Surgery Can Affect a Woman’s Sex Life

How pelvic surgery cancer can affect sex

Many different organs may be affected in pelvic surgery for cancer.

This section reviews some of the more common types of surgery used to treat certain cancers and the ways they can impact your sex life.

Radical hysterectomy

Radical hysterectomy is an operation done to treat some cancers of the cervix. The surgeon takes out the uterus and the ligaments (tissue fibers) that hold it in place. The cervix and an inch or 2 of the vagina around the cervix are also removed. A hysterectomy done to treat uterine or ovarian cancer removes less tissue.

After taking out the cervix, the surgeon stitches the vagina at its top. Some fluid drains from the vagina during healing. The top of the vagina soon seals with scar tissue and becomes a closed tube. The vagina does not, as some women fear, become an open tunnel into the pelvis.

The ovaries may or may not be removed

If a woman is under age 40, the surgeon will often try to leave an ovary or part of one during a hysterectomy. Even one ovary can produce enough hormones to keep a woman from going through early menopause. Because the uterus is removed, a woman will not have menstrual periods and she will not be able to carry a pregnancy.

If a woman is between 40 and 50 when she has this surgery, doctors weigh the benefits of removing both ovaries to prevent ovarian cancer against the costs of causing sudden early menopause. Women should discuss these choices with their doctor before surgery.

A surgeon most often removes both ovaries in women over the age of 50 having this surgery.

Effects of hysterectomy on bladder function

A radical hysterectomy can affect a woman’s ability to pass urine while the nerves in the tissue around the uterus are healing after surgery. With new surgical techniques and nerve-sparing surgery, problems like this are less common. Still, some doctors may leave a catheter in the bladder for a few days after surgery to reduce urinary problems.

If a woman still cannot fully empty her bladder a few weeks after surgery, she may have long-term damage. To prevent urinary tract infections, she may be taught to slip a small, soft tube, called a catheter, through the urethra and into the bladder to drain out the remaining urine. This is called self-catheterization. A few women may need to do this several times a day for the rest of their lives. If you are self-catheterizing, make sure your bladder is empty before sex to help prevent urinary tract infections or discomfort.

Effects of hysterectomy on sexual function

Hysterectomy shortens the vagina and may cause numbness in the genital area. Some women feel less feminine after a hysterectomy. They may view themselves as “empty,” or not feel like a “real” woman. Such negative thoughts can keep women from thinking about and enjoying sex. A trained therapist often can help with such concerns.

If cancer is causing pain or bleeding with vaginal sex, a hysterectomy can help stop those symptoms, and a woman’s sex life may improve after the surgery. The vagina might be shorter after surgery, but couples usually adjust to this change. Extra time spent on caressing and other forms of foreplay can help ensure that the vagina has lengthened enough to allow penetration. It’s also important for the vagina to have moisture to allow the tissues to stretch and move. (See  "Vaginal dryness" in Treating Sexual Problems for Women With Cancer for more on this.)

If the vagina seems too shallow, there are ways a woman can give her male partner the feeling of more depth. For instance, she may spread some lubricating gel on her outer genital lips and the tops of her thighs and press her thighs together or cup her hands around the base of her partner’s penis during sex. There are also rings that can be put around the base of the penis to reduce the depth of penetration.

Orgasm after radical hysterectomy

Women who have had a radical hysterectomy sometimes ask if the surgery will affect their ability to have orgasms. This has not been studied a great deal, but to date, there's no science showing that there is an effect.

 Sex problems are likely to be somewhat worse and last longer for women who have pelvic radiation along with radical hysterectomy. See Pelvic Radiation Can Affect a Woman's Sex Life for more on this.

Radical cystectomy

A radical cystectomy is done to treat bladder cancer. The surgeon removes the bladder, uterus, ovaries, fallopian tubes, cervix, front wall of the vagina, and the urethra.

If you have bladder cancer, talk with your cancer care team about surgery that's right for you. This surgery tends to affect a woman's sex life, but sometimes things can be done during surgery to help preserve female sexual function (see below).

Changes in the vagina 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. See "Vaginal reconstruction after pelvic surgery in Surgery Can Affect a Woman's Sex Life for more on this.

If your vagina is short because it hasn’t been reconstructed, you may still enjoy sexual activity. Certain positions, like those where the partners are side by side or with you on top, limit the depth of penetration. You can also try spreading lubricating gel on your outer genital lips and the top of your thighs as you press your thighs together during vaginal penetration. And there are rings that can be put around the base of the penis to reduce the depth of penetration. If 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. There are 2 nerve bundles that run along each side of the vagina, and it’s easy to damage them when removing the front of the vagina. Talk with your doctor about the surgery that’s planned and whether these nerves can be “spared” (left in place) during surgery. If so, this can help 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 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 as part of surgery for bladder cancer. 

