This guide was written by your health care team. It is meant to give you general information on the topic. It should not be used to replace the advice of your health care team, or to replace any cancer treatment.
Many treatments for gynecologic cancers can affect your intimate relationships and your sexual function. It can be hard to feel like a sexual person during and after cancer treatment.
Sexual function is:
- What you do sexually and how your body responds.
- Sexual function does not only mean sexual intercourse or vaginal penetration (putting something in your vagina, like a penis, finger or sex toy).
- It also includes other ways of expressing yourself sexually, like touching and kissing.
Intimacy is:
- The physical and emotional closeness you share with another person.
Both intimacy and sexual function can affect how we see ourselves, and how we think of ourselves.
Intimacy and sexual function can be affected by cancer and its treatments. It is important to know that there are things you can do to manage changes to your intimacy and sexual function.
How will the different cancer treatments affect me?
There are many different treatments for gynecologic cancers. The treatments you get depend on the type of cancer you have. Because gynecologic cancer is in your sex organs, these treatments may affect how your body responds to sex.
Gynecologic cancer treatment may also affect how you feel about your body.
Changes to your intimacy and sexual function can be caused by:
- illness
- pain
- hormone changes
- cancer-related fatigue (tiredness that does not go away with rest or sleep)
- body image
- stress or anxiety (feeling uneasy)
- anger
- sadness
- medications
- relationship problems with a partner
- relationship problems with other people in your life
- problems a partner may have with their sexual function
You can learn to manage these things by:
- being creative
- being a good communicator
- being patient
There are also other things you can do to keep your sex life healthy. Read the next sections to learn about different types of treatment, and how they can affect you and your sex life.
How surgery may affect you
How will surgery affect my sexual function?
These surgeries may change the way your body reacts to sex:
Surgeries can leave behind scars that are both physical and emotional. For some people, these scars can affect intimacy and how they view their body.
Read the sections below to learn about the different types of surgery, and what you can do to help you and your partner cope with changes to your intimacy and sexual function.
Hysterectomy
A hysterectomy is a surgery to remove the uterus.
What can I expect?
After a hysterectomy, the vagina may be shorter. This can make vaginal penetration uncomfortable at first. But over time, the vagina stretches, so there will be less discomfort during sex.
Most people with a clitoris have orgasms (sexual climax) though it's stimulation (touching or stroking).
The clitoris is on the outer genitals (see image below).
The clitoris is not damaged by having a hysterectomy. This surgery will not usually directly affect your ability to have an orgasm.
Bilateral salpingo-oopherectomy (BSO)
During a bilateral salpingo-oopherectomy (pronounced bye-lat-er-all sal-ping-go oo-fer-ek-ta-me), or BSO for short, both the fallopian tubes and the ovaries are removed.
What can I expect?
This surgery can cause menopause to happen early if you have not gone through it yet. When menopause starts, your body starts to make less estrogen. This may cause your vagina to become drier and less stretchy. This can make sex with vaginal penetration and medical pelvic exams more uncomfortable.
Over time, dryness in the vagina can lead to:
- pain (often with vaginal penetration)
- burning
- itching
- higher chance of getting an infection in your vagina
- higher chance of getting an infection in your urinary tract (this includes your urethra, bladder and kidney)
It is important to keep your vagina moist. Read
"Know How to Use Vaginal Moisturizers and Lubricants" (currently under revision) to find out more about how to keep your vagina moist and healthy.
Colostomy and ileostomy
During a colostomy (pronounced koh-LOS-toh-mee) or ileostomy (pronounced IL-ee-OS-toh-mee), parts of the intestines or anus are removed. The surgeon creates a different path for feces (poo) to leave the body.
This surgery is only used in cases of advanced cancer.
What can I expect?
This surgery may not change your sexual function, but it may change the way you feel about your body. It may affect your body image or sexual confidence. Feeling good about your body is part of feeling sexy.
Vulvectomy
During a vulvectomy (pronounced vul-vek-tah-me), parts of the vulva are removed. The vulva is the name for the outer genitals. This includes the labia minora and labia majora (inner and outer lips of the vagina) and the clitoris.
