Coping with Sexual Pain After Cancer Treatment

Women often experience sexual pain after cancer treatment, but far too often they don’t discuss it with their doctor or their pain is dismissed as a psychological rather than physical problem, according to a recent review article by two gynecologic oncologists.

The article, written by Vanessa Kennedy, a gynecologic oncologist at UC Davis Health System and co-author Deborah Coady of New York University Langone Medical Center, states that improved treatment and higher survival rates for cancer have lead more women to grapple with the long-term effects of treatment. Sexual pain falls into this category, but it’s often “written off as ‘in people’s heads,’” the oncologists say, even though it’s likely a physical issue.

Part of the challenge is that sexual pain was categorized for a long time as a type of female sexual dysfunction and therefore a mental health disorder in the American Psychiatric Association’s (APA) manual. However, the APA recently updated this language to exclude sexual pain where another medical condition is the cause or contributing factor.

Cancer treatment comes with several well-known side effects, including nausea, anemia, fatigue loss of appetite and possible infertility, but what we don’t often discuss is the impact cancer has on women as sexual beings. 

Sexual pain happens because of low estrogen levels, which occur after ovary removal, a hysterectomy, hormone therapy or radiation treatment. Radiation treatment, in particular, can cause scarring and thinning of tissue that leads to pain during intercourse. Ovary removal can cause vaginal dryness that makes sex more painful. Women who have had surgery also may experience pelvic pain from the surgery itself. In these cases, a doctor can help you discover the underlying source of the pain and suggest treatment, which may include medication or physical therapy.

Sex often isn’t a topic for polite conversation. These social mores often enter into the patient-doctor relationship. Women may be nervous or uncomfortable about bringing up the topic with their doctors, and physicians may not always think to ask, especially when other parts of the post-treatment process — like preventing cancer recurrence — take priority.

But patients and doctors shouldn’t be shy about having this conversation. Survivorship is one element of a patient’s post-treatment journey, but quality of life is just as critical. Positive sexual health is a part of this.

What You Can Do

During treatment, patients should have an open dialogue with their GYN oncologist about the long-term, personal side effects of surgery and other treatments like radiation. You should ask several questions, including:

• How will taking out my ovaries if I’m pre-menopausal affect my libido and vaginal health?
• Will I be orgasmic if I have a hysterectomy?
• How can I make sex more comfortable for me and my partner after treatment?

Patients also should ask their doctor about lubricants, since some over-the-counter lubricants have sugar in them that can lead to yeast infections and bacterial vaginosis. I often tell patients that it’s best to use natural products like coconut or olive oil to make sex more comfortable. This is advice you may not get if you don’t seek the counsel of your doctor and have an honest conversation with him or her. Complementary therapies like acupressure and acupuncture also can reduce postoperative pain.

While sexual pain after treatment is predominantly physical, many patients and their partners often grapple with emotional responses to the long-term side effects of treatment. Sometimes the patient and her partner have a fear about re-engaging in sexual activity or possibly hurting the person, spreading their cancer or getting cancer themselves (the latter two aren’t a possibility). Counseling or therapy can help patients and their spouses deal with these psychological issues.

Aside from therapy, you should have a discussion with your health care team about the best ways to re-engage in intimacy to make it less painful and decrease anxiety. Hormone replacement therapy is another option if you’re an appropriate candidate, but it’s best to discuss this treatment approach with your physician.

In the review article, Kennedy and Coady suggest ways doctors can broach this topic with patients and they provide a sexual-symptom checklist that physicians can use to assess where a patient stands. This is a good start, but what this all boils down to is better and more open communication between patients, their partners and their care team. If you’re experiencing sexual pain after treatment, schedule a separate, standalone appointment with your doctor as soon as possible to discuss solely this issue. The conversation may be uncomfortable at first, but it’s also necessary.