Urostomy

Women who have had a radical cystectomy will also have an ostomy. This is an opening on the woman’s belly (abdomen) where waste can pass out of the body. This type of ostomy is called a urostomy. It’s the way for urine to get out of the body after the bladder is removed. The urine flows through the urostomy into a plastic pouch glued to the skin around the ostomy. For ideas on how to manage an ostomy during sex, see "Urostomy, colostomy, or ileostomy" in Treating Sexual Problesm for Women With Cancer. Some women now have continent ostomies that stay dry and are emptied with a catheter.

Abdominoperineal resection

Abdominoperineal (AP) resection is a type of surgery that may be used to treat colon cancer. The lower colon and rectum are removed, and a colostomy is made so that stool can pass out of the body. Sometimes the uterus, ovaries, and even the rear wall of the vagina must be removed, too. The remaining vaginal tube must then be repaired with skin grafts or with a flap made of skin and muscle.

AP resection does not damage the nerves that control the feeling in a woman’s genitals and does allow orgasm. Some women may notice vaginal dryness, especially if their ovaries were removed. If so, a water-based gel lubricant can help make vaginal sex more comfortable. (See "Vaginal dryness" in Treating Sexual Problems for Women With Cancer for more on products that can help with this.)

Sex in certain positions may be uncomfortable or even painful. Without a rectum, the vagina becomes scarred down to the tailbone. You may need to try different positions to find one that works. If a skin graft or flap was used to repair the vagina, the section called “Vaginal reconstruction after total pelvic surgery” in Surgery Can Affect a Woman's Sex Life may be helpful.

For suggestions on how to manage an ostomy during sex, see "Urostomy, colostomy, or ileostomy" in Treating Sexual Problems for Women With Cancer.

Vulvectomy (removing the vulva)

Cancer of the vulva is sometimes treated by removing all or part of the vulva. This operation is called a vulvectomy.

  • A partial vulvectomy removes only the cancer and an edge of normal tissue around that affected area.
  • The modified radical vulvectomy removes the cancer and an edge of normal tissue, as well as some of the lymph nodes in the groin. If there’s cancer in or very near the clitoris, it may need to be removed to be sure all the cancer is taken out.
  • The most extensive surgery is called a radical vulvectomy, which is rarely ever done. In this case, the surgeon removes the whole vulva. This includes the inner and outer lips, the clitoris, and often the lymph nodes that drain the vulva. The vagina, uterus, and ovaries remain.

After part or all of the vulva has been removed, women often feel discomfort if they wear tight slacks or jeans because the “padding” around the urethral opening and vaginal entrance is gone. The area around the vagina also looks very different.

Women often fear their partners may be turned off by the scarring and loss of outer genitals, especially if they enjoy oral stimulation as part of sex. Some women may be able to have reconstructive surgery to rebuild the outer and inner lips of the genitals. It may help with the way the vulva looks, but the feeling (sensation) will be different.

When touching the area around the vagina, and especially the urethra, a light caress and the use of a lubricant can help prevent painful irritation. The area around the scar may be numb. If scar tissue narrows the entrance to the vagina, penetration may be painful. Vaginal dilators can sometimes help stretch the opening. When scarring is severe, the surgeon may use skin grafts to widen the entrance. Vaginal moisturizers on the external genital area can also be very helpful and promote comfort. (See "Vaginal moisturizers" in Treating Sexual Problems for Women With Cancer.)

When the lymph nodes in the groin have been removed, women may have swelling of their genital areas or legs. Though swelling just after surgery may go away, it can become a long-term problem. This condition, called lymphedema, can cause pain, a feeling of heaviness, and fatigue. It also can be a problem during sex. Couples should discuss these issues to decide what solutions work best for them. (See Lymphedema to learn more.)

Orgasm after vulvectomy

Women who have had a vulvectomy may have problems reaching orgasm. It depends on how much of the vulva has been removed. The outer genitals, especially the clitoris, are important in a woman’s sexual pleasure. If surgery has removed the clitoris and lower vagina, then orgasms may not be possible. Still, some women find that stroking the front inside part of the vagina, about 1 to 4 inches inside the opening, can feel pleasurable.

Also, after vulvectomy, women may notice numbness in their genital area. Feeling may return slowly over the next few months.

Pelvic exenteration

Pelvic exenteration is the most extensive and complex pelvic surgery. It’s used most often when cancer of the cervix or the rectum has come back in the pelvis after treatment.

In this surgery, the uterus, cervix, ovaries, fallopian tubes, vagina, and sometimes the bladder, urethra, and/or rectum are removed. If 2 ostomies are created, this surgery is called a total pelvic exenteration (1 ostomy is for urine and the other is for stool). The vagina is usually rebuilt. (See below.)

Long-term swelling in the legs (called lymphedema) may be a problem after this surgery. Contact us to learn more about this and what you can do to help prevent it or treat it.

Because pelvic exenteration is such a major surgery, some cancer centers offer counseling sessions before surgery to help a woman prepare for the changes in her body and her life.

