Female Sexual Health and Cancer

The female reproductive system includes internal organs (the uterus, cervix, fallopian tubes and ovaries) and external structures (the vulva). The breasts, nipples and other areas of the body may also play a role in sexual response.

When a person becomes sexually aroused, the body undergoes a series of physical and emotional changes. Cancer and its treatments can affect these responses, influencing sexual desire, arousal, vaginal lubrication, the ability to achieve orgasm and overall sexual satisfaction.

Hormonal, physical and emotional changes associated with cancer may cause:

  • Reduced sexual desire.
  • Persistent fatigue or tiredness.
  • Vaginal dryness.
  • Pain during sexual activity.
  • Urinary problems or pelvic discomfort.
  • Difficulty achieving orgasm.
  • Changes in body image and self-esteem.

Your doctor, specialist nurse or sexual health professional can advise you on the options available to prevent or manage these symptoms.

Sexual desire is closely linked to emotional wellbeing. Anxiety, depression, fear of recurrence, physical changes and concerns about a relationship can all affect sexual response. Discussing these concerns and seeking professional support can be very helpful.

Effects of Surgery in Women

Any major surgical procedure can affect sexuality, either temporarily or permanently.

Hysterectomy

A hysterectomy is surgery to remove the uterus. In some cases, the cervix, fallopian tubes or ovaries may also be removed.

Some women notice changes in orgasm sensations or vaginal lubrication, although many continue to enjoy a satisfying sex life after recovery.

Radical Trachelectomy

This procedure removes the cervix and surrounding tissues while preserving the uterus.

It may result in slight shortening of the vagina and temporary changes in comfort during sexual activity.

Oophorectomy

An oophorectomy is surgery to remove one or both ovaries.

Removal of both ovaries causes immediate surgical menopause, which may result in:

  • Hot flushes.
  • Vaginal dryness.
  • Reduced sexual desire.
  • Mood changes.

Cystectomy

A cystectomy is surgery to remove the bladder.

Depending on the extent of the procedure, anatomical and functional changes may affect sexual function.

Rectal Surgery or Abdominoperineal Resection

Rectal surgery may cause pelvic discomfort, pain or nerve-related changes that can temporarily affect sexual activity.

Lumpectomy or Mastectomy

Breast surgery may affect body image, self-esteem and perceptions of femininity. Some women require time to adjust to these physical and emotional changes.

Any surgery affecting visible parts of the body can also have an impact on confidence and body image.

Effects of Radiotherapy in Women

Radiotherapy may cause temporary or permanent side effects that affect sexuality.

General side effects may include:

  • Fatigue or marked tiredness.
  • Skin reactions in the treated area.
  • Pain or local tenderness.
  • Changes in body image.

Pelvic Radiotherapy

Radiotherapy directed at the pelvis (including the bladder, rectum, anus, vulva, vagina, cervix, uterus or ovaries) may cause:

  • Diarrhoea.
  • Nausea.
  • Urinary or bowel discomfort.
  • Vaginal bleeding.
  • Vaginal dryness.
  • Loss of vaginal elasticity.
  • Pain during sexual intercourse (dyspareunia).
  • Hormonal changes.

Patients are now routinely informed about preventive and therapeutic measures such as lubricants, vaginal moisturisers, pelvic floor physiotherapy and vaginal dilators when appropriate.

If the ovaries receive radiation, ovarian failure and premature menopause may occur and can sometimes be permanent.

Effects of Chemotherapy in Women

Chemotherapy and Sexuality

Chemotherapy uses medicines to destroy cancer cells. During treatment, side effects that reduce interest in sexual activity are common, including:

  • Nausea.
  • Fatigue.
  • Weakness.
  • Emotional changes.
  • Changes in body image.

In general, there is no medical reason to avoid sexual activity during chemotherapy. However, in specific situations, such as very low platelet or white blood cell counts, the medical team may recommend temporary precautions.

Physical Effects of Chemotherapy

Some treatments may cause:

  • Peripheral neuropathy (tingling or numbness in the hands and feet).
  • Persistent fatigue.
  • Changes in body image related to hair loss or weight loss.
  • Vaginal dryness.
  • Reduced sexual desire.

In most cases, these symptoms gradually improve after treatment ends, although some effects may persist for longer.

Hormonal Changes

Chemotherapy can affect ovarian function.

This may lead to:

  • Menstrual irregularities.
  • Temporary or permanent absence of menstrual periods.
  • Hot flushes.
  • Sleep disturbances.
  • Vaginal dryness.
  • Reduced fertility.
  • Premature menopause.

It is important to remember that the absence of periods does not necessarily mean infertility. If pregnancy is possible, effective contraception should be used during treatment and for the period recommended by your healthcare team, as recommendations vary according to the medications used.

Vaginal and sexual symptoms can often be managed through a variety of medical and supportive approaches.

Effects of Hormone Therapy in Women

Hormone Therapy and Sexuality

Some cancers are sensitive to sex hormones. For this reason, certain treatments reduce hormone levels or block their action to lower the risk of cancer recurrence.

The main hormones involved are:

  • Oestrogen.
  • Progesterone.
  • Testosterone.

These treatments may be given as tablets, injections or surgical procedures.

Tamoxifen and Aromatase Inhibitors

In addition to tamoxifen, commonly used hormonal treatments include aromatase inhibitors such as:

  • Anastrozole.
  • Letrozole.
  • Exemestane.

These treatments may cause symptoms similar to menopause:

  • Hot flushes.
  • Dry skin.
  • Vaginal dryness or irritation.
  • Pain during sexual activity.
  • Mood changes.
  • Anxiety.
  • Reduced sexual desire.
  • Sleep disturbances.

Not all women experience these effects, and their severity varies considerably.

Other Hormonal Treatments

Medicines such as goserelin, leuprorelin and triptorelin may be used to temporarily suppress ovarian function.

These treatments may result in:

  • Absence of menstrual periods.
  • Menopausal symptoms.
  • Reduced sexual desire.
  • Vaginal dryness.
  • Emotional changes.

For many women, these effects improve after treatment ends, although recovery depends on age, the treatment received and previous ovarian function.

Coping With These Changes

Current international guidelines recommend actively addressing sexual difficulties associated with cancer. Helpful measures may include:

  • Vaginal lubricants and moisturisers.
  • Specialist pelvic floor physiotherapy.
  • Treatment of menopausal symptoms when appropriate.
  • Sexual counselling.
  • Psychological support.
  • Open communication with a partner.

Many women are able to regain a satisfying sexual life, even when some physical changes from treatment persist.