Changes to the vagina

Some cancer treatments may change the vagina, which can cause discomfort and/or pain during intercourse.

Shortening and narrowing of the vagina – Surgery may shorten the vagina, and radiation therapy to the pelvis can narrow the vagina. You may be advised to use a vaginal dilator after treatment ends. This is a tube-shaped device made from plastic or silicone. You insert the dilator into the vagina for short periods of time to gradually widen the entrance and prevent the side walls sticking together.

If you have any concerns about using a vaginal dilator, ask your health care team for a referral to a pelvic health physiotherapist.

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 health care team for a referral to a pelvic health 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 be more likely to get vaginal infections, such as thrush.

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

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 and arousal.

Learn tips for coping with these vaginal changes.

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-based creams. 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 developing 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 – Pessaries or creams can help restore oestrogen levels in the vagina and relieve discomfort. These may not on if you are having hormone therapy for cancer.

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