In a
partial vulvectomy, only the parts of the vulva affected by cancer are removed. A small edge of tissue around the cancer (called a “margin”) and some lymph nodes in the groin may also be removed.
In a
radical vulvectomy, the whole vulva is removed. A radical vulvectomy is only necessary in very rare situations.
The surgeon will save as much of the vulva as they safely can. A vulvectomy surgery does not include removing the vagina, uterus or ovaries.
What can I expect?
Having a vulvectomy may change how the area around the vagina will look and feel. You may have numbness (lack of feeling) in the genital area where the surgery was done. Some feeling may return slowly within a few months after surgery.
It is common to worry about how a partner will react to seeing your genitals after a vulvectomy. You may be able to have reconstructive surgery to rebuild the outer and inner lips of your genitals. This may help with the way the vulva looks.
Read the sections below for information about how to feel more sexually confident and comfortable after surgery.
Other surgeries
Other cancer-related surgeries may also affect your intimate relationships and sexual function.
This includes surgeries that:
- change the way urine (pee) leaves your body
- remove the clitoris
- change the shape of the vagina
With the right education and support, you can still have a very happy sex life. Ask your surgeon nurse or another member of your health care team about how you can keep a healthy sex life after surgery. If you have a primary partner, try to have them there for these talks too. Share this information with your partners.
There are many helpful questions you can ask, such as:
- How will this surgery affect my sexual function?
- How soon after this surgery can I have sex?
- How soon after this surgery can I insert something into my vagina?
- What can I do to make sex more comfortable and pleasurable after this surgery?
Coping after surgery
How soon after the surgery can I have sex?
At your first follow up visit after your surgery, ask your doctor when it is safe for you to start having sex.
How long you will need to wait to have sex will depend on the type of surgery you have. Most people can safely have sex with vaginal penetration starting 6 to 8 weeks after surgery.
Before having sex with vaginal penetration make sure that:
- The surgical incision (cut) at the top of the vagina has healed
- Blood spots and bleeding from the vagina has stopped
There is much more to sex and intimacy than vaginal penetration. Kissing, hugging, massaging and cuddling are safe to do right away. These types of intimate activities may also help you feel closer to your partners.
Will there be pain the first time I have sex with vaginal penetration after the surgery?
It depends. Some people still feel pain and discomfort after surgery. Pain can get in the way of pleasure and is a common worry for gynecologic surgery patients and their sexual partners.
Read the next section to learn what you can do to help prevent and reduce pain.
What can I do to help reduce pain during sex?
You and your partners can do things to reduce pain and increase pleasure during sex:
1. Find a comfortable position when having sex with vaginal penetration.
How you and your partners place your bodies during sex with vaginal penetration is important to reducing pain and making you more comfortable. Try these positions:
- When you are lying on your back, place pillows under your knees or behind your lower back.
- Try placing yourself in a top or in a side-lying position. This will allow you to control the depth of penetration (for example, how far a penis or sex toy enters your vagina).
Top position
Side-lying position
2. Talk to your partner and share your feelings.
Let you partner know if you feel any pain or discomfort during sex. If you feel any pain or discomfort during sex, it may help to:
- Move your position.
- Switch to a different sexual activity (such as touching and caressing on the outside of your vagina).
- Take a short break.
You and your partner should let each other know how you are feeling physically and emotionally so that you can try to avoid pain.
3. Use a dilator.
Use a dilator if you have vaginal stenosis (narrowed vagina). This can be caused by some cancer treatments. A dilator is a smooth plastic tube that you place in your vagina to stretch the inside walls.
Use a dilator to help reduce discomfort during sex with vaginal penetration or during medical pelvic exams.
Ask your doctor or a member of your health care team if you may need a dilator.
Read the resource called
How to Manage Vaginal Stenosis to learn more about vaginal dilators.
4. Use a vaginal lubricant or moisturizer.
Use water-based or silicone-based lubricants (lube) for sexual activities involving the genitals. Using a lubricant will help reduce discomfort caused by vaginal dryness.
There are many options for lubricants. You can buy them at your local pharmacy or at many sex shops. You do not need a prescription.
