Gynecological Cancer
Physical side effects from the treatment of gynecological cancer include pain, loss of sensation, sensitivity and sexual desire, as well as shortening and dryness of the vagina. These may be because of anatomical changes from treatment or from changes due to lack of ovarian hormones following surgery, radiation or chemotherapy. Fatigue is a frequent side effect of both radiation and chemotherapy. Body image and relationship changes are also common. Body image plays an important role for many women in how they view themselves as female and scarring, swelling or weight gain can impact body image and have long lasting effects on the women and her sexual relationship. The loss of potential to have children may also play a role in how women see themselves following treatment for gynecological cancer.
Hysterectomy is commonly performed when cervical, endometrial or ovarian cancer is diagnosed. The surgery generally destroys pelvic nerves that contribute to sexual functioning. The absence of the uterus also alters the sensation of orgasms for many women. Radiation therapy further impacts on sexual functioning by reducing blood flow to vaginal tissues resulting in dryness which makes intercourse very painful. The bladder and bowel may also suffer radiation damage and can cause pelvic pain.
Women who have had radiation therapy are often instructed to perform vaginal dilation to keep the vagina open. This is important for future check-ups as a pelvic examination is necessary. The woman should start as soon as it is comfortable to do so and within four weeks of completion of therapy is regarded as optimal. Start with a dilator with a narrow diameter (1 � 2 cm) and gradually increase the diameter up to a maximum of 3 cm. Women should be encouraged to use the dilator daily but she should use if at least three times a week. This should continue for at least three years although some physicians say it should be used forever. A lubricant should be used to ease insertion; KY jelly may be used or any other lubricant that the woman finds comfortable. Some women may prefer to have regular penetrative intercourse instead of using the dilator however for women without a partner this may not be a viable option. Some women may not be ready for intercourse soon after treatment is over and may be fearful of pain or damage to tissues. In these cases a dilator may be prefered, especially in the short term after treatment.
Women who experience vaginal dryness often find that using a vaginal moisturizer (such as Replens) provides them with comfort. This product is not designed for sexual activity but rather for moisture in the vagina. It is used three times a week and is available over the counter at drug stores. For sexual activity, a lubricant is suggested. There are many lubricants on the market; some of them are water-based (like KY jelly) and others are glycerine-based (like Astroglide). KY jelly tends to get tacky with friction while Astroglide remains very slick. It is important to experiment until you find the product that you like the most. Be careful to avoid anything that has perfume or dyes as part of the ingredients as these can irritate vaginal tissues.
Chemotherapy can have a profound effect on the woman and many women find that they cannot even think of being sexual while undergoing this treatment. If you are going to have sexual intercourse, it is important to discuss what precautions need to be taken to protect your partner; this is usually dependent on the particular drug you are taking. You may need to use condoms for intercourse and latex dental dams for oral sex.