How Cancer Surgery Can Affect Sex for Women

Radical hysterectomy is a type of surgery used to treat some cervical, ovarian and endometrial cancers. There are a few types of radical hysterectomy, but they all involve removing your uterus and the ligaments (tissue fibers) that hold it in place.

If your cervix is removed: Your cervix and 1 or 2 inches of the vagina around your cervix might also be removed, depending on the type of cancer you have and how advanced it is. After taking out your cervix, the surgeon stitches your vagina at its top. The top of the vagina soon seals with scar tissue and becomes a closed tube.

Simple or modified hysterectomy: Not everyone with these types of cancer will need a radical hysterectomy. Some women can have a simple or modified radical hysterectomy, which removes less tissue and is less likely to cause sexual problems.

If your ovaries are removed: Depending on your type of cancer, age, stage of life, and preferences, the surgeon might leave an ovary or part of one during a hysterectomy. If you haven’t yet started menopause, the remaining ovary can make enough hormones to help prevent early menopause.

Because your uterus is removed, you won’t have menstrual periods and won’t be able to carry a pregnancy. The surgeon and cancer care team can help you weigh the risks and benefits of removing one or both ovaries.

How a radical hysterectomy can affect your sexual function

Having a radical hysterectomy can change how you experience sex.

• Your vagina may be shorter and drier than before. This can make sex more painful for a while. These problems are likely to be worse if you had pelvic radiation along with a radical hysterectomy.
• Lubrication during vaginal sex can help. Many women can still have vaginal sex as long as their vagina is well-lubricated.
• Trying different positions can help. You can find tips for making sex more comfortable in Managing Sexual Side Effects as a Woman with Cancer.
• You may have some numbness in your genital area. This might cause some problems having an orgasm after surgery, but this usually gets better in 6–12 months. And you don’t need a uterus or cervix to reach orgasm.
• Pain or bleeding with intercourse might get better. If you had pain or bleeding with intercourse before you were diagnosed with cancer, you might find that having a hysterectomy improves your sex life by stopping these symptoms.

Cancer of the vulva is often treated with surgery. Depending on how widespread your cancer is, you might just need to have your cancer and some tissue around it removed. Or you may need to have a larger area removed, which may include more of your vulva, nearby lymph nodes, and even your clitoris.

If other organs are affected, such as your bladder, vagina, or rectum, other treatment will usually be used instead.

How a vulvectomy can affect the look and feel of your genitals

A vulvectomy can change the way your vulva (and the structures around it) looks and feels.

• You might have discomfort if you wear tight pants because the “padding” around your urethra and vagina is gone.
• The area around your vagina might look very different. The outer and inner lips of your genitals may be partially or entirely removed, and you may have visible scarring.
• The area around your vagina and urethra might be easily irritated. Lubricant and a light touch can help prevent painful irritation.
• If scar tissue narrows the entrance to your 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 your external genital area can also be very helpful and provide comfort.

Lymphedema (swelling) could cause problems during sex.

• When the lymph nodes in your groin have been removed, you may have swelling of your genital areas or legs (lymphedema).
• This might be temporary, or it can become a long-term problem.
• It can cause pain, a feeling of heaviness, and fatigue. It also can be a problem during sex. You and your partner can work together to figure out the most comfortable positions and other solutions to manage this.

Surgery to rebuild your vulva

You may feel self-conscious about the scarring and loss of your outer genitals (vulva).

Some women can have reconstructive surgery to rebuild the outer and inner lips of their vulva. That might help with the way your vulva looks, but the feeling (sensation) will be different.

Orgasm after a vulvectomy

You may have problems reaching orgasm after a vulvectomy. This depends on how much of your vulva was removed. You might also need to have your clitoris removed.

The outer genitals, especially the clitoris, are important in a woman’s sexual pleasure. If surgery removed your clitoris and lower vagina, orgasms may not be possible and you might have numbness in the area.

Sex might not be the same as it was before, but you can work with your partner to find new ways of feeling intimacy and pleasure. Learn more in: Managing Sexual Side Effects as a Woman with Cancer.

