What causes sexual problems for women after cancer? 

Sexual problems can be caused by many kinds of treatment for cancer. Radiation, surgery, chemotherapy, and hormone therapy can all cause sexual problems. They can cause damage to nerves and blood vessels, remove glands and organs, cause scar tissue to form, and change the balance of sex hormones in your body. 

Who’s at risk?

Many women with cancer have sexual problems. Your risk depends on:

• The type of cancer and where it was in your body

• Your sexual function before you had cancer

• The kinds of treatment you had

• How long treatment lasted

• Your stress level and how you are coping with changes 

Types of sexual problems for women after cancer 

Cancer treatments can cause many kinds of sexual changes. Some of these may get better or go away with time as nerves, blood vessels, and other tissues heal. The problems can include: 

• Low sex drive. This means loss of interest in having sex. It’s also called low libido.

• Vaginal dryness. This can make the vagina less flexible.

• Vaginal stenosis. This is the narrowing or tightening of the vagina. It can make it difficult and painful to have sex.

• Vaginismus. This is a spasm of the muscles of the vagina that can make sex hurt. 

• Pain during sex. This is a very common side effect of cancer treatment. It can be caused by vaginal dryness, scar tissue, damage to vaginal or vulvar tissues, or low hormone levels. Or it can be caused by a combination of these.

• Vulvovaginal atrophy. This is a thinning and dryness of the tissues of the vulva, the lining of the vagina, or both. It can lead to pain during sex.

• Vaginal shortening. This can make sex more difficult and painful.

• Change in sensitivity. You may have reduced feeling in the vulva, vagina, or clitoris. Breast surgery and radiation can lead to reduced feeling in the nipple and breast.

• Changes in orgasm. It may take you longer to have an orgasm. You may have orgasms that are less intense. Or you may have no orgasm.

• Other physical problems. You may have extreme tiredness (fatigue), pain, nausea, or shortness of breath after cancer treatment. These may lead you to avoid sex, or make it harder to enjoy sex.

• Body image problems. You may have also lost or gained weight, lost breast tissue, and have changes in your vulva or vagina. You may have an ostomy bag on your belly. You may have scars or skin changes. Any of these changes can make you feel self-conscious and less interested in sex.

• Mood changes. Depression and anxiety after cancer treatment can cause loss of interest in sex. And medicines that can help treat depression and anxiety may affect your sex life while you are taking them. 

Getting help and treatment 

Some sexual problems may get better over time. But talk with your healthcare team to get help. There are many kinds of treatment that may help. To get treatment for sex problems, you may work with different kinds of healthcare providers, such as:

• Your primary healthcare provider. Your primary provider may be able to treat some kinds of sexual problems. Or he or she can refer you to someone else.

• Gynecologist. This is a doctor who treats problems of the female genitals and reproductive organs.

• Counselor. A counselor may be a licensed social worker, psychologist, or psychiatrist. He or she can provide different kinds of talk or behavioral therapy, and may be able to prescribe medicine.

• Sex therapist. A sex therapist can help you work with your partner to find new ways to enjoy sex, or find methods or positions that make sex less difficult. 

The types of treatment include:

• Hormone therapy. Sometimes hormones can be used to help boost sex drive and function. You may be given hormones in a cream, ointment, or patch.

• Vaginal dilator therapy. This is a series of slim plastic or rubber wands that you can use for a short time each day (like a tampon) to help gently stretch and widen your vagina. It can help make sex easier and less painful.

• Pelvic floor physical therapy. These are exercises to help train and strengthen pelvic floor muscles. This therapy may help reduce pain during sex.

• Topical lidocaine. This is pain medicine in a cream or ointment. It can help ease the symptoms of painful sex.

• Vaginal moisturizers and lubricants. Moisturizers are used every few days to help ease vaginal dryness. Lubricants are used during sex. 

Managing menopause after cancer treatment 

Many cancer treatments can cause the ovaries to stop working. This can lead to menopause. Menopause is when your ovaries stop releasing eggs, make a lot less estrogen, and you stop having menstrual periods. It’s a time when some women start having symptoms such as hot flashes, sleep problems, and mood changes. Menopause can also cause low sex drive, painful sex, and vaginal dryness. 

You may have blood tests to check your hormone levels and confirm menopause. If needed, your healthcare provider can help you manage the symptoms of menopause with treatments such as hormone therapy. Talk with your healthcare team about ways to feel better. 

Talking with your partner 

Coping with sexual changes after cancer treatment can be upsetting. You may feel angry, sad, or scared. You may worry about disappointing your partner. But it’s important to keep in mind that there are many ways to have sexual pleasure. Talk with your partner about your concerns. Together you can work on new ways to give and receive pleasure. You can also work with a counselor or sex therapist. And remember that some sexual changes are short term. Your healthcare team can tell you more about how long sexual side effects may last, and can help you get treatment for them.