Some cancer treatments can affect your vaginal health. Experiencing side effects like vaginal dryness, itchiness and atrophy can be extremely uncomfortable and you may feel embarrassed to talk about it. We’ve put together information on how treatment affects your intimate area and some suggestions on what to do if this affects you.
Radiotherapy and vaginal problems
If you need radiotherapy for a pelvic cancer, you may have vaginal side effects. Pelvic cancers include bladder cancer, womb cancer, ovarian cancer and bowel or rectal cancers. The treatment can cause the sensitive tissues of the vagina to become sore and inflamed. The skin lining the vagina can become more easily damaged and more prone to infection. If you feel like it, (and many women understandably don’t) sex during this time may be painful.
Longer term effects include vaginal dryness and the tissues of the vagina becoming less stretchy. This can make having intercourse difficult but there are ways to help prevent problems.
Hormone therapy and vaginal problems
Treatments that block sex hormones in women are often used for breast cancer. These can cause menopausal symptoms in both pre- and post-menopausal women. These include vaginal dryness, which often makes the vagina sore and more prone to infections such as thrush. Hormone treatments can sometimes cause a vaginal discharge. You may also find that your desire for sex is less than it was.
Chemotherapy and vaginal problems
If you have chemotherapy before you’ve had your menopause, your ovaries may be affected causing an early menopause. This can trigger the development of a number of symptoms, collectively known as atrophic vaginitis or “genito-urinary syndrome of menopause (GSM)”. The onset of symptoms can be sudden and include:
- Vaginal dryness
- Irritation of genital skin
- Vaginal discharge
- Pain having sex
You may also find you have a lowered sex drive.
Because chemotherapy lowers your resistance to infection, you may be more prone to vaginal thrush or other infections whether you were pre- or post-menopausal before treatment.
Surgery and vaginal problems
If you have surgery to the pelvis, it may affect your vagina. An operation to remove your womb (hysterectomy) or radical bladder surgery may result in your vagina being shorter and/or narrower than before. This can make sex painful or affect your comfort, but shouldn’t stop you from being able to have intercourse.
What can help if you experience vaginal problems
If you develop vaginal soreness during a course of radiotherapy, the first thing to do is speak to your radiotherapy nurse or radiographer. They may ask the doctor to examine you and give you any medicines you need for infection or to relieve soreness. After your treatment has finished, any skin damage should start to get better.
If you’re having pelvic radiotherapy, do also ask about vaginal dilators if this isn’t suggested to you. These are torpedo-shaped metal or plastic tubes that come in a range of sizes. You start with the smallest and using a lubricating gel, you gently push it into your vagina to stretch it. Your nurse or radiographer will give you instructions, but generally you do this at least every 2 or 3 days for around 10 minutes. As the tissues of the vagina stretch, you move up a dilator size. If you don’t want to use dilators, you can use your fingers or have sex instead.
Skin in an area treated by radiotherapy can sometimes become fragile and more prone to bleeding. You may notice slight bleeding when using dilators or after sex. This is probably nothing to worry about but do tell your doctor and get it checked out, just in case. Any abnormal vaginal bleeding should be investigated by a doctor.
Vaginal dryness after chemotherapy or while taking hormone therapy can make your vagina sore and itchy. It also increases your risk of infection. Hormone replacement therapy can relieve this but you may not be able to have HRT if you’ve had a hormone dependent cancer such as breast cancer.
There are also vaginal oestrogen pessaries (tablets that you put into your vagina) that can reduce the symptoms of vaginal atrophy. Although doctors think that only a small amount of oestrogen gets into your bloodstream, we don’t know enough about the safety of these in hormone dependent cancers. So if you’ve had breast cancer, your doctor may not want you to use them.
Ask your nurse about vaginal moisturisers. These are creams or gels. There are different types – some you use every day or two. Others you use just before sex. There are water-based and silicone-based products. One type may suit you better than the other so it’s worth persevering if the first one you try isn’t right. Your doctor may suggest doing a patch test on a small area of skin before you use them internally, just to make sure they don’t cause irritation.
If you’re finding sex uncomfortable after pelvic surgery, try experimenting with different positions. If this doesn’t help, speak to your doctor. A referral to a sex therapist may help you and your partner to manage the change in your sex life.
Whatever treatment you’ve had, do consult your doctor if you notice white discharge, red sore patches or if a vaginal discharge increases or smells offensive. You probably have an infection, which will almost certainly clear up with the right treatment.