Do not use massage oils and oil-based lubricant:
- inside your vagina
- with condoms
Massage oils and most oil-based lubricants should not be used for sexual activities involving vaginal penetration. Oils can break down the latex in condoms. This will make them more likely to break.
Some oils can also increase your risk of getting a yeast infection or urinary tract infection.
Choose water-based or silicone-based lubricants that are free of:
- perfumes
- glycerin (sugar-based alcohol)
- parabens (un-natural chemicals)
These can irritate the vagina.
Use a vaginal moisturizer 2 to 3 times per week to keep the inside of your vagina moist. Using vaginal moisturizers often will help keep your vagina healthy. It will also make sex more comfortable.
Replens® and Zestica Moisture® are product examples of vaginal moisturizers. You can also use a natural oil as a vaginal moisturizer, such as natural almond oil or natural coconut oil.
Read the resource called
"Know How to Use Vaginal Moisturizers and Lubricants" (currently under revision) to learn more about the different lubricants and moisturizers, and how to apply them.
5. Ask your doctor about hormone treatment.
A doctor can prescribe (give you) vaginal estrogens to help reduce discomfort from vaginal dryness. But this hormone treatment is not safe for some patients. Ask your doctor if this is a safe option for you.
6. Take your pain medication.
If you feel pain anywhere on your body, take your pain medication before having sex. This may make sex more comfortable and feel better.
You may be able to take over-the-counter pain medication such as Advil® or Tylenol®, or your doctor may prescribe other pain medication for you to use. Always check with your doctor before trying any new pain medication. Some over-the-counter pain medications may not be safe for you to use.
7. Try being intimate without vaginal penetration.
You and your partner can try different ways of touching and caressing to learn pain-free ways to become aroused. This can include:
- kissing
- touching
- massaging your own body and your partner’s body
- using your mouth or hands on the genitals
Will sex with vaginal penetration feel different for my partner?
Your partner will not be able to feel that you had surgery to remove any internal sex organs (such as the uterus, fallopian tubes, or ovaries). The vagina is very elastic (stretchy). Sex with vaginal penetration can be very pleasurable for your partners even if your vagina is shortened from surgery.
If you have had both ovaries removed (BSO), you may notice that your vagina feels drier. Using a lubricant makes sexual activities feel more gentle and pleasurable.
Vulvectomy surgery may or may not change how sex feels for a partner. It may depend on which parts of the vulva have been removed during the surgery. The vulva looks different after vulvectomy surgery. Changes in how the vulva looks can affect how some partners feel about having sex.
Having surgery to your genitals may affect how a partner feels about some sexual activities such as oral sex. It is important you and your partners speak openly about what you are feeling, both physically and emotionally.
Ask for help from a member of your health care team if you and your partners are having a hard time coping with sexual changes after surgery.
Will I be able to have an orgasm after surgery?
Having surgery to remove the internal sex organs (e.g. uterus, fallopian tubes, ovaries) will not affect the nerves involved in orgasms. If you were able to have an orgasm before the surgery, you will likely still be able to have orgasms after.
Vulvectomy surgery can sometimes damage the nerves involved in orgasm. This will depend on the parts of the vulva that have been removed during the surgery. If you have had a vulvectomy, speak to your doctor to find out if your surgery may affect your ability to have an orgasm during sex.
Some cancer treatments lower hormone levels. This may change the way your body becomes aroused. For example, you may notice a decrease in genital fullness or vaginal lubrication.
If your cancer treatment has lowered your hormone levels, talk to your partner. Let them know that:
- These changes are caused by your surgery.
- These changes do not mean that you have lost all desire for sex.
- You are still attracted to them.
Together, and with the support of your health care team, you can find ways to adjust to these changes.
What can I do to feel more confident with my body?
There are many things that you can do to feel more confident with your body. For example, if you have had a colostomy or ileostomy, try wearing attractive clothes or lingerie that covers the ostomy (new opening on your body where body waste exits) during sex. This may help you to feel more attractive and sexy.
No matter what surgery you had, you can:
How radiation treatment can affect you
How will radiation affect my sexual function?
