cancer on top of it. To be lighter.”
Tracie’s Top Tips
“Remember the P’s!”
Permission– you can have your body back. Take ownership of your body and give yourself permission to feel sexy again.
Pleasure– it is allowed! A cancer diagnosis doesn’t have to mean the end of your sexuality. Allow yourself to feel pleasure throughout your treatment and beyond.
Pace– take it at your own pace, only doing what you feel comfortable with.
Patience– You don’t have to be ready straight away. Be kind to yourself, and if you’re not feeling up to it, be patient, give yourself the day off. You can always try again tomorrow.
Worried about a gynae health issue? Unusual symptoms such as bleeding between periods or after sex, persistent bloating, and unusual discharge shouldn’t be ignored. Ask Eve is a confidential, nurse-led information service. So whether you’re a patient, a woman worried about symptoms, a relative of a woman affected by cancer, or a healthcare professional with a question or concern, Ask Eve is available to provide support. Give them a call on freephone 0800 802 0019, email [email protected], or visit the website
We’re donating 7p from every pack of Sylk sold to The Eve Appeal until September. Sylk is also co-sold with Amielle dilators, and is available on prescription, OTC in all chemists, and direct from the Sylk website. Get your free sample here