Experience with surgical treatment of vaginal stenosis after radiation therapy : once created will go here
Female Sexual Response
Normal Sexual Response and Definitions of Sexual Dysfunction for Women
Non-linear Model of Female Sexual Response by Rosemary Basson
This is a model of female sexual response that incorporates the importance of emotional intimacy, sexual stimuli, and relationship satisfaction (see Figure above). This model acknowledges that female sexual functioning proceeds in a more complex manner than male sexual functioning and that female functioning is dramatically and significantly affected by numerous psychosocial issues (e.g., satisfaction with the relationship, self-image, previous negative sexual experiences).
Reprinted from Association of Reproductive Health Professional
Additional Reading:
Healthy Women: Sexual Dysfunction
Linda Rogers, CRNP
Summary: The website includes an overview of women’s sexual arousal cycle, causes of sexual dysfunctions in women, types of sexual dysfunctions, and pain related to sexual dysfunction. It also includes some general treatment and prevention methods of sexual dysfunction.
Female Sexual Health After Cancer
How cancer and cancer treatments affect women’s sexual health
If you develop a sexual problem, talk to your health care provider as early as possible about any symptoms or concerns. Some women may feel uncomfortable discussing sexual concerns. However, your health care team can answer questions, refer you to a specialist and help you find solutions. All of your physical and emotional concerns are important, so talk to your health care team. This is especially true if you are experiencing pain during sex or feeling that your intimate relationship has become less enjoyable. Sexuality is an important part of your quality of life after cancer.
When to Start Thinking About Sex After Cancer
You may decide to wait for a while after treatment before having sex. Others may be ready right away. Here are some signs that it may be time to talk with your health care provider about sexual health after cancer treatment:
- Loss of desire for sex.
- Negative thoughts and feelings during sex.
- Difficulty feeling sexual excitement and pleasure during sex.
- Difficulty reaching climax.
- Vaginal dryness and tightness.
- Pain when your genital area is touched or from sexual intercourse.
New sexual problems often begin during or soon after cancer treatment. Be certain to discuss any problems and symptoms with your health care provider—especially if you begin to notice any changes in your ability to have or enjoy sex. Some problems, such as loss of vaginal size and lubrication after radiation to the pelvis, may develop months or even years after cancer treatment is done.
Physical Effects of Treatment on Sexual Functioning
There are many different causes of sexual functioning concerns in female cancer survivors. Some are physical. Others may be due to changes in how you feel about yourself, your body, or other aspects of your life after cancer.
Approximately half of survivors of breast cancer and other cancers that affect the pelvic area (such as the cervix, ovaries, uterus, bladder, colon or vagina) develop long-term sexual problems. Yet, most problems are actually caused by treatment and not the cancer itself. For example:
- Chemotherapy can damage the ovaries, causing hormonal changes and temporary or permanent menopause in younger women.
- Radiation to the pelvic area can also damage the ovaries, triggering sudden menopause in younger women; radiation to the vagina can irritate the delicate lining, decreasing the moisture produced with sexual excitement. Over time, scarring of the vaginal walls can make the vagina shorter and less able to expand with excitement.
- Surgery for pelvic cancer may remove parts of a woman’s sexual organs, including areas of the vulva, part or all of the vagina, and one or both ovaries. Removing both ovaries is another treatment that leads to menopause.
- Surgery for breast cancer may involve removing the whole breast, with or without reconstruction. Even partial mastectomy can interfere with pleasure from breast caressing if the nipple or underlying tissue was removed.
- Medicines used to treat pain, nausea, depression or anxiety can decrease a woman’s desire for sex or make it difficult for her to reach a climax.
Talk with your health care team about the risks to sexual functioning before you begin cancer treatment. If you have already undergone treatment, talk with your health care provider about finding ways to treat symptoms or concerns now.
Emotional Effects of Treatment on Sexual Functioning
Emotional reactions to cancer diagnosis and treatment can also interfere with feeling attractive and sexual. It is common in the first year of a cancer diagnosis to have:
- Sad or depressed feelings.
- Concerns about changes in the way you look.
- Stress in the relationship with your partner.
- Difficulty with self-esteem because of feeling ill and being unable to fill all your usual roles in the family and at work.
If you had concerns or negative feelings about sex before cancer, going through treatment could increase your distress. Ask your health care provider for a referral to a licensed mental health professional who has experience working with cancer survivors.
