Sexuality for the Woman With Cancer

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Pelvic exenteration

Sex and pelvic radiation therapy

Radiation to the pelvic area often affects a woman’s sex life. If the ovaries get a large radiation dose, they may stop working. Sometimes this is just for a short period of time, but often it’s permanent.

If a woman has already gone through menopause, she may notice little or no change. This is because her ovaries have already stopped making hormones. But if she hasn’t reached menopause, radiation may cause sudden menopause with hot flashes and vaginal dryness. These problems are discussed in “Dealing with sexual problems.”

Young women who get smaller doses of pelvic radiation, as they might during treatment for Hodgkin disease, may start to menstruate again as their ovaries heal. But with larger doses of radiation therapy, such as those used for cervical cancer, the damage is almost always permanent. Women who get radiation to the pelvis often become infertile. But no matter what the radiation dose, women younger than 50 should talk with their doctors before stopping birth control since it may be possible to become pregnant.

During radiation, tissues in the treatment area get pink and swollen, and may look sunburned. A woman’s vagina may feel tender during radiation treatment and for a few weeks afterward. As the irritation heals, scarring may occur. The thick walls of the vagina may become fibrous and tough. This means the walls might not stretch out as much during sexual excitement and activity.

The scarring that can occur after pelvic radiation can shorten or narrow the vagina. A woman can often keep tight scar tissue from forming by stretching the walls of her vagina with vaginal penetration during sex at least 3 or 4 times a week or using a vaginal dilator on a regular basis.

A vaginal dilator is a plastic or rubber tube used to stretch out the vagina. It feels much like putting in a large tampon for a few minutes. Even if a woman is not interested in staying sexually active, keeping her vagina normal in size allows more comfortable gynecologic exams. And gynecologic visits are an important part of follow up after treatment. For more information, see “Using a vaginal dilator” under the section called “Preventing pain during sex.”

Radiation to the vagina can also damage its lining, making it thin and fragile. Many women notice some light bleeding after intercourse, but they felt no pain at the time. Rarely, women get ulcers, or open sores, in their vaginas, which may take several months to heal after radiation therapy ends.

Can a woman have sex while getting pelvic radiation?

As long as a woman is not bleeding heavily from a tumor in her bladder, rectum, uterus, cervix, or vagina, she can usually have sex during pelvic radiation therapy. The outer genitals and vagina are just as sensitive as before. Unless intercourse or touch is painful, a woman should still be able to reach orgasm, too. But some studies suggest waiting 4 weeks after radiation to let the swelling and inflammation decrease, and to reduce the risk of tearing the tissues.

A woman should follow her doctor’s advice about sex during radiation therapy. Radiation therapy from a machine outside the body does not leave any radiation in the body, so your partner will not come in contact with it.

Some women are treated with an implant. An implant is a radiation source put inside the bladder, uterus, or vagina for a few days. Intercourse may not be allowed while the implant is in place. Women treated with this type of radiation do not transmit radiation after the implant is removed.

Last Medical Review: 08/29/2013
Last Revised: 08/29/2013