Some cancer treatments can change the size of the vagina and make sex uncomfortable or painful. A lack of oestrogen from some cancer treatments can cause vaginal dryness, which may lead to thrush. Treatments such as radiation therapy may cause a loss of sensation in the vagina.
Below are tips for coping with vaginal changes.
Tight vaginal muscles
After cancer treatment, some people experience tight vaginal muscles (vaginismus) or pain in the vulva or vagina (vulvodynia). If this happens, a qualified pelvic physiotherapist who specialises in rehabilitation after cancer can help you learn how to relax the pelvic muscles during penetration. Ask your doctor for a referral.
Fear of painful penetration can make tightness or pain worse. You should never try to push though the pain, as this can also make the tightness worse and increase discomfort. Learn more about pain.
Vaginal dryness
After some cancer treatments, you may need vaginal moisturisers and lubricants to avoid discomfort during sex. Taking more time to become aroused before and during penetration can also help the vagina relax and lubricate.
Hormonal creams
A lack of oestrogen may cause vaginal dryness after some cancer treatments. Talk to your doctor about whether oestrogen creams or pessaries (tablets put into the vagina) are an option for you. These may not be suitable if you are having hormone therapy for cancer. Vaginal oestrogen creams may help relieve dryness, a lack of elasticity and bladder symptoms. They are applied in the vagina or on the vulva.
Moisturisers
Non-hormonal vaginal moisturisers (e.g. hyaluronic gels) help restore moisture and lubrication. You can buy them without a prescription. They are usually applied 2–3 times a week at night.
Personal lubricants
These liquids or gels are used during sex. You can put them on the clitoris, labia and vaginal entrance – as well as your partner’s penis or a sex toy. Try applying lubricant during foreplay.
Lubricants can be water-based or silicone-based. Those with a silicone base may last longer. Do not use oil or petroleum-based products (e.g. baby oil or Vaseline), as they can cause vaginal infection and damage latex condoms.
Thrush
Dryness may cause too much growth of a yeast-like fungus found in the vagina. This is called thrush. It can cause itching, burning, an unpleasant discharge, and pain during intercourse. Some cancer treatments that lower your immunity may also cause thrush.
Talk to your doctor to make sure the symptoms are not caused by other types of vaginal infections. Your doctor may suggest a prescription or over-the-counter cream or medicine. Use a condom during sex to avoid spreading thrush to your partner. Also avoid soap, bubble bath, scented creams and lubricants with added sugar, as these can irritate your genitals and make thrush worse.
Loss of sensation
After some treatments, including radiation therapy, sex may not feel the same. Some people lose some feeling in the vagina or labia, which may be temporary or permanent. It can make sex uncomfortable or less enjoyable, or may make you feel less interested in sex. If your doctor has checked it is not an infection or thrush, these tips may help.
- Focus on other parts of the body or genitals that feel good to touch.
- Try regular sexual activity of some kind to keep some interest in sex.
- Use different sexual positions to find what improves sensation.
- Try a vibrator to increase sensation.
- A sex therapist can show you strategies to help reconnect to your body through sensation and pleasure.
Short or narrow vagina
Surgery may shorten the vagina and pelvic radiation therapy may narrow the vagina (vaginal stenosis). Scar tissue from treatments may also cause the vagina to become shorter and narrower. This can make sexual penetration difficult and painful.
These changes to the vagina can also cause thinning of the walls and dryness. Using water-based lubricants or vaginal moisturisers can help. In some cases, your doctor may recommend using an oestrogen-based cream.
A vaginal dilator may help after treatment. It may help to widen your vagina or to keep it supple after you’ve finished radiation therapy. This can make sex more comfortable, and may also make cervical screening easier.
Ask your doctor for a referral to a qualified pelvic health physiotherapist for advice before trying to use a vaginal dilator.
Other tips that may help with changes to the vagina’s size include:
- trying different positions to find what feels most comfortable
- using lubricant to make penetration comfortable
- applying a non-hormonal vaginal moisturiser
- trying a vibrator or having regular, gentle sexual intercourse
- placing a foam ring around the base of your partner’s penis to reduce pain or discomfort during intercourse.
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Dr Michael Lowy, Sexual Health Physician, Sydney Men’s Health, NSW; Gregory Bock, Clinical Nurse Consultant – Oncology Coordinator, Urology Cancer Nurse Coordination Service, Cancer Network WA; Anita Brown-Major, Occupational Therapist and Director, Thrive Rehab, VIC; Helena Green, Psychosexual Therapist and Clinical Sexologist, Insync for Life Psychology and Women Centre, WA; Dr Lisa Mackenzie, Clinical Psychologist, HNE Centre for Gynaecological Cancer, Hunter New England Local Health District, NSW; Dr Tonia Mezzini, Sexual Health Physician, East Obstetrics and Gynaecology, SA; Sophie Otto, Prostate Cancer Nurse Consultant – Central Adelaide Local Health Network (CALHN), SA; Giovanna Raco, 13 11 20 Consultant, Cancer Council Victoria; Kath Schubach, Urology Nurse Practitioner, VIC; Emily Stevens, Gynaecology Oncology Clinical Nurse Consultant, Southern Adelaide Local Health Network, Flinders Medical Centre, SA; Anja Vukovic, Clinical Specialist Social Worker, Gynaecological Oncology, Westmead Hospital, NSW; Alan White, Consumer; Kathleen Wilkins, Consumer; Merran Williams, Consumer.
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