Finding Help with Female Sexual Functioning
Sexual problems after cancer are very common. Talk with your health care provider about when it is safe to have sex. Also talk with your partner. Many partners hesitate to start sex because they don’t want to pressure you or cause you physical pain. You can prepare for your sexual experience by taking time to get in the mood, focusing on pleasure rather than on whether you will have intercourse or reach an orgasm, and using vaginal moisturizers and lubricants if you notice dryness. Here are other ways to help:
| Sexual Functioning Concerns | How to Find Help |
| Loss of desire for sex after cancer | Ask a member of your health care team to check your medications for possible side effects. Get medical treatment for pain during sex that will not go away or fatigue that may be affecting your energy and desire for sex. If you are in menopause, see a gynecologist or an endocrinologist. If there are no physical causes, see a licensed mental health professional to find out if your loss of desire could be related to feelings of depression, anxiety, low self-esteem, or relationship conflict. |
| Negative thoughts and feelings during sex | Women often find themselves distracted during sex by negative images and thoughts, for example about losing a breast or being infertile. Try focusing on pleasurable feelings in your body or on a sexy thought or fantasy. If that does not help, ask for a referral to a mental health professional who can help you change negative feeling and thinking patterns |
| Difficulty feeling pleasure during sex | If you have lost feeling in an area of your body that had given sexual pleasure, you may need to find new caresses that you enjoy. Communicate with your partner. Ask for a referral to a sex therapist who specializes in treating cancer survivors. |
| Vaginal dryness and tightness, making sexual activity uncomfortable or painful | Talk with a gynecologist who has expertise in menopause and problems with pain during intercourse. Ask your gynecologist, for advice on using over-the-counter vaginal moisturizers for before and during sexual activity. You also may benefit from learning to control the muscles around the vaginal entrance. Some women can benefit from low-dose vaginal estrogen in a cream, tablet or ring form. Such hormones can help the vagina regain moisture and ability to stretch with less getting into the general blood circulation. |
| Difficulty reaching orgasm | Ask your health care team to check your medications. Antidepressants or anti-anxiety medicines may make it more difficult for you to have an orgasm. Give yourself time. Try not to pressure yourself to have an orgasm. Try to have a goal of enjoying sex and getting as much pleasure as possible. The nerves that help a woman feel pleasure around the clitoris and in the vagina are rarely damaged by cancer treatment. Cancer or its treatment rarely will physically prevent you from having an orgasm. |
Treatment Options for Women with Sexual Concerns
Loss of desire for sex is often a complex problem that needs both counseling and some medical help. There is no magic pill that can restore desire, but communication with your partner, patience, and experimenting with touch can often help. But there are some treatment options for sexual functioning concerns. Talk with your health care provider about these common methods:
| Treatments for sexual functioning concerns | Pros | Cons |
| Vaginal moisturizers (such as Replens®, Hyalo-D®, or Luvena®) | Vaginal moisturizers are designed to keep the vaginal lining moist all the time. Some include prebiotic ingredients to help grow healthy bacteria and keep the vagina at a good pH. Need to be used regularly at bedtime 2 to 3 times a week May replace the need for lubricants during sex, although women may benefit from an extra lubricant for lovemaking even if they are using a moisturizer. | Can be costly and is not covered by insurance. May be messy. Some women may need to use a mini-pad, but the discharge decreases after a couple of weeks. |
| Water- or silicone-based vaginal lubricants | Water-based lubricants last longer and work better than old-style gels. Silicone-based lubricants last even longer but are more expensive and may stain sheets or clothing. Can be purchased at most drugstores or over the Internet. Look for brands that do not contain perfumes or chemicals such as parabens or gycerine, and that try to keep the vagina at the same pH as is normal before menopause (4.5). | May wear off and need to be re-applied during sexual caressing or intercourse. May not be effective enough to prevent pain if there is severe vaginal dryness. |
| Low-dose vaginal estrogen replacement (such as Estring, Vagifem) | The Estring releases a small dose of hormone over three months. The Vagifem suppository is used a couple of times a week. Both Estring and Vagifem produce a low dose of estrogen. This is considered to be helpful treating vaginal dryness with very little hormone released into the bloodstream. Generally thought to be safer than pills, patches, or creams. | Some oncologists still worry about breast cancer survivors using these products. A small study found that some women using suppositories still had levels of estrogen in their blood high enough to interfere with the benefits of aromatase inhibitors. |
| Find comfortable positions for intercourse | Certain positions may help avoid pain during sex. | Requires good communication between partners. |
| Learn to relax muscles around the vaginal entrance | Learn methods of relaxation to avoid pain during intercourse. Try “Kegel” exercises. Women can use silicone vaginal dilators to practice muscle control, starting with a smaller size and going up to larger ones. Always use a water-based lubricant on the dilator and be gentle inserting the dilator. | Can help minimize pain, but may not relieve pain if tissue scarring is present in the vagina. |
| Herbal pills or genital lotions | Lotions may act as lubricants. | Herbal remedies may interfere with other medicines or may have unknown dangers. No scientifically valid studies have identified lotions to help with sexual dysfunction. Some lotions may irritate skin or tissues. Lotions containing L-arginine may trigger episodes of genital herpes if a woman has a history of infection with this virus. |
Adopted from:
https://www.livestrong.org/we-can-help/finishing-treatment/female-sexual-health-after-cancer
Additional Reading:
- Vulvar Skin Care Guidelines by Dr. Colleen Stockdale
- Summary: The goal is to promote healthy vulvar skin. This is done by decreasing and removing chemicals, moisture, or rubbing (friction). Products listed below have been suggested for use because of their past success in helping to decrease or relieve vulvar/vaginal burning, irritation, or itching.