The effects of radiation treatment are different for each person. How radiation affects you also depends on:
- the dose of your radiation treatment, and
- the area of your body treated
Radiation to the pelvis or abdomen may cause side effects, such as:
- fatigue (tiredness that does not go away with rest or sleep)
- nausea (feeling of having to throw up)
- diarrhea (watery, or loose poo)
- swollen bladder or bladder infection
- swollen vagina
- vaginal stenosis (narrowed vagina)
- fluid or blood leaking out of the vagina
- sunburn-like effect on skin of vulva or groin
Some side effects of radiation treatment do not show up right away. They may appear months or years after treatment is done.
Delayed side effects can include:
- vaginal stenosis (narrowed vagina)
- swollen legs
These side effects may affect:
- your desire for sex
- how your body responds to sex
What can I do during and after treatment?
Try these tips:
-
Have sex with vaginal penetration often. Frequent sex with vaginal penetration (2 to 3 times a week) can help to stretch the vagina and reduce vaginal narrowing. This may include penetration with a penis, fingers or sex toys (such as a vibrator). Having any type of sex with vaginal penetration helps to keep the vagina healthy.
Using a lubricant can increase your comfort and pleasure during these sexual activities. -
Use a vaginal dilator 3 times a week. This will help keep your vagina open to a normal size so you feel comfortable having sex with vaginal penetration. Using dilators also makes it easier to for you to have pelvic exams. Read the resource called
How to Manage Vaginal Stenosis to learn more about dilators.
-
Arouse yourself often. When you are aroused, more blood flows to your vagina. Increased blood flow to your vagina helps keep it healthy. This is true with or without vaginal penetration. You can pleasure yourself (masturbation) or arouse yourself with a partner.
-
Use lubricant and vaginal moisturizers. Use a vaginal moisturizer 2 to 3 times a week. Use a lubricant for added moisture right before sex. Read the resource called
"Know How to Use Vaginal Moisturizers and Lubricants" (currently under revision) to learn more.
Is it safe to have sex during radiation treatments?
Yes, it is usually safe to have sex during radiation treatment. Cancer is not contagious, meaning you cannot pass cancer onto your partner during sex. Radiation treatment will not cause you to pass on any radiation to your partner during sex.
During radiation treatment, your vagina may become tender or swollen. It may feel like a sun-burn. Try using lubricants and vaginal moisturizers to see if it helps ease your discomfort.
If you are very sore during radiation treatment:
- You may need to take a short break from sex with vaginal penetration.
- You can try having sex with vaginal penetration again 2 to 4 weeks after radiation treatment ends.
- Sex with vaginal penetration will usually be more comfortable after you allow some time for your body to heal.
How chemotherapy can affect you
How will my sexual function be affected during chemotherapy?
The chemotherapy medicine itself does not change the way your body responds to sex. But, there are some side effects that can affect your mood or desire to have sex. Some examples of side effects are:
- fatigue (tiredness that does not go away with rest or sleep)
- nausea (feeling of having to throw up)
- mouth sores
- constipation (not being able to go poo)
- diarrhea
Not all types of chemotherapy cause the same side effects.
What can I do during and after chemotherapy?
Below is a list of some side effects that can happen during and after chemotherapy, and what you can do to help increase your sexual comfort and pleasure.
Fatigue
This is a common side effect of chemotherapy. Red blood cells carry oxygen throughout your body. The oxygen keeps you alive and gives you energy. During chemotherapy, you may have a lower number of red blood cells in your blood. This lack of energy may lower your desire for sex.
To help with fatigue, you can:
Hair loss
Some types of chemotherapy cause hair loss. If you have hair loss due to chemotherapy, your hair will likely start to grow back after many months.
Hair loss can affect your self-esteem and body image. Taking steps to feel more comfortable with how you look can help you to feel more attractive and confident.
To cope with hair loss and improve your self-image, you can try some of the following steps:
Infection
Chemotherapy may cause you to have a lower number of white blood cells in your body for 7 to 10 days after treatment. Since white blood cells help your body fight infection you are more likely to get an infection during this time.
