Vaginal Problems.
For so many years since my treatment, I have found it very difficult to understand the issue around sexuality and cancer. I do want to have a normal sex life. It is very difficult to get an answer, when you ask your team questions like, Can I have sex? Some have said, I don’t know, some said, No you can’t, and some said, There are different ways you can have intimacy. I have seen so many cancer leaflets, and they all talk about dilators and how these can help you. Before writing this page, I had to think very hard about the best way to write about this. First I will talk about my experience and I will look at what they say about this.
As well as having the stenosis,
-I suffer from constant fatigue.
-I suffer from pain and discomfort in the lower pelvis area.
-Because of the treatment I have had, I keep thinking sex can make matters worse. The surgery I had involved shortening and stretching the vagina. From my research, I have realized this can’t help making things better for me.
- Because I am not on any HRT the wall of the vagina has become thinner, which makes sex painful. Some women do get a lot of pain because of this.
For quite sometime now, I have been going to hospital for check ups and extra treatments. This has caused me some distress. I have lost my confidence and self worth because of this. I don’t have a partner, but one day I would like to have one. I guess women who communicate very well with their loved ones may find it easier to deal with this problem. I think it would help a great deal if counselling were offered even before treatment starts.
With dilators, I found that I don’t use it for a couple of months and when it comes to near my check up I will try and use it for a couple of days to avoid pain and discomfort during internal examination. I don’t really know if I am causing more harm than good. In my opinion, the information we get from the health officials is not enough. Can you stop using it and start again when you feel ready? And will you be doing more harm than good? These are questions which need to be answered. I guess your doctors do know who will find it difficult to have sex, but I don’t think they like to talk about it.
Marie Waller, who is a specialist nurse in coloproctology, says lower pelvic surgery can affect nerves that play a role in arousal and sexual feeling. Removal of the uterus and vaginal wall can alter the anatomy, which can result in pain during the intercourse. Some surgery can result in scarring which is a boundary in sexual activity. Dryness of the vagina occurs if the nerves that lubricate it during sex are damaged, which can lead to discomfort and pain. There are some lubricating jellies available on prescription to help with this.
With all the problems I mentioned, many women find it difficult to use their dilators regularly. They need to be encouraged to do this so that their doctors can spot any sign of recurrence. I guess doctors do know which patient will find it difficult to have a normal sex life. It is best to take your time in your own space and talk about what suits you best with your partner.
Vaginal Stenosis
Vaginal Stenosis – its nature and causes Vaginal stenosis is often a side effect of radiotherapy and/or genital surgery. It is the narrowing and/or loss of flexibility of the vagina, often accompanied by other changes such as the dryness and loss of resilience of scar tissue. Although the following text mainly addresses stenosis as a result of radiotherapy, many of the symptoms and the mitigating responses can be applied to other treatment causes as well.
Radiotherapy, or radiation treatment such as X-rays, is used to kill cancerous cells. It is likely to be used on the pelvic area to treat cancer of the bladder, rectum (lower bowel), or lymph glands. But most often radiotherapy is used in this area to treat conditions such as cancer of the uterus or cancer of the cervix.
Such radiation treatment, whether by external beam radiation or by the use of internal implants, will result in changes to the vagina such as the drying and thinning of the vaginal lining, fibrosis (formation of scar tissue), shortening and narrowing of the vagina, and reduction in the amount of vaginal lubrication. It is also likely to diminish the size and number of small blood vessels within the vagina. All of these side effects lead to vaginal stenosis and much drier, friable vaginal tissue. However, good personal hygiene and care may prevent or greatly reduce these effects and mitigate the impact of others, such as vaginal discharge.
The Effects of Vaginal Stenosis can lead to long-term problems with sexual intercourse and pain during physical examinations. To help reduce the impact of this it is highly desirable to obtain a professional sexual assessment as early as possible and to involve the patient’s partner, if there is one, in this counselling.
As a means of reducing the effects of vaginal stenosis, patients may sometimes be given a vaginal dilator and instructions for its use. But this will depend very much on the patient's individual treatment plan and the precise procedures they are undergoing. Exercises to increase the circulation within the vaginal area and use of an oestrogen cream are also sometimes employed.
However, whether or not sexual intercourse is permitted whilst treatment is on-going will also depend entirely on the precise nature of the treatment plan being followed and whether or not the relevant Qualified Medical Practitioner (QMP) is willing to allow intercourse to continue.
During radiotherapy, and for a while after, patients may well lose interest in normal sexual intercourse. However, this is not usually permanent but may also be associated with a general loss in confidence. All of this can usually be overcome by professional counselling, the importance of which cannot be overstressed. It should be noted that cancer is not contagious and cannot be passed on by physical contact, including during sexual intercourse.
If intercourse is permitted by the QMP, then it is quite possible that couples will together be instructed on how to use a water based lubricant to facilitate penetration and to protect dry vaginal tissue. It is likely that adjusting intercourse positions will not only increase the woman's comfort but may also help protect fragile vaginal tissue. Vaginal penetration with either a dilator or sexual intercourse has been found to significantly decrease the occurrence of vaginal stenosis and dyspareunia (see Female Reproductive Anatomy pages for further information).
Eventually, however, when permitted, sexual activity will not cause a return of the cancer, and partners will not suffer from any after effects of the patient’s radiation treatment.
Radiotherapy to the female pelvic region will result in infertility if the ovaries are within the treatment area. However, contraception, if used before, should continue to be used until advised otherwise by a QMP. Menopausal symptoms may also be exhibited as a result of radiotherapy, although the type and severity of these is likely to vary significantly from individual to individual.
Many patients experience considerable vulvar (the area surrounding the vaginal opening) and vaginal inflammation towards the end of their treatment, which may result in sexual intercourse becoming unacceptably painful. It may nevertheless prove possible to continue using a dilator at this time. However, it is generally the case that healing of the damaged tissue will occur and it should be possible at some stage for normal sexual intercourse to be resumed.
It should be noted that radiotherapy and other such treatments in this part of the body have many emotional as well as physical side effects that can adversely affect a woman's sexuality and quality of life. Professional teaching, counselling, aftercare and support are likely to make a considerable difference in the quality of life for individuals both before, during and after treatment. As such, professional expert advice should be sought as soon as possible in such cases. Problems of body image and sexual function can usually also be helped significantly in this way.
