Some cancer treatments can affect your identity. Talk to your cancer care team about what is important to you, so this can be considered when planning your treatment.
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Surgery
Surgery to treat cancer may cause physical changes that make you feel uncomfortable or increase gender dysphoria. In some cases, surgery can affirm your gender, reduce gender dysphoria, or even lead to gender euphoria (when your body and gender feel aligned).
If you need to stay in hospital, ask which ward you will be on. You may be able to stay in a private room or mixed-gender ward. It can feel isolating to receive treatment in settings that do not reflect your gender.
Radiation therapy
If you’ve had gender-affirming treatment, such as surgery to create a penis (phalloplasty or metoidioplasty) or a vagina (vaginoplasty), radiation therapy to the pelvic area may affect these organs.
If you’ve had surgery to make a penis
Pelvic radiation therapy can usually be given in a way that avoids this area. If you also still have a vagina (sometimes described by trans people as a front hole), radiation therapy may make this area dry, narrow or cause bleeding.
Your treatment team may suggest using dilators after treatment to help keep the vagina/front hole open. Dilators can help with cervical screening or sex, but it’s your choice whether or not to use them.
If you’ve had surgery to make a vagina
Pelvic radiation therapy may narrow the vagina or make the skin more fragile and sensitive. Keeping the vagina open and supple can make penetrative sex more comfortable and it’s also important for having medical examinations in the future.
You may be offered dilators to prevent scarring and shortening of the vagina. Some people find using a dilator upsetting. Talk to your doctor about your recovery goals, so they can understand what you’d like and how you feel.
If you’ve had other genital surgery
Other genital surgeries, including zero-depth vaginoplasty (to create a vulva) and metoidioplasty (to create a penis from the clitoris), may also be affected by radiation therapy. Talk to your surgeon and treatment team about what to expect and how you can look after yourself.
Using gender-affirming hormones during treatment
If you’re taking gender-affirming hormones, you may be able to continue taking them during cancer treatment. This will depend on the type of cancer and the treatment you have.
Stopping or reducing hormones can cause physical changes and may bring back gender dysphoria.
Your reasons for taking hormones are also important, and you may feel the benefits of continuing them outweigh the risks for you. Your cancer care team should help you weigh up these effects alongside the cancer treatment outcomes. Ask whether gender-affirming hormone therapy could affect any cancer treatment side effects.
→ READ MORE: Impact of cancer treatment on body image
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This resource was developed as part of the Western Sydney University Out with Cancer research project.
Prof Alison Brand, Clinical Professor, The University of Sydney and Director, Department of Gynaecological Oncology, Westmead Hospital, NSW; Dr Daniel Brown, Clinical Psychologist and Researcher, School of Psychology and Public Health, La Trobe University, VIC; Dr Rosalie Power, Senior Research Fellow and Deputy HDR Director, Translational Health Research Institute (THRI), Western Sydney University, NSW; Dr Sarah Bishop Browne, Palliative and Supportive Care Staff Specialist, Chris O’Brien Lifehouse, NSW; Collette Butler, Clinical Nurse Consultant and McGrath Breast Care Nurse, Cancer Support Centre, Launceston, TAS; Prof Ada Cheung, Endocrinologist, NHMRC and Dame Kate Campbell Research Fellow and Head, Trans Health Research Group, The University of Melbourne, VIC; Dr Tiffany Daly, Radiation Oncologist, Princess Alexandra Hospital, Raymond Terrace, QLD; A/Prof Ian Faragher, The University of Melbourne and Head, Colorectal and General Surgery Unit, Western Health, VIC; Hall & Wilcox (law firm); A/Prof Peter Heathcote, Urologist, Brisbane Urology Clinic, QLD; Prof Richard Hillman, Senior Staff Specialist, HIV and Immunology, St Vincent’s Health Network, Sydney, NSW; Mads Kennedy, Project Coordinator, Silver Rainbow, LGBTIQ+ Health Australia, NSW; Dr Sanjeev Kumar, Breast Cancer Medical Oncologist and Clinician Scientist, Chris O’Brien Lifehouse, NSW; Madeline Lee, 13 11 20 Consultant, Cancer Council NSW; Luke Mitchell, Urological and Sexual Health Nurse Practitioner, Men’s Health Melbourne, VIC; Nadia Reddish, Consumer; Dr Stephen Rowles, Sexual Health Physician and General Practitioner, The Centre Clinic and Melbourne Sexual Health Centre, VIC; Teresa Simpson, Senior Clinician, Psycho-Oncology Social Work Service, Cancer Therapy Centre, Liverpool Hospital, NSW; Mel Tume, Consumer; Prof Jane Ussher, Professor of Women’s Health Psychology and Chief Investigator, Out with Cancer Study, Western Sydney University, NSW; Syr Lumi Vor, Community Member; John Wenborn, Shine a Light (LGBTQIA+ Cancer Support Group). We also thank the health professionals, consumers and editorial teams who worked on the first the edition of this title. We particularly acknowledge ACON and Intersex Human Rights Australia for their extensive input on the first edition. Intersex-Inclusive Progress Pride Flag designed by Valentino Vecchietti (2021).
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