Recovery from pelvic exenteration takes a long time – sometimes years. Still, a woman can adjust to these changes physically and emotionally over time. So, if a woman has pelvic exenteration surgery, it doesn’t mean that she can’t lead a happy and productive life. With practice and determination, some women who have had this procedure can again have sexual desire, pleasure, and orgasm. Usually the outer genitals, including the clitoris, are not removed, which means a woman may still feel pleasure when touched in this area.

Since the exact surgical procedure can vary from one person to another, it may help to speak with your surgeon about the full extent of the surgery before you have it. Ask what you can expect in the way of sexual function, including orgasm, after surgery.

Vaginal reconstruction after pelvic surgery

If surgery removes only half of the vagina, penetration is still possible. But vaginal penetration of a narrow vagina may be painful at first. This is especially true if a woman has had radiation, which can make the vaginal walls firm. Penetration is easier when the vagina is shorter and wider, but movement may be awkward because of the lack of depth. Surgeons try to save as much of the front vaginal wall as possible to limit this problem.

In some cases, all or most of the vagina must be removed as part of cancer surgery, but it’s possible to rebuild a vagina with tissue from another part of the body. A neovagina (new vagina) can be surgically made out of skin, or by using both muscle and skin from other areas of the body. This new vagina can allow a woman to have vaginal sex.

Skin grafts: When the vagina is repaired with skin grafts, the woman must use a vaginal stent. This stent is a special form or tube worn inside the vagina to keep it stretched. At first, the stent must be worn all the time. Then it’s worn for most of each day for many months after surgery. After about 3 months, the use of a dilator to stretch out the vagina for a few minutes each day or regular vaginal penetration during sex can help to keep the vagina open. This may become a life-long routine because without frequent stretching, the neovagina may shrink, scar, or close. (See "Using a dilator for vaginal tightness" in Treating Sexual Problems for Women With Cancer.)

Muscle and skin grafts: There are other ways to rebuild the vagina using muscle and skin from other parts of the body.

A vagina that is rebuilt with muscle and skin makes little or no natural lubricant when a woman becomes excited. A woman will need to prepare for sex by spreading a gel inside the vagina. If hair was present on the skin where the graft came from, she may still have a little hair inside the vagina. During sex with a rebuilt vagina, a woman may feel as if the area the skin came from is being stroked. This is because the walls of the vagina are still attached to their original nerve supply. Over time, these feelings become less distracting. They can even become sexually stimulating.

Care of the rebuilt vagina: A natural vagina has its own cleansing system. Fluids drain out, along with any dead cells. The rebuilt vagina cannot do this and needs to be cleaned with a douche to prevent discharge and odor. A doctor or nurse can offer advice on how often to douche and what type to use.

Women also notice that the muscles around the vaginal entrance cannot be squeezed. A woman may miss being able to tighten her vagina. After the vagina is rebuilt, partners need to try different positions to find one that is best. Minor bleeding or “spotting” after penetration is not a cause for alarm, but heavy or increased bleeding should be discussed with your cancer care team.

Surgery for breast cancer can affect sexuality, too

Sexual problems have been linked to mastectomy and breast-conserving surgery (lumpectomy) – surgeries that remove all or part of the breast. Losing a breast can be very distressing. A few women lose both breasts.

The most common sexual side effect related to breast changes is feeling less attractive. If a breast is changed or removed, a woman may feel less secure about whether her partner will accept her and still find her sexually pleasing.

The breasts and nipples are also sources of sexual pleasure for many women and their partners. Touching the breasts is a common part of foreplay. Some women can reach orgasm just from having their breasts stroked. For many others, breast stroking adds to sexual excitement.

Surgery for breast cancer can interfere with pleasure from breast caressing. After a mastectomy, the whole breast is gone and there’s a loss of sensation or feeling. Some women still enjoy being stroked around the area of the healed scar. Others dislike being touched there and may no longer even enjoy having the remaining breast and nipple touched.

Some women who have had a mastectomy feel self-conscious being the partner on top during sex. This position makes it easy to notice that the breast is missing. Some women who have had mastectomies wear a short nightgown or camisole, or even just a bra, with the prosthesis inside during sexual activity. Other women find the breast prosthesis awkward or in the way during sex. A woman may choose to have breast reconstruction. This surgery rebuilds the shape and size of the breast. This may help a woman enjoy sex more because it may help her feel whole and attractive. But it may not fully bring back the physical feelings of pleasure she used to have from having her breast touched.

If surgery removed only the tumor (breast-conserving surgery: segmental mastectomy or lumpectomy) and was followed by radiation treatment, the breast may be scarred. It also may be different in shape, feel, or size. While getting radiation, the skin may become red and swollen. The breast also may be tender or painful in some places. As time passes, some women may have areas of numbness or decreased sensation near the surgical scar.

There’s no physical reason breast surgery or radiation to the breasts should decrease a woman’s sexual desire. These treatments do not change her ability to have sexual pleasure. They don’t lessen her ability to produce vaginal lubrication, feel and enjoy normal genital sensation, or reach orgasm.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: January 12, 2017 Last Revised: January 12, 2017

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