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Sex is an important part of being in a relationship, but certain types of surgery can cause sexual problems to develop. Managing these issues might involve several different therapies, treatments, or devices, or a combination of them. Counseling can also be helpful.

The information below describes common sexual problems an adult female having certain types of cancer surgery may experience. You can find out about the effects of hormone therapy on specific types of cancers in Cancer A to Z.

 If you are a transgender person, please talk to your cancer care team about any needs that are not addressed here.

Ask questions

It’s very important to talk about what to expect, and continue to talk about what's changing or has changed in your sexual life as you go through procedures, treatments, and follow-up care. Don't assume your doctor or nurse will ask about any concerns you have about sexuality. Remember, if they don't know about a problem you're having, they can't help you manage it.

How pelvic surgery cancer can affect sex

Many different organs may be affected in pelvic surgery for cancer. Here are 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 done to treat some cancers of the cervix and some cancers of the endometrium (uterus) that have spread to 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.

Depending on a woman's age, stage of life, and preferences, the surgeon might leave an ovary or part of one during a hysterectomy. For women who have not yet started menopause, leaving even one ovary can produce enough hormones to help prevent early menopause. Because the uterus is removed, a woman will not have menstrual periods and she will not be able to carry a pregnancy.

The cancer care team can help weigh the risks and benefits of removing one or both ovaries.

Effects of hysterectomy on bladder function

A radical hysterectomy procedure can affect a woman’s ability to pass urine while the nerves in the tissue around the uterus are healing after surgery. Some doctors may leave a catheter in the bladder for a few days after surgery to reduce urinary problems. In some cases, there can be long-term effects on bladder function, and different options can be offered to help manage this.

Effects of hysterectomy on sexual function

Hysterectomy shortens the vagina and may cause numbness in the genital area. This can affect a woman's sex life.

In some cases, cancer causes 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, and it's important for the vagina to have moisture to allow the tissues to stretch and move.

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 some bladder cancers. The surgeon removes the bladder, uterus, ovaries, fallopian tubes, cervix, front wall of the vagina, and the urethra.

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.

If your vagina is shorter 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.

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

People who have had a radical cystectomy will also have an ostomy or need reconstructive surgery. This is an opening on the abdomen (belly) 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. Some people now have continent ostomies that stay dry and are emptied with a catheter. There is also a way to send urine back into your urethra by creating a new bladder from a piece of intestine (called a neobladder).

For more about these reconstructive methods, see Bladder Cancer Surgery.

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.

Sex in certain positions may be uncomfortable or even painful. Without a rectum, the vagina becomes scarred. You may need to try different positions to find one that works.

For suggestions on how to manage an ostomy during sex, see Urostomy, colostomy, or ileostomy in Managing Female Sexual Problems Related to 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 simple partial vulvectomy removes only the cancer and an edge of normal tissue around that affected area.
• A simple vulvectomy removes the entire vulva and tissue under the skin.
• 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 and deep tissues. 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.

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.

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 and there might be numbness.

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 the bladder, urethra and rectum are removed, this surgery is called a total pelvic exenteration ( a urostomy for urine and another ostomy for stool will need to be created). The vagina is usually rebuilt. (See below.)

Long-term swelling in the legs (called lymphedema) may be a problem after this surgery. Contact us (800-227-2345) 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.

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.

Vaginal rebuilding with 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. After a certain amount of time, 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.

Vaginal rebuilding with 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 sexually 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.

After the vagina is rebuilt, partners need to try different sexual 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

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. Sometimes hormone therapy or other treatment is needed, and the effects of those treatments might add to sexual problems from losing a breast.

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.

To learn more about physical problems related to cancer surgery and sexuality and how to talk to your cancer care team about them, see Managing Female Sexual Problems Related to Cancer.