Pelvic exenteration is the most extensive pelvic surgery. It’s most often used for rectal, vulvar, or cervical cancers that have spread to many organs in the pelvis. It might also be used when a cancer comes back after treatment in the same area where it started but has not spread.

In this surgery, the uterus, cervix, ovaries, fallopian tubes, vagina, and sometimes the bladder, urethra, and/or rectum are removed.

How pelvic exenteration can affect your sexual function

Your sexual function can be affected in many ways after a pelvic exenteration.

• Ostomy: If your bladder is removed, you will need a urostomy. If your rectum is removed, you will need a colostomy. To learn more about managing an ostomy during sex, see Managing Sexual Side Effects as a Woman with Cancer.
• Vaginal reconstruction: You might need to have your vagina rebuilt and will likely need to use a dilator. Your surgeon or cancer care team can help you learn how to use this.

Talk to your surgeon before you have surgery to find out which organs they plan to remove and whether you will need any ostomies or to have your vagina rebuilt. Ask what you can expect in the way of sexual function after surgery, including orgasm.

Vaginectomy is surgery to remove the vagina. This surgery is only used for very early-stage vaginal cancers and for cancers that were not cured with radiation. Surgery may be the only treatment needed for a very small vaginal cancer.

The extent of vaginectomy depends on the size, location, and stage of the cancer.

• If only part of the vagina is removed, it’s called a partial vaginectomy.
• If the entire vagina is removed, it’s called a total vaginectomy.
• Radical vaginectomy removes the vagina along with the supporting tissues around it. This type of surgery may be considered for patients with vaginal cancer that cannot be treated with radiation or chemotherapy.

Depending on the amount of the vagina that was removed, you might still be able to have sexual intercourse, but a lubricant might be needed.

Vaginal reconstruction might be an option if most or all of your vagina was removed.

A radical cystectomy is done to treat some bladder cancers. During this surgery, your bladder, uterus, ovaries, fallopian tubes, cervix, and the front wall of your vagina are removed. Your urethra may also be removed if your bladder cancer has spread there.

This surgery tends to affect sex for most women, but things can often be done during surgery to help preserve your sexual function.

Changes to your vagina after radical cystectomy

Radical cystectomy often removes the front part of the vagina. But for many women, penetration is still possible.

• If your vagina is rebuilt: Surgeons sometimes rebuild the vaginal tube using the back wall of the vagina or a skin graft. There are pros and cons with both types of vaginal reconstruction.
• If your vagina isn’t rebuilt: If your vagina is shorter because it hasn’t been reconstructed, you can still enjoy vaginal sex. Certain sexual positions limit the depth of penetration, like those where the partners are side by side or with you on top.

Orgasm after radical cystectomy

Many women who have the front wall of their vagina removed are still able to have orgasms, but some women have problems with orgasms.

• Nerve-sparing surgery: If the 2 nerve bundles that run along each side of your vagina are damaged during surgery, your orgasms may be affected. Talk with your doctor before surgery to see if these nerves can be spared (left in place). If so, this can help increase your chance of having orgasms after surgery.
• Removing part of your urethra: If your bladder cancer grows into your urethra (the tube that empties urine from your bladder), the surgeon might need to remove the part of your urethra that opens to the outside of your body. This can decrease the blood supply to your clitoris, which may affect your ability to be sexually aroused or have an orgasm. Talk with your surgeon about whether the end of your urethra can be spared and how your surgery might affect the function of your clitoris.

Urinary diversion after radical cystectomy

After a radical cystectomy, you will need a different way to store and pass urine out of your body. How this happens will depend on several things, including whether or not your urethra is also removed.

• You may need a urostomy. A urostomy is an opening on your abdomen (belly) where urine can pass out of your body.
• You may need a urostomy pouch. If you have a urostomy, you might need to wear a pouch (bag) on the outside of our body for urine to drain into.

This will take getting used to, but there are ways to reduce the effect a urostomy has on your sex life. See Managing Sexual Side Effects as a Woman with Cancer to learn more.