Managing sexual changes – women only

As well as general sexual issues experienced by both men and women after cancer, treatments may cause a variety of changes to a woman’s vagina, which can lead to discomfort and/or pain during intercourse. Early menopause can also be a result of some cancer treatments and may affect a woman’s sexuality.

Topics on this page:


Vaginal health

When treatment leads to changes in the vagina, women may need both vaginal lubricants and vaginal moisturisers to prevent discomfort and pain. Some women can also use oestrogen products. Avoid products containing perfumes, oils or glycerine.

  • Vaginal lubricants (personal lubricants) – These are liquids or gels that are applied around the clitoris and labia and inside the vaginal entrance during sexual activity. You can buy water-based or silicone-based lubricants at supermarkets and chemists. Lubricants with a silicone base may last longer than the water-based ones. Petroleum-based products (e.g. Vaseline) are not recommended as they can increase the chance of a vaginal infection.
  • Vaginal moisturisers – These non-hormonal, over-the-counter products help to restore lubrication and the natural pH level to the vagina and vulva. They are usually used 2–3 times per week.
  • Vaginal oestrogen therapy – Prescription suppositories or creams can help restore oestrogen levels in the vagina. These may not be an option if you are having hormone therapy for cancer. 
Read more about vaginal health

Shortening and narrowing of the vagina

The vagina may be shortened by surgery, and vaginal narrowing can occur after radiotherapy to the pelvis.

Doctors may advise you to use a vaginal dilator. You insert the dilator into the vagina for short periods of time to gradually widen the entrance and prevent the side walls sticking together. Although dilators are not designed specifically for use during sexual activity, some couples do incorporate them into their sexual play. Some people find it is more fun to use a vibrator to help gradually widen the vagina.

Tips for coping with a shorter or narrower vagina

  • Use personal lubricant to make intercourse comfortable. Choose a water-based or silicone-based gel that has no added perfumes or colouring (e.g. Pjur, Sylk or Astroglide).
  • Use a non-hormonal vaginal moisturising cream several times a week to help keep your vagina lubricated.
  • Try a vibrator or regular, gentle sexual intercourse. Experiment with different positions for penetration.
  • Use a foam ring around the base of your partner’s penis to reduce discomfort and pain during intercourse.
  • Ask your doctor about dilators to widen your vagina. Using dilators can be challenging and some women feel like giving up. Call Cancer Council 13 11 20 and ask to speak to someone who has used a dilator after cancer treatment
Read more about shortening and narrowing of the vagina

Tight vaginal muscles

After cancer treatment, some women experience vaginismus, when the muscles around the vagina become tight. This is often caused by fear that intercourse will be painful, and can make penetration difficult. Ask your doctor for a referral to a pelvic floor physiotherapist, who can help you learn how to keep the muscles relaxed during intercourse.


Vaginal dryness

A lack of oestrogen often causes vaginal dryness, which can make penetration during sex painful. You may also become prone to vaginal infections, such as thrush.

Tips for coping with vaginal dryness

  • Avoid soap, bubble bath and creams that can irritate your genitals.
  • Use a non-hormonal vaginal moisturising cream several times a week.
  • Talk to your doctor about whether oestrogen creams or suppositories are an option with your type of cancer.
  • Apply lubricant as part of your sexual play. Choose a water-based or silicone-based gel that has no added perfumes or colouring (e.g. Pjur, Sylk or Astroglide).
  • Take more time before and during penetration to help the vagina relax and become well lubricated
Read more about coping with vaginal dryness

Thrush (candida)

Thrush can occur when genital dryness causes an overgrowth of a fungus that is commonly found in the vagina. It can cause itching, burning and an unpleasant discharge, and may make intercourse painful.

Tips for managing thrush

  • Seek medical advice to rule out other types of vaginal infections.
  • Treat thrush with prescription creams or medicines.
  • Wear loose, cotton clothes. Avoid nylon pantihose, tight jeans or trousers.
  • Avoid using petroleum-based products (e.g. Vaseline) as a lubricant.
  • Use a condom to avoid the spread of thrush to your partner.