The infection could be in your:
- lungs
- stomach and intestines
- vagina
- other areas
Your doctor or nurse may give you other instructions to lower your chance of getting an infection.
If your partner is sick or feeling sick (has a sore throat or cold), do not have intimate contact with them for 7 to 10 days after treatment. Doing this will help you avoid possible infection.
Talk to your doctor or nurse about any concerns you may have during or after chemotherapy. There are medications that can help reduce or relieve many of the side effects of chemotherapy.
Some medications can have sexual side effects. Let your doctor know if you are having side effects that are affecting your intimacy and sexual function.
General tips to help improve pleasure and desire
Talk about it.
If you are worried about current or future problems with your sexual function talk to your doctor, nurse, social worker, or other health care professionals with whom you feel comfortable. Dealing with your concerns about your sexuality and intimacy is an important part of your return to wellness.
- If you have a primary partner or regular sex partners, include them in any talks about sex with your health care team. This will help them reduce any fears they might have.
For example, some partners are afraid that sex will be painful for the patient. They may even be afraid that they may catch cancer. Let your partner know that cancer is not contagious (you cannot pass cancer onto your partner). - You might have concerns about when to tell a new partner about your cancer diagnosis.
Try joining a support group through the hospital, online, or in the community.
- Going to a support group can help you connect with other people who are dealing with concerns about dating and other similar issues.
- Ask a member of your health care team to help you to find a cancer support group to meet your needs.
Plan ahead.
Schedule time for you and your partners to have sex such as scheduling a “date night”. Planning ahead allows you to focus on your intimacy and create a comfortable environment for you to be sexual.
Set the mood for intimacy.
Create a setting that is relaxing, comfortable and sensual. Choose lighting (such as candles), music, and scents (such as perfumes, lotions) that you find sexy. Think about ways that you can move from your regular hectic day into a more relaxed and erotic frame of mind. You can try:
- a warm bubble bath
- watching a romantic movie
- reading a sexy novel
Save your energy and reduce fatigue.
Do not leave sex for the end of the day when you feel the most tired. It may be helpful for you to:
- Plan your sex and intimacy at times when you have the most energy (morning, after a nap, or on a weekend).
- Get a good night’s sleep and take naps when you can.
- Let your doctor know if you are having trouble sleeping.
- If possible, get some help with activities that are likely to lower your energy such as housework and other chores.
Eat a healthy diet and get regular exercise.
Take care of your body by eating healthy and exercising.
- This will give you more energy. It may also help to improve how you feel about your body.
- Good nutrition and exercise help improve sex drive and pleasure.
- Ask your health care team if it is safe to exercise before you start.
Manage your pain.
Try these tips:
- If you have pain from your cancer or treatment, take your pain medications 1 hour before having sex.
- Keep your lubricant in an easy to reach place so that you can quickly use it to help with any pain from vaginal dryness.
- If you are going to have sex with vaginal penetration, spend more time having “foreplay”. Make sure that you are feeling aroused and moist before inserting anything into your vagina.
- Use pillows to support your body comfortably. When having sex with vaginal penetration, choose positions that allow you to control the depth of penetration and move comfortably.
Manage your nausea.
If you have nausea from treatment, take your anti-nausea medications 1 hour before having sex.
Get to know your own body intimately.
You can do this by self-pleasuring (masturbating). Self-pleasuring can be helpful because:
- Most people do it! Self-pleasuring is a normal and healthy thing to do for people of all ages. This is normal whether you are in a relationship or not.
- Self-pleasuring can maintain good blood flow to the vagina. This will help keep it healthy.
- Cancer treatments can sometimes change how your vagina and genitals feel when touched. Learning what feels good through self-touch can help you be a better guide for your partners.
Be playful and change up your sexual routines.
Trying something new can add fun and excitement to your sexual relationship:
- Let your partners know if you would like to try new and exciting ways of pleasuring each other.
- Try new ways of touching, kissing, massaging and caressing one another.
- Visit your local bookstore or library to find books with tips on how to improve your sex life.
- Be playful and talk openly with your partner about what you each like and do not like.
Try a sex toy.
Toys add a sense of fun and excitement in the bedroom.
