Surgery

Surgery aims to remove cancer from the body.

Many different types of surgery are used to treat cancer in different areas of the body, including:

• Abdominoperineal resection
• Breast-conserving surgery or mastectomy
• Colectomy 
• Craniotomy 
• Cystectomy
• Face
• Hysterectomy
• Laryngectomy
• Oophorectomy
• Orchidectomy or orchiectomy 
• Penectomy
• Prostatectomy
• Vagina
• Vulva (vulvectomy)

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Abdominoperineal resection

This removes the anus, rectum and part of the colon. It may be used for anal or bowel cancer. The anus is a key erogenous zone for many people. For men who have sex with men, some sexual acts may no longer be possible, but you can find new ways to express intimacy.

For more on this, see Removal of a body part. 

Breast-conserving surgery or mastectomy 

This removes part of the breast (breast-conserving surgery or lumpectomy) or the whole breast (mastectomy). Breast and nipple sensation usually remain the same after breast-conserving surgery, but can change after mastectomy. This can affect sexual arousal if you previously enjoyed being touched or kissed on the breast and nipple. The loss of a breast may make you feel self-conscious and like you’ve lost a part of your identity. A breast reconstruction may help improve self-esteem.

For more on this, see Removal of a body part. 

If lymph nodes are removed during surgery, this may cause the arm to swell (lymphoedema). The swelling may make you feel self-conscious.

For more on this, see Lymphoedema.

Colectomy 

This removes part of the colon. Sometimes one end of the bowel is brought through an opening made in your abdomen and stitched onto the skin. The opening – called a stoma – allows faeces to be collected in a bag. Erection problems can be an issue for some men after a colectomy.

Craniotomy 

Brain and spinal cord tumours may be treated with different types of operations. Depending on the part of the brain removed, surgery may cause changes in behaviour and personality, erection problems, or interest in sex. Difficulty speaking or swallowing may also occur.

Cystectomy 

This removes part or all of the bladder and nearby lymph nodes. A radical cystectomy may involve removing sex organs. In females, this includes the uterus, ovaries, fallopian tubes and part of the vagina. For females who have not yet gone through menopause, removing the ovaries will cause periods to stop and you will be  unable to have children naturally.

For more on this, see Early Menopause.

In males, this includes the prostate, seminal vesicles and part of the urethra. The nerves needed for an erection are likely to be affected.

If you have a radical cystectomy, you will need another way to collect and store urine (called a urinary diversion). Often the urine will drain into a bag attached to the outside of the abdomen, which may affect your body image.

Face 

Surgery to your face and mouth can change how you feel about yourself. Surgery may affect your ability to kiss or give oral sex. It may also cause problems with controlling saliva. If you have a dry mouth, kissing and oral sex may be uncomfortable.

Hysterectomy 

This removes the uterus, and sometimes the cervix, fallopian tubes and ovaries. It may be used to treat gynaecological cancers, such as cancer of the cervix, ovary, uterus (womb) and endometrium (lining of the uterus), and sometimes the vagina.

If your uterus is removed, you will be unable to become pregnant and your periods will stop.

For more on this, see Early Menopause.

A hysterectomy may shorten the top part of the vagina, but this doesn’t change your ability to have sex. The clitoris and the lining of the vagina will remain sensitive, so you will usually still be able to feel sexual pleasure and reach orgasm. If the uterus was removed, contractions in the uterus will no longer happen during orgasm, and this can affect sexual pleasure for some.

Laryngectomy 

This surgery removes part or all of the voice box (larynx). Your speech will be affected and this may affect your self-esteem and ability to express yourself during sex.

Oophorectomy 

If both ovaries are removed (bilateral oophorectomy) and you haven’t already been through menopause, you will no longer have your monthly periods or be able to become pregnant.

For more on this, see Early Menopause.

Hormonal changes after oophorectomy can cause vaginal dryness. If only one ovary has been removed, the other should continue to release eggs and produce hormones. You will still have periods and may be able to become pregnant if your uterus wasn’t removed.

Orchidectomy or orchiectomy 

If only one testicle is removed, there should be no lasting effects on your ability to have sex or your fertility. Unless there are unrelated fertility issues, your remaining testicle will make enough testosterone and sperm for you to be able to father a child. The scrotum’s appearance can be improved and maintained with an artificial testicle.

For more on this, see Removal of a body part.

Having both testicles removed (bilateral orchidectomy), which is rarely required, causes permanent infertility because you will no longer produce sperm. However, you may be able to store sperm before the surgery to use later. Your body will also produce less testosterone, which may affect your sex drive, but this can be improved with testosterone replacement therapy.

Penectomy 

Part or all of the penis may be removed to treat penile cancer. The part of the penis that remains may still get erect with arousal and may be long enough for penetration. It is sometimes possible to have a penis reconstructed after surgery, but this is still considered experimental and would require another major operation.

Prostatectomy

This removes the prostate. Side effects may include:

• erection problems
• not ejaculating semen during climax (dry orgasm)
• semen going backwards into the bladder instead of forwards (retrograde ejaculation)
• leaking urine during sex
• loss of pleasure
• pain during orgasm
• penile shortening.

Vagina 

A small section of the vagina may be removed to treat vaginal cancer. Enough vaginal tissue should remain so you are still able to have intercourse. Some people need a larger operation that removes the whole vagina (vaginectomy). A vaginal reconstruction may be an option, but after surgery scar tissue can form and make intercourse painful and difficult.

For more on this, see Managing Pain.

Vulva (vulvectomy) 

Removing part or all of the vulva will change the look and feel of your genital area, and can affect your body image, self-esteem and how you enjoy sex. If the clitoris has been removed, it may still be possible to have an orgasm through stimulation of other sensitive areas of your body, such as your breasts or inner thigh. However, it will take time for you and your partner to adjust to these changes.

For more on this, see Adapting to changes.

Most people feel shocked and upset about having cancer in one of the most intimate and private areas of their body. Cancer Australia’s resource Intimacy and sexuality for women with gynaecological cancer – starting a conversation can help you talk with your doctors.

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