- Yoga for Pelvic Pain from the Mayo Clinic
- Summary: Your health care provider recommends that you do certain yoga poses one or two times a day to help with pelvic pain. The yoga poses are gentle stretches that help promote muscle relaxation and decrease pain.
- Questions Women Have about Cancer, Sex, and Getting Professional Help by American Cancer Society
- Summary: questions many women with cancer have and answers to them.
- Renewing Intimacy & Sexuality after Gynecologic Cancer by Foundation for Women’s Cancer
- Summary: a brochure answers many common questions women with cancers have.
- Surgery Can Affect a Woman’s Sex Life by American Cancer Society
- Summary: it provides information about how surgeries like pelvic surgery, radical hysterectomy, breast cancer surgery can affect woman’s sexuality
- Pelvic Radiation Can Affect a Woman’s Sex Life by American Cancer Society
- Summary: describes how pelvic radiation affect woman’s sexuality
- Chemo and Hormone Therapy Can Affect a Woman’s Sex Life by American Cancer Society
- Summary: this article describes how chemo and hormone therapy and therapy-related problems affect sexuality. It also provides information about pregnancy and fertility during and after chemo.
- Treating Sexual Problems for Women with Cancer by American Cancer Society
- Summary: provides general suggestions for cancer patients to improve sexual functions
Female’s Fertility After Cancer
How cancer and cancer treatments affect women’s fertility
- How Cancer Treatments Can Affect Fertility in Women by American Cancer Society>
- Summary: some cancer therapies and surgeries can affect women’s fertility and cause problems during pregnancy. This article provides general information about how cancer treatments can affect women’s fertility
- Preserving Fertility in Women with Cancer by American Cancer Society
- Summary: it includes some options for women to preserve fertility and options for women who are not fertile after cancer treatment.
- Fertility Brochure by Livestrong
- Summary: This booklet provides an overview of information about the risks of infertility from cancer treatments and family-building options for both men and women. It also provides additional fertility resources and sample questions to ask your doctors about fertility.
Self Help Books for Low Libido in Females
UpToDate.com, accessed 10-26-2020
- The Joy of Sex, by Alex Comfort
- Becoming Orgasmic: A Sexual and Personal Growth Program for Women, by Julia Heiman and Joseph Lopiccolo
- For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life, by Jennifer Berman, Laura Berman, and Elisabeth Bumiller
- Getting the Sex You Want: A Woman’s Guide to Becoming Proud, Passionate and Pleased in Bed, by Sandra Leiblum and Judith Sachs
- Come As You Are: The Surprising New Science That Will Transform Your Sex Life, by Emily Nagoski
- I [heart] Female Orgasm: An Extraordinary Orgasm Guide, by Dorian Solot and Marshall Miller
- Real Sex for Real Women: Intimacy, Pleasure & Sexual Wellbeing, by Laura Berman
- Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking, by Patricia Love and Jo Robinson
- Dr. Ruth’s Sex after 50: Revving Up the Romance, Passion & Excitement, by Ruth Westheimer
- Passionate Marriage: Keeping Love and Intimacy Alive in Committed Relationships, by David Schnarch
- Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain, by Deborah Coady, MD and Nancy Fish, MSW, MPH
Websites on Low Libido
UpToDate.com, accessed 10-26-2020
- American Association of Sexuality Educators, Counselors, and Therapists
- American College of Obstetricians and Gynecologists
- American Urological Association
- North American Menopause Society – Module on “Sexual Health and Menopause”
- Sexuality Information and Education Council of the United States
- Society for Sex Therapy and Research
Dilators
- Vaginal dilators for radiation therapy by OncoLink, Penn Medicine, 2021
- Vaginal changes after radiotherapy to the pelvis, New South Wales government publication, Australia
- Recovering after pelvic radiation therapy – a guide for women. Centre for Medical Psychology and Evidence-based Decision–making, University of Sydney, Australia
- International Guidelines on Vaginal Dilation after Radiation Therapy, National Forum for Gynecological Oncology Nurses, UK, 2012