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Gynecologic CancersOvarian CancerSexuality & Cancer

Gynecologic Cancer Surgery, Sex, and Intimacy

Cancer diagnosis, treatment, and recovery can lead to changes in your sexual anatomy, functioning, and your feelings about your sexuality.
October 2015 Vol 1 No 5
Kristen M. Carpenter, PhD
Lynn Weatherby, RN

It is important to tell your nurse or doxtor if you notice and changes in your ability to have and enjoy sex. Cancer diagnosis, treatment, and recovery can lead to changes in your sexual anatomy, functioning, and your feelings about your sexuality. It is perfectly normal for women to lose interest in sex at times, but cancer can make lack of interest worse, and can even make the thought of resuming sexual activity frightening or depressing. The impact of cancer on sexuality is most obvious during treatment. Many women find that, once they return to their normal routines, their interest in sex begins to return. There are a number of strategies you can use to help improve this aspect of your life after cancer.

Cancer Treatment and Sexuality

We find that women often don’t have a good understanding of the sexual changes after cancer treatment. Gynecologic cancers are typically treated with surgery. The extent of surgery for gynecologic cancer can vary widely from woman to woman. Some women have one ovary removed in a simple robotic procedure; others have a total hysterectomy (removal of the uterus), removal of both ovaries, and extensive “debulking” of tumors from other organs, with a large incision up the abdomen. Many patients also undergo chemotherapy or radiation treatment, which can result in pain, discomfort, and fatigue that can last for months or years. Sometimes a woman may struggle with her body image after surgery, or feel less attractive. She may worry that sex will hurt, or she will have no feeling at all. Women who are premenopausal at the time of treatment may become menopausal as a result of the removal of the ovaries or because of damage caused by chemotherapy. In this case, a woman may stop having periods and will have hot flashes or dryness in the vagina. Sometimes this is temporary, and ovarian function will return for a small number of patients, but for most patients, the ovarian failure is permanent. All these side effects can cause the woman to have less desire to have sex.

Talking with Your Nurse or Doctor

Often you will hear your nurse navigator or your primary nurse ask if you have any questions. “Hi. My name is Lynn, and I am your primary nurse. I will be with you during your cancer journey. What questions do you have?” But how do you ask the “big” question—the sex question? Sometimes it’s easier to wait until your nurse or doctor is almost out of the room, to say: “Oh, by the way, I was wondering about when I could have sex after my surgery.” In some cases, because of the focus on survivorship, your nurse navigator may ask you if you have questions about sex or intimacy. Your nurse or physician may ask you questions such as:

  • Do you have a desire for sexual intimacy?
  • What questions do you have about vaginal intercourse?
  • What is most concerning to you right now about feeling close to your spouse or significant other?

It is important to tell your nurse or doctor if you notice any changes in your ability to have and enjoy sex. These questions are part of helping you to feel whole again. You have the right to ask or be asked these questions. Your nurse or doctor is there to listen, provide support, and perhaps give some simple suggestions. If your questions require more information, there are sex specialists who can help you. Your nurse or doctor may suggest some actions you can take, because your sexual health is important. Sharing pleasure and closeness with a partner can be done with simple touching. Kissing, stroking, or even massage can help you be physically close with your partner. You and your partner can also hug and cuddle, bathe together, or do other activities that make you feel closer. Loving words or actions are other ways to express feelings of love and intimacy. You can also be open to explore new ways to show love. If you need additional support, there are experts who can help.

The following types of cancer treatments for women can cause changes in sexuality:

Hysterectomy: Removal of the Uterus

  • Can help stop troubling signs or symptoms of cancer, such as pain or bleeding with intercourse
  • Some women may feel that their femininity is threatened because of the loss of their reproductive organs
  • Does not usually change a woman’s ability to feel sexual pleasure, but can change the sensations of orgasm for some women
  • May cause shortening of the vagina (because of the surgery)

Oophorectomy: Removal of the Ovaries

  • Causes menopausal symptoms, such as hot flashes and vaginal atrophy (the vagina becomes tight and dry) in women who have not yet reached menopause
  • This is not an issue if only one ovary is removed (unilateral)

Vulvectomy: Removal of Portions of the Vulva

  • Can cause the area around the vagina to look very different, which can impact body image
  • Sensation in the area may be different
  • Numbness may occur soon after surgery, with feeling returning slowly over the next few months for some patients
  • Surgical changes can lead to problems reaching orgasm, particularly if the clitoris or large portions of the labia have been removed or changed
  • Can cause swelling of the genital area or legs; this may go away after recovery, or can become a long-term problem (lymphedema), which can cause pain, a feeling of heaviness, and fatigue
  • Can lead to the concern that partners will be “turned off” by scarring, and the loss of outer genitals

Trachelectomy (Cervicectomy): Removal of the Cervix

  • In a simple trachelectomy, the cervix itself is removed. In a radical trachelectomy, the cervical stump (lower third of the uterus), parametria (tissue adjacent to the cervix), and vaginal cuff (the end of the vagina close to the cervix) are removed, and a neocervix is constructed using the remaining tissue
  • May cause shortening of the vagina (because of the surgery)
  • Natural conception is possible after trachelectomy, but not vaginal delivery

Patient Resources

CancerCare
www.cancercareinc.org/ovarian/faqs.php

Mayo Clinic
www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20047214

Ovarian Cancer Research Foundation
www.ocrf.org/about-ovarian-cancer/living-with-ovarian-cancer/facing-life-with-ovarian-cancer

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