Loss of sensation

Some women experience a loss of sensation in their vagina temporarily or permanently, depending on the type of treatment they have had. This can make sex uncomfortable or unsatisfying, or may cause low libido.


Difficulty reaching orgasm

A woman’s ability to reach orgasm may be unchanged after cancer treatment. However, women who have had their clitoris or other sensitive areas of the vulva removed will have difficulties. Removal of the uterus, cervix and ovaries can also change how a woman experiences orgasm.

Initially, you or your partner might feel that the activities listed below are not ‘real sex’, but if they provide sexual pleasure and connection they are not inferior to intercourse.

Tips for reaching orgasm

  • Try different ways of getting in the mood for intimacy: wear clothes that make you feel sensual, shower or bathe together, or have a weekend away if you can – whatever makes you feel sexy, relaxed and good about each other.
  • Use stroking, caressing and massage, or guide your partner’s hands or fingers to areas that arouse and excite you.
  • Focus on your breathing. Try to tense and relax your vaginal muscles in time with your breathing during intercourse or while your clitoris is being stroked.
  • Think about a past sexual experience or use erotic books, magazines or films.
  • Set the mood or atmosphere with soft lighting, candles and soothing music.
  • Consider using an electric vibrator, which may give you the extra stimulation you need to reach orgasm faster.
  • Explore reaching orgasm without penetration. Try oral sex, masturbation or all-over touching.
Read more tips for reaching orgasm

Early menopause

Menopause occurs when your ovaries stop working and you have not menstruated for one year. This means you will not be able to fall pregnant naturally. For most women, this happens naturally between 45 and 55.

Most menopause symptoms are associated with the decrease in your body’s oestrogen levels. These may include:

  • irregular periods
  • aching joints
  • mood changes
  • hot flushes
  • night sweats
  • sleep disturbance
  • a dry vagina
  • increased urinary frequency
  • ‘fuzzy’ thinking.

Early menopause (or premature menopause) is the term for menopause that occurs before the age of 40. When this happens because of cancer treatment, it may be called induced menopause. The sudden start of menopause can cause more severe symptoms than natural menopause because your body hasn’t had time to get used to the loss of hormones. Premature menopause may also cause bones to weaken (known as osteoporosis or osteopenia).

The loss of menstruation and fertility at a younger age can lead to feelings of grief and low self-esteem. You may feel old before your time or less feminine, and worry that you are less attractive.

A number of cancer treatments can affect your ovaries, either temporarily or permanently, and result in menopausal symptoms or early menopause. These treatments include:

  • surgery in which both of your ovaries are removed
  • hormone therapy to decrease your ovaries’ production of oestrogen
  • radiotherapy and chemotherapy, which may affect your ovaries’ ability to produce eggs and hormones.

If your uterus is removed (hysterectomy) but one of your ovaries remains, you will no longer have monthly periods or be able to carry a child, but you will continue to produce oestrogen and can still go through natural menopause at the normal stage of life. If both of your ovaries and/or your uterus are removed, your periods will stop and you will experience induced menopause.

If you wish to have children, it is important to talk to your doctor about your options before any treatment that may affect fertility.

Tips for managing menopause symptoms

  • If your cancer treatment causes early menopause, consider seeing a menopause clinic to discuss the options for managing symptoms.
  • Identify and avoid things that trigger hot flushes, such as alcohol, hot drinks, spicy foods and anxiety.
  • Eat well, exercise regularly and learn relaxation techniques.
  • Ask your doctor whether it is safe for you to use hormone replacement therapy (HRT) to treat menopausal symptoms. There are also non-hormonal options, such as acupuncture, that you could try.
  • Antidepressants may help manage depression and/or anxiety, but can lower libido, so talk to your doctor.
  • Ask your GP to arrange a bone density test to check for osteoporosis/osteopenia.
  • Eat high-calcium foods and/or take a calcium and vitamin D supplement, and exercise regularly to strengthen your bones and help reduce the rate of bone loss.

