A variety of factors can interfere with a woman’s sexuality. In addition to her psychological make-up and past experience with intimate relationships and medications, cancer treatments may affect her sexual response cycle and how she as a woman may respond sexually.
The following sections address some cancer treatments that may affect a woman’s sexual response.
A variety of factors can interfere with a woman’s sexuality.
Hysterectomy: Surgical removal of the uterus.
Operative procedures may change the way your body looks, and some procedures may interfere with the nerves in your genital and pelvic area, which are vital to the sexual response cycle. Removal of your reproductive organs, such as hysterectomy, or changes in your breasts may affect your self-esteem and influence how you view yourself as a woman. With extensive surgical resection and radical surgery, women often shift their perceptions of their body and femininity. Large tumor resections that involve extensive physical changes, such as bowel removal, may result in functional changes such as ileostomies, colostomies, and ileoconduits that may be perceived as embarrassing or ugly.
Bilateral salpingo-oophorectomy: The surgical term for the removal of both the right and left Fallopian tubes and ovaries.
Women with breast cancer who have a genetic predisposition for the development of ovarian cancer because of BRCA gene mutations may opt to undergo a prophylactic oophorectomy (risk-reducing bilateral salpingo-oophorectomy [RRBSO], or voluntary removal of the ovaries). Women who undergo removal of the ovaries may have negative sexual consequences as well as develop serious concerns about body image and the development of underlying malignancies.
Mastectomy: The removal of the breast
When breast cancer survivors undergo prophylactic mastectomy (removal of the unaffected breast tissue) and reconstruction after breast removal (sometimes with saline/water or silicone implants), sometimes the breast is not acceptable to them. Poor cosmetic results, with scarring and changes in how the breasts look and feel, may affect sexual enjoyment and self-image. Surgical scarring after procedures may interfere with extremity mobility, especially with arm movement. Finding a comfortable sexual position may be difficult or challenging. It has been the author’s experience that some breast cancer survivors complain of changes in arm range of motion, where even putting their arm around their partner is a painful experience because of lymph edema and decreased range of motion. These complaints are present in those who have had lymph node dissections and surgical scarring.
Radiation therapy can cause skin changes such as thickening, contractures, or different textures and colors. Other side effects including unexplained fatigue, loss of hair on your head or in the genital area, and gastrointestinal complaints of diarrhea, nausea, and vomiting may all contribute to a lack of sexual interest. Patients and/or their partners may have unfounded concerns about being “radioactive.” The truth is that you cannot catch radiation and neither are you considered radioactive if you have undergone radiation treatment.
Vaginal fibrosis with stiffening and hardening of a shortened vaginal vault can be caused by direct radiation to the vaginal area. This can seriously affect a woman’s capacity for penetrative intercourse and her genital, pelvic, and clitoral sensitivity during sexual activity. Her sexual sensation or orgasms may be less intense than before, so it may take longer for her to reach the same level of excitement and arousal.
Many agents can cause nausea, diarrhea, and membrane irritation and induce premature menopause, which can present as hot flashes and vaginal dryness or atrophy. Loss of hair on the head, eyebrows, eyelashes, and hair on the genitals is distressing and affects a female’s perception of sexual attractiveness. Chemotherapy-induced early ovarian failure from surgical removal (adjunctive radiation therapy) can cause menopausal symptoms. The symptoms of hot flashes, sleep instability, vaginal dryness, and mood problems also affect desire, sexual interest, and arousal. Vaginal dryness can lead to painful intercourse or penetration.
Selections from the book: Michael L. Krychman, “100 Questions and Answers about Women’s Sexual Wellness and Vitality: A Practical Guide for the Woman Seeking Sexual Fulfillment”, 2010.