- There are many sex toys you can use for pleasure.
- Sex toys that vibrate can be very arousing. The added stimulation can be helpful for those who have less feeling in and around the vagina after treatment.
- You may find you are able to become aroused and reach orgasm much easier when using a vibrating sex toy.
- Some sex toys can be inserted into your vagina. These can work as a dilator and to help keep your vagina open and healthy.
- Sex toys can be used alone or with partners.
Talk to your doctor about hormone options.
Your doctor can let you know whether these products are a good option for you. Some examples of products are testosterone or estrogen-based creams. These creams can help boost sexual function and desire for some people.
Work on your relationship issues.
The strength of a relationship can affect your sex life. Cancer can put more stress on your relationships.
It is important for partners to be able to talk openly and honestly with each other. This will help you resolve conflicts and help you both work through problems together.
Where to find more information
Members of health care teams that treat cancer have different levels of comfort and training on the topic of sex and intimacy.
- Do not give up if you are still having problems with sex and intimacy. It is normal to go through this.
- Problems with sex during and after cancer treatment are very common. You can get support from trained experts.
- Ask a member of your health care team to refer you to a registered sex therapist. A registered sex therapist is an expert in sexual counseling and relationship issues.
- It might also be helpful to see a physiotherapist. Some physiotherapists have special training in pelvic health, and they can help you resolve vaginal pain and tightness.
Important phone numbers and contacts
To find a registered sex therapist:
Find a registered sex therapist in your area. Learn what to expect during sex therapy and how to find a therapist near you. Sex therapy services are often not covered by OHIP, but may be covered by some extended health benefits.
To find a pelvic health physiotherapist:
Email:
information@physiotherapy.ca
Phone: 1 800 387 8679
Find a physiotherapist with expertise in pelvic health.
Email:
info@collegePT.org
Phone: 1 800 583 5885 or 416 591 3834
To find more information and support:
The free workshops offered by Look Good Feel Better can help you regain control over your appearance. During the workshop you’ll receive warm support and guidance from our expert volunteers. You will also have the chance to connect with others facing cancer.
Visit the
Patient & Family Events Calendar for times. Call 1 800 914 5665 to register.
Take a class from a trained Physiotherapist and Registered Sex Therapist. Learn how cancer and cancer treatment affects sex and intimacy, what to expect, and how you can help.
This class is for Cancer Rehabilitation and Survivorship patients only. Registration is required. Call or email to register.
Email:
ellicsr@uhnResearch.ca
Phone: 416 581 8620
Princess Margaret Cancer Centre – 2nd Floor
610 University Ave
Hours: Monday to Friday, 9:00 am to 5:00 pm
Email:
survivorship@uhn.ca
Phone: 416 946 4501 extension 2363
Princess Margaret Cancer Centre – Main Floor Lobby
610 University Avenue
Hours: Monday to Thursday, 8:30 am to 4:30 pm
Friday, 8:30 to 4:00 pm
Email:
patientEducation@uhn.ca
Phone: 416 946 4501 extension 5383
Hours: Monday to Thursday, 8:30 am to 4:30 pm
Friday, 8:30 am to 4:00 pm
Closed on weekends and holidays.
The Patient & Family Library is open to all patients and their families, and the general public. The Library can help you and your family find reliable and up-to-date information about cancer and other health topics.
Contact or go in person to the Library to get any of the resources listed in this guide.
Princess Margaret Cancer Centre – 5th Floor
610 University Avenue
Phone: 416 964 4525
Hours: Monday to Friday, 9:00 am to 5:00 pm
Meet with social workers to get information on emotional, social and financial support resources.
Phone: 416 961 1928
Toll Free: 1 877 499 9904
Meet other people living with cancer. Wellspring offers daily classes, support groups, and programs that can help you cope with and manage the impact of cancer on your life.
Email:
info@cis.cancer.ca
Phone: 1 888 939 3333
To learn about clinical trials, visit their
Clinical trials page.
Email:
info1@ostomyCanada.ca
Phone: 1 800 826 0826
This website is for people who have had a colostomy and ileostomy. Visit the website to learn about surgery, find support and get help with your needs.
