Sexuality for the Woman With Cancer

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Preventing pain during sex

Pain during intercourse is one of the most common sexual problems for women. This can be pain in a non-sexual area of the body or pain in the genitals. Even if your pain is in a non-genital part of the body, it can keep you from feeling pleasure during sex. This type of pain might be soreness in one arm after a mastectomy or tingling and numbness in your hands and feet after some types of chemotherapy. Pain may even make it hard for you to use intercourse positions that you enjoyed in the past.

Non-genital pain

If you are having pain other than in your genital area, these tips may help lessen it during sex.

  • Plan sexual activity for the time of day when you feel the least pain. If you are using pain medicine, take it an hour before planned sexual activity so it will be in full effect when you want to be intimate. Try to find doses of medicine that offer pain relief without drowsiness.
  • Find a position for touching or intercourse that puts as little pressure as possible on the sore areas of your body. If it helps, support the sore area and limit its movement with pillows. If a certain motion is painful, choose a position that doesn’t require it or ask your partner to take over the movements during sex. You can guide your partner on what you would like.
  • Focus on your feelings of pleasure and excitement. With this focus, sometimes the pain lessens or fades into the background.

Genital pain

Another side effect of some cancer treatments is genital pain. Sexual activity may cause pain in the vagina itself or in the delicate tissues around it. Sometimes the vagina is shorter and narrower after surgery or radiation. If you don’t produce enough natural lubricant or moisture to make your vagina slippery, the vagina can be dry and painful. It can cause a burning feeling or soreness. The risk of repeated urinary tract infections or irritation also increases.

If you have genital pain during sexual activity:

  • Always tell your doctor about the pain. A number of common problems can cause pain on the vulva or deep in the vagina. Simple solutions can often help. Do not let embarrassment keep you from seeking medical care.
  • Make sure you feel very aroused before you start vaginal penetration. Your vagina expands to its fullest length and width only when you are highly excited. Also, the walls of your vagina then produce lubricating fluid. As women go through menopause, because of aging or cancer treatment, it may take a longer time and more touching to get fully aroused.
  • Spread a large amount of water-based lubricating gel around and in your vagina before vaginal penetration. You can also use lubrication suppositories (pellets) that melt during foreplay.
  • Let your partner know if any types of touching cause pain. Show your partner ways to caress you or positions that aren’t painful. Usually, light touching around the clitoris and the entrance to the vagina won’t hurt, especially if the area is well-lubricated.
  • For vaginal penetration, try a position that lets you control the movement. Then if deep penetration hurts, you can make the thrusts less deep. You can also control the speed.

One position that often works well is for you to kneel over your partner with your legs on either side of their body. Either sit up or lean forward and support yourself with your arms. An advantage of this position is that your partner can easily caress your breasts or clitoris. This may add more pleasure to intercourse.

Another good position is for partners to lie on their sides, either with your partner behind you, like spoons, or face to face.

Using Kegel exercises to learn to relax the vaginal muscles

Once a woman has felt pain during intercourse, she often becomes tense in sexual situations. Without knowing it, she may tighten the muscles just inside the entrance of the vagina. This makes vaginal penetration even more painful. Sometimes she clenches her muscles so tightly that her partner cannot even enter her vagina.

Learning pelvic muscle awareness and control is important in understanding and treating your vaginal pain. You can become aware of your vaginal muscles and learn to relax them during vaginal penetration. Exercises that teach control of the pelvic floor and vaginal muscles are called Kegels (pronounced kee-guls). (They are named for the gynecologist Dr. Arnold Kegel, who came up with them.)

The first step is to find your vaginal muscles. Imagine that you are urinating and contract the muscles you would need to stop the stream. It’s important to not actually start and stop urine flow. This can lead to not emptying your bladder completely and increase your risk of infection. Another method to identify the pelvic floor muscles would be to put your finger about 2 inches into the vagina and tighten or contract the pelvic floor muscles. When you do this, you should be able to feel at least a slight twitch of the vaginal walls around your finger and your pelvic floor muscle pull upward.

Once you have located the muscle, practice gaining control over it. Research has shown that women with good pelvic floor strength and control have a stronger arousal response than those with poor pelvic floor tone (or strength). Because of this, it’s important to work on these muscles to build up muscle strength and tone.

As with any exercise, the more you practice, the more you can do. For instance, when starting to exercise, some women first walk a block or two, over time they may be able to walk ½ mile, then a mile or more. This is the same idea with pelvic floor exercises. The basic pelvic floor (Kegel) exercise is to tighten your vaginal muscles and hold for 3 to 6 seconds, then relax the muscle completely for 3 to 6 seconds. Repeat this until your muscles feel tired or you are unable to hold the muscles firmly. You may first start at 5 to 10 times per session. Over time this number should increase in order to build up strength and tone. Once you reach 20 to 25 per session, you can start again at 5 to 10 times but hold the pelvic floor muscle contract for longer, from 6 to 10 seconds. Over time you will build up the number. Repeat this exercise once or twice a day. People around you can’t tell that you are doing Kegels, so you can practice whenever you wish – while reading, watching TV, or working at your computer.

Along with enhancing circulation and arousal, pelvic floor muscle exercises (Kegels) can also add to a couple’s pleasure during sex. If a woman tightens and relaxes her vaginal muscles during sexual activity, she may focus more on the feelings that are building. Her partner can feel the movement of her vagina. This movement may add to their excitement.

One of the most important benefits of Kegel exercises is to lessen discomfort by helping to relax your vagina during entry and sex. Begin by making sure your vagina is wet when you and your partner are both aroused. Take a few seconds to tighten your vaginal muscles. Then let them relax as much as possible before your partner enters. Agree ahead of time that if you feel any pain, your partner will stop and you can do a set of pelvic floor exercises to tire the pelvic floor and relax the vaginal muscles.

If vaginal penetration is painful and difficult, you can do a set of pelvic floor muscle exercises before intimacy to make your vagina less reactive and more relaxed. You or your partner can also gently stretch your vagina with a finger before trying penetration. Lubricate a finger and slowly slip it inside your vagina. Use the Kegel movements to tighten and release your vaginal muscles as you slowly move it deeper in. When one finger is no longer painful, try using 2 fingers, and then 3, before you try your partner’s penis. Remember to use plenty of gel, and go slowly.

If you try most of these ideas but are still having genital pain, you might need some help from a gynecologist, sex therapist, or physical therapist. You might benefit from using a series of vaginal dilators in different sizes to gently stretch the vagina.

Using a vaginal dilator

A vaginal dilator is a tube or cylinder made in the shape of the vagina. Most dilators are made of plastic or rubber, and are used to enlarge or stretch out (dilate) the vagina. Dilators also help women learn to relax the vaginal muscles if they are used with pelvic floor muscle exercises. Dilators come in many forms.

Vaginal dilators are often used after radiation to the pelvis, cervix, or vagina, but research suggests waiting up to 4 weeks after radiation before starting dilator therapy. This allows time for inflammation to decrease. Dilators are a resource to use several times a week (3 times is recommended) to keep your vagina from getting tight from scar tissue that may develop after radiation treatment. An alternative to dilator therapy can be to have sex with vaginal penetration a few times a week.

Since scarring in the pelvis after radiation can develop over many years, dilators can be a good tool for you to use throughout your life. After surgery that rebuilds the vagina with skin grafts, you may need to keep a special type of dilator in your vagina all day or night for a while.

Your doctor may suggest a certain way to use the dilator. Here we describe a typical way a vaginal dilator is used:

  • Lubricate the dilator with a water-based gel.
  • Lie down on your bed at a time when you know you will have at least 15 minutes of privacy. Gently and slowly slip the dilator into your vagina. If your vagina feels tight, hold the dilator still while you contract and relax your vaginal muscles (do pelvic floor muscle exercises). Remember to do these exercises to try to make your pelvic floor muscles tired so that your vagina is relaxed (or less tight).
  • When your pelvic floor muscles feel tired, your vagina will be relaxed and looser. You should be able to push the dilator farther in. You may need to repeat this process several times (or over days) before the dilator can be put all of the way into your vagina.
  • When the dilator is in as far as is comfortable, leave it in your vagina for about 10 to 15 minutes. If the dilator slips out, gently push it more deeply into your vagina.
  • Before you take it out, gently push the dilator back and forth to give a gentle stretch in length. You can rotate the dilator by doing wide circles to gently stretch in width.
  • When done, remove it, and wash it with a mild soap and hot water. Be sure to rinse all the soap off so no film is left to irritate your vagina the next time you use it.
  • usually come in a set or a series of different sizes, but a woman may be given one dilator in the size needed to fit her vagina. If you have a set, start off with the smallest size and slowly work up to the larger sizes in order to allow for comfortable penetration.
  • to find a private, uninterrupted time to do your dilator therapy with pelvic floor exercises. Many women find it easier to do it early in the day. Often, with work and family obligations, evening exercises may be difficult.

Dilators work best when used regularly after radiation or surgery to keep the vagina from shrinking. Women must heal before using a dilator, but don’t wait until you have an overly tight vagina. The dilator will not work nearly as well. If you go for many months without vaginal penetration, it’s very important to use your dilator to keep your vagina in shape.

If you feel hesitant about using a dilator, you may need some practice getting more relaxed. The exercises on looking at and touching your genitals, described earlier in this section, may help you. Use a mirror to find your vaginal opening the first time you insert the dilator.

Some women wonder if using a vaginal dilator is the same as masturbating. The answer is no. The section called “Overcoming anxiety about sex” may help you clarify your feelings about self-stimulation. Even if you don’t feel comfortable masturbating, you can use a vaginal dilator without creating strong sexual sensations, just as you use a tampon.

A dilator is not the same thing as a dildo or a vibrator. A dildo is an object shaped like a penis. Its purpose is to stimulate a woman’s vagina in masturbation. Although you can move your dilator inside your vagina to give yourself sexual pleasure, it’s not a dildo. Sexual pleasure is not its purpose.

A vibrator is a small appliance that may also be shaped like a penis. Other types look more like a handle that comes with attachments. A vibrator provides strong stimulation when touched to the genital area. It’s designed to add pleasure and variety to your sex life. If you have a vibrator that fits comfortably inside your vagina, you can use it instead of a vaginal dilator to stretch your vagina.

If you feel comfortable with self-stimulation, you may sometimes choose to combine sexual pleasure with stretching your vagina. No matter how you decide to use your dilator, the key is to use it as often as prescribed. You should feel relaxed about making dilation a lifelong habit.

Your gynecologist or radiation oncologist can give you dilators, but you can also buy them online and have them shipped for privacy.

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