Printed copies are available for free - Call 13 11 20 to order

Instructions for downloading and reading EPUB files

Apple devices

The iBooks application must be installed on your Apple device before you can read the EPUB.
Different ways to download an EPUB file to your Apple device:

  • email EPUB files to yourself and transfer the attachment to iBooks.
  • copy EPUB files into DropBox (or a similar service) and use the DropBox app to send them to iBooks.
  • open EPUB files directly from Mobile Safari and open them in iBooks, where they are saved automatically by downloading the EPUB from the website.

Need more help? Visit: http://support.apple.com/kb/HT4059

Kobo

To download an EPUB file to your Kobo from a Windows computer:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • select “Open folder to view files” to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

To download an EPUB to your Kobo from a Mac:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • open your “Finder” application.
  • select “Kobo eReader” from the listed devices to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, probably in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
Need more information? Visit: http://www.kobo.com/help/koboaura/response/?id=3784&type=3

Sony Reader

To download an EPUB file on your Sony Reader™:

  • ensure you have already installed the Reader™ Library for PC/Mac software
  • select the eBook you want from our website and click the link to download it.
  • connect the Reader™ to your computer.
  • open the Reader™ Library software and click “Library” in the left-hand pane and select the eBook to view it.

Need more help? Visit: https://au.readerstore.sony.com/apps_and_devices/

Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
  • connect the USB cable to your computer’s USB port, and the micro USB end of the cable to your Kindle™. Note: the Kindle™ won’t be available as a reading device while it is connected to your computer until it has been disconnected.
  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
  • safely eject your Kindle™ from your computer and unplug the USB cable. Your content will appear on the Home Screen.

Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&nodeId=200767340&qid=1395967989&sr=1-1
For more information on accessing a PDF on your Kindle™, visit www.amazon.com/manageyourkindle, log in to your account and click on Personal Document Settings.
Need more help? Visit https://www.amazon.com/gp/help/customer/display.html?nodeId=200375630

Android and PC

You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.

Read more about early menopause

Instructions for downloading and reading EPUB files

Apple devices

The iBooks application must be installed on your Apple device before you can read the EPUB.
Different ways to download an EPUB file to your Apple device:

  • email EPUB files to yourself and transfer the attachment to iBooks.
  • copy EPUB files into DropBox (or a similar service) and use the DropBox app to send them to iBooks.
  • open EPUB files directly from Mobile Safari and open them in iBooks, where they are saved automatically by downloading the EPUB from the website.

Need more help? Visit: http://support.apple.com/kb/HT4059

Kobo

To download an EPUB file to your Kobo from a Windows computer:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • select “Open folder to view files” to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

To download an EPUB to your Kobo from a Mac:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • open your “Finder” application.
  • select “Kobo eReader” from the listed devices to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, probably in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
Need more information? Visit: http://www.kobo.com/help/koboaura/response/?id=3784&type=3

Sony Reader

To download an EPUB file on your Sony Reader™:

  • ensure you have already installed the Reader™ Library for PC/Mac software
  • select the eBook you want from our website and click the link to download it.
  • connect the Reader™ to your computer.
  • open the Reader™ Library software and click “Library” in the left-hand pane and select the eBook to view it.

Need more help? Visit: https://au.readerstore.sony.com/apps_and_devices/

Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
  • connect the USB cable to your computer’s USB port, and the micro USB end of the cable to your Kindle™. Note: the Kindle™ won’t be available as a reading device while it is connected to your computer until it has been disconnected.
  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
  • safely eject your Kindle™ from your computer and unplug the USB cable. Your content will appear on the Home Screen.

Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit http://www.amazon.com/gp/help/customer/display.html/ref=help_search_1-1?ie=UTF8&nodeId=200767340&qid=1395967989&sr=1-1
For more information on accessing a PDF on your Kindle™, visit www.amazon.com/manageyourkindle, log in to your account and click on Personal Document Settings.
Need more help? Visit https://www.amazon.com/gp/help/customer/display.html?nodeId=200375630

Android and PC

You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.


This information was last reviewed in May 2016
View who reviewed this content
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