Sexuality for the Woman With Cancer

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Radical cystectomy

A radical cystectomy is done to treat bladder cancer. This means the surgeon removes the bladder, uterus, ovaries, fallopian tubes, cervix, front wall of the vagina, and the urethra. Although women who have this surgery are often past the age of menopause, many still have active sex lives.

If you have bladder cancer, talk with your doctor about surgery that’s right for you. The most common type of radical cystectomy can result in less ability to have orgasms in some women. It can also cause less lubrication, as well as pain during vaginal penetration. Some women report less desire for sex. But some things can be done during surgery to help preserve female sexual function (see below).

Vaginal reconstruction after radical cystectomy

Radical cystectomy often removes half of the vagina, but penetration is still possible. Surgeons sometimes rebuild the vagina with a skin graft. More commonly, they use the remaining back wall of the vagina to rebuild the vaginal tube. There are pros and cons with both types of vaginal reconstruction. Vaginal penetration of a narrow vagina may be painful at first. This is especially true if a woman has had radiation to her bladder, which makes the vaginal walls less elastic. It’s easier to start intercourse when the vagina is shorter and wider. But with a shorter and wider vagina, movement may be awkward because of the lack of depth. Surgeons try to spare as much of the front vaginal wall as possible to help avoid this problem.

Vaginal insertion can be made less painful by using lubricating gels on anything that’s going into the vagina. Vaginal moisturizers, replacement hormones, and vaginal dilators can also help to treat vaginal pain. See the section called “Preventing pain during sex.”

Sex without vaginal reconstruction

If your vagina is short because it hasn’t been reconstructed, you may still enjoy sexual activity. Certain sexual positions, like those where the partners are side by side or with you on top, limit the depth of penetration. Also, you can spread lubricating gel on your outer genital lips and the top of your thighs as you press your thighs together during vaginal penetration. If intercourse or vaginal penetration remains painful, a couple can still reach orgasm by touching each other with their hands.

Orgasm after radical cystectomy

Many women who have had the front wall of the vagina removed as part of a cystectomy say that this has little or no effect on their orgasms. But others say that they were less able to have orgasms. Women have 2 nerve bundles, which run along each side of the vagina, and it’s easy to damage these nerve bundles when removing the front of the vagina during radical cystectomy. Small studies have suggested that women who had surgery that preserved these nerve bundles had much better sexual function after surgery than those whose nerve bundles were removed or cut. Talk with your doctor about the surgery that is planned and whether these nerves can be left in place or preserved during surgery. This can increase your chance of having orgasms after surgery.

Another possible problem that can happen during radical cystectomy is that the surgeon takes out the end of the urethra where it opens outside the body. This can make the clitoris lose a good deal of its blood supply and may affect some parts of sexual arousal – remember that, like the penis, the clitoris fills with blood (engorgement) when a woman is excited. Talk with your surgeon about whether the end of the urethra can be spared, and how that may affect your clitoral function. It’s not always necessary to remove the end of the urethra when you have surgery for bladder cancer.

Urostomy

Women who have had a radical cystectomy will also have an ostomy. An ostomy is an opening on the woman’s belly (abdomen) where waste can pass out of the body. Since this is an opening for urine after the bladder is removed, this type of ostomy is called a urostomy. The urine flows through the urostomy into a plastic pouch, which fits into a plastic face plate glued to the skin around the ostomy. For ideas on how to manage an ostomy during sex, see “Urostomy, colostomy, or ileostomy” under the section called “Special aspects of some cancer treatments.” Some women now have continent ostomies that stay dry and are emptied with a catheter. (If you would like to read more about urinary ostomies, see our document called Urostomy: A Guide. The “To learn